CPR Performance Counts

Quality Improves Survival
A monograph sponsored by the CPR Improvement Working Group and published by Elsevier Public Safety. Cardiovascular disease is a leading cause of death in the U.S., and the quality of CPR delivered has a direct impact on ROSC. This monograph alerts health care professionals to the disparity between how they perceive their performance and their actual CPR performance; and the role that retraining, monitoring and feedback play in the delivery of quality CPR.

Quality Makes the Difference
Fifty years after the introduction of CPR, we clearly know that immediate, uninterrupted and properly performed CPR saves lives. We know how to do CPR; now we must close the gap between knowing how to do CPR and the way we actually perform CPR. Providers now have more opportunity than ever to improve survival from sudden cardiac arrest. The focus must shift from “Do CPR” to “Do CPR right.”

A.J. Heightman, MPA, EMT-P | Bentley J. Bobrow, MD | Marion Leary, RN, BSN

Perception vs. Reality
An international survey of health care providers to assess 1) provider perceptions of their CPR knowledge and ability, 2) recall of recent CPR performance, 3) adoption and implementation of CPR Guidelines, 4) attitudes toward the importance of CPR, 5) perceptions of CPR training and quality improvement, and 6) level of awareness and experience with CPR measurement and feedback systems.

Robert E. O’Connor, MD, MPH

The Science of CPR
Although CPR has been used for many years in conjunction with other resuscitation interventions, recent studies demonstrating the reality of its use in clinical settings and linking its quality to patient outcomes have revolutionized attitudes surrounding the importance of properly performed chest compressions.

Dana Peres Edelson, MD, MS | Deborah Walsh, MS, RN

Retraining Pays Off
Case studies of some interesting techniques and guidelines for improving CPR from around the world.

Teresa McCallion, EMT-B,

Change Our Philosophy From "Do CPR" To "Do CPR Right"

A.J. Heightman, MPA, EMT-P | Bentley J. Bobrow, MD | Marion Leary, RN, BSN | From the CPR Performance Counts Issue

An EMT who recently underwent full CPR retraining using CPR feedback described the experience as “invaluable.”
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“Knowing is not enough; we must apply. Willing is not enough; we must do.”
—Johann Wolfgang von Goethe

The impact of out-of-hospital cardiac arrest (OHCA) is enormous, taking the lives of nearly 300,000 people each year in the U.S.(1) Although survival rates vary widely, they are still generally low (less than 10%) in most areas of the country.(2) Yet many communities have significantly improved their survival rates.(3-5)

The common theme in the communities saving the most lives from OHCA is high-quality cardiopulmonary resuscitation (CPR). Growing scientific evidence suggests that simple changes in technique, especially focusing on ensuring the proper compression rate, depth and chest wall recoil, minimizing interruptions and avoiding over-ventilation, markedly improve survival.(3-5)

These concepts are becoming better understood, but there remains a huge gap between what we know and what we consistently do. The 2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (6) stressed the importance of quality CPR. However, an enormous opportunity for improved translation of high-quality CPR into the everyday practice of our EMS systems and hospitals remains. This is why the new 2010 AHA CPR Guidelines (7) clearly advise providers to focus on the quality of CPR delivered throughout resuscitation attempts for adult and pediatric victims of cardiac arrest, both inside and outside the hospital.

The 2010 Guidelines also emphasize that in order to close the knowledge-practice gap and save more lives, emergency medical providers should develop a culture of measuring and ensuring high-quality CPR.

The Physiology of CPR
The goal of CPR is to optimize blood flow to the vital organs, particularly the heart and brain, in order to maximize the chance of return of spontaneous circulation (ROSC) and a good neurologic outcome.

Effective CPR generates blood flow to vital organs until circulation is restored by defibrillation or other therapy. CPR also been shown to prolong the duration of ventricular fibrillation in OHCA victims,(8) thus expanding the window of opportunity for successful defibrillation.

CPR Quality Matters
“CPR is CPR, right?” Absolutely not.

There is a vast difference between the coronary and cerebral perfusion pressures generated by poor-quality and high-quality CPR. It is this critical forward blood flow to the heart and brain during CPR that best determines ROSC and survival.(9)

The Current State of CPR
“Our professional CPR is fine, right?” No, again.

Unfortunately, without any measurement or feedback, CPR quality is usually poor and has been equated with “trying to drive at night with your headlights turned off.” Despite the fact that CPR is a critical link in the chain of survival, it is often unmonitored and performed with inconsistent quality in both the in-hospital
and out-of-hospital settings.(10,11)

Wik demonstrated this during 176 adult OHCAs by continuously monitoring all chest compressions and ventilations using modified defibrillators programmed for CPR data collection in recently retrained paramedics and nurse anesthetists. He found the quality of CPR was dramatically different from that recommended by the AHA Guidelines. Only 28% of the compressions had a depth of 38–52 mm, and chest compressions were given only 48% of the available time during resuscitation.(10) It has been suggested that shallow chest compressions may be identical to interruptions in CPR if the compressions are not deep enough to generate a functional cardiac output.(12)

There are many reasons why manual CPR is difficult to perform, including rapidly occurring physical and mental fatigue (within one to two minutes); changes in chest wall compliance during resuscitation; prioritizing other interventions; and trying to perform CPR on a soft surface or while transporting patients down hallways and stairways, or in moving ambulances. All of these factors make hitting the proper rate, depth and recoil a moving target.(13)

These findings have spurred develop­ment of a variety of FDA-approved CPR feedback and mechanical-assist devices. Feedback devices provide rescuers with real-time audio-visual feedback, instruct them on how to deliver Guidelines-quality CPR, give them the opportunity to precisely review their performance and guide training.

CPR Feedback Strategies
Experts propose three strategies to develop a culture of high-quality CPR and improve outcomes from sudden cardiac arrest.

1. Implementation of a continuous quality improvement (CQI) program. As Lord Kelvin said in 1883, “If you cannot measure it, you cannot improve it.”

Standardized data collection tools are now available to accurately monitor cardiac arrest and resuscitation metrics inside and outside the hospital. Some of these tools include the National Registry of CPR (www.nrcpr.org) and the Cardiac Arrest Registry to Enhance Survival (www.mycares.net).

Monitoring, reporting and benchmarking cardiac arrests are fundamental steps to improve survival and, in some ways, are “interventions” themselves.

2. Use of real-time audio-visual CPR feedback. Feedback devices provide audio and visual CPR feedback, along with prompting, to assist providers in delivering AHA-recommended compression depth and rate, and limit interruptions to compressions. Some devices also provide feedback on chest wall recoil and the rate and tidal volume of ventilation.

There is a perception by health care providers that their CPR skills are adequate, but in reality, when CPR is monitored without feedback, that’s often not the case. Even with feedback devices, it has been shown that proper CPR performance must be continually monitored, “coached” by the feedback device and periodically corrected by the provider.

The gap between the perception of performing quality CPR and the reality of inadequate performance only adds to the many reasons why survival rates for this patient population are so dismal. A recent observational study showed that trained health care providers performing actual CPR at one urban hospital became fatigued after roughly 90 seconds and that their chest compression depth decreased accordingly over time.(13)

3. Utilization of CPR data for provider feedback and training. Although CPR monitoring devices with feedback are one solution, they should be used in concurrence with debriefing after arrest events to bolster CPR education. Two different studies, one simulation and one clinical, conducted in the hospital setting demonstrated that debriefing offered in conjunction with CPR monitoring resulted in marked improvement in CPR quality at subsequent CPR events.(14,15)

Conclusion
Fifty years after the introduction of CPR, we clearly know that immediate, uninterrupted and properly performed CPR saves lives. We know how to do CPR; now we must close the gap between knowing how to do CPR and the way we actually perform CPR. Providers now have more opportunity than ever to improve survival from sudden cardiac arrest. The focus must shift from “Do CPR” to “Do CPR right.”

Santa's Christmas Truck

Here's an interesting video I think we should all take a look at. It's an interesting use of fire apparatus, I quite enjoyed it.

For Santa's Christmas Truck Click Here

Lightweight Wood Structures Are Becoming More and More Dangerous

Lightweight wood frame structure fires are among the most dangerous types of incidents for firefighters

By Chief Gary Bowker (Ret.)

Photo Gary Bowker Today's lightweight wood frame structures include commercial buildings which can be massive in size, creating huge un-sprinklered void spaces with the entire structure being wrapped in foam insulation.

Today's residential structure fire is not your daddy's residential structure fire. Today's lightweight wood frame structure is burning faster, failing sooner, and often doing so with tragic results, much quicker than traditional wood frame structures built in years past.

In just the past few months we have seen three separate fire incidents in Fargo, N.D, Coatesville, Pa., and Harrisonburg, Va., that have involved large wood frame apartment buildings, which resulted in close calls and firefighters being injured.

Each of these incidents occurred in lightweight wood frame "disposable" structures. As the Ol' Professor, the late Francis Brannigan taught "The Building is your Enemy, Know your Enemy." Today the lightweight wood frame structure fire is the enemy. It has evolved into one of the most dangerous types of structure fires you will encounter.

A fire in today's lightweight wood frame structure is a structure fire on steroids and can devastate anyone and anything in its path, including unsuspecting firefighters. To understand why this is occurring, we must first look at the history of wood frame construction in our country and define what a "disposable" structure is.

We must know where we have been in terms of construction and culture in the American fire service in order to understand and appreciate where we are going. Fire officers must understand the nature of the risk we face in order of effectively managing it.

Origins of the constructions
Wood frame (Type V) construction has been used extensively in this country since the 19th century for homes and businesses. During the great American expansion westward, many prairie towns were built exclusively of wood frame material.

Lumber was plentiful and cost effective but the fire problem it posed was significant. As building and fire codes evolved, Ordinary (Type III) construction usage increased for business and industrial use. Quick recovery after a fire was essential for economic survival. Most homes though continued to be built of wood frame construction well into the 20th century.

It is essential to understand that wood frame structural members used in home construction during that time period utilized full dimension lumber, which yielded more mass for structural support during a fire. Floors and roofs were typically built using a minimum dimension of 2 x 8 and 2 x 6 inch solid wood. The walls and ceilings were typically covered with plaster and lath, giving the structure reasonably good resistance to a room and contents fire.

These structures were built to last a lifetime and could survive a moderate to serious fire, generally speaking. Typical fire loads used during that era consisted mainly of natural materials for furnishings and contents, which continued into the 1950s.

It was also during this time that traditional aggressive interior firefighting operations were becoming well established or "hard-wired" into our fire service culture. However, in the 1970s, a significant shift began to occur in the wood frame construction dynamic, with the introduction of smaller 2 x 4 inch lumber use in floor and roof truss support systems.

With the use of smaller dimension lumber in structural supporting systems, "lightweight" construction was born, and has continued to evolve into lighter, cheaper materials with less mass for structural support. Less mass means quicker failure. The combustibility of lightweight building components has also greatly increased from those used in traditional wood frame construction.

The vast majority of new homes and apartments, fast-food restaurants, hotels, and commercial buildings constructed in the past 20 years are lightweight wood frame. Lightweight or engineered wood frame support systems include smaller than 2 inch dimension wood products that are not solid lumber.

Glued and finger-jointed wooden trusses, and Truss/Joist I-Beams (TJIs) made of wood chips or particle board that are pressed together with combustible adhesives to eliminate waste, are commonly found today.

In addition most of these newer wood frame structures are wrapped in synthetic insulating material, which adds to the fuel load, speed, and toxicity of a fire. Wood frame structures today are not built to last like the wood frame structures were prior to the 1970s. Today's wood frame structure is "disposable."

Much in our society has become disposable, from diapers to appliances to homes. Time is money and less material and waste is money. So it should come as no great surprise as to why this has occurred within the building industry.

__________________________________________________________

About the author:

Gary Bowker is a retired fire chief with the U.S. Air Force, and is the past fire chief with the Sumner County Rural Fire District #10. Chief Bowker recently retired as fire marshal with the City of Winfield, Kansas, a community of 12,000 people. Chief Bowker has more than 36 years of fire service experience and now teaches an associate instructor with the University of Kansas Fire & Rescue Training Institute. He also serves as a Kansas advocate with the National Fallen Firefighters Foundation's Everyone Goes Home program and speaks frequently on firefighter life safety and health issues. You can contact Chief Bowker at glbowker@hotmail.com.

Plamondon VFD Suspends Service As Burnout Sets In

The demands of Highway 63 have proved too much for another northern fire department.

The 16-member Plamondon volunteer fire department suspended service along the highway that links Edmonton and Fort McMurray on Dec. 1 in an effort to prevent burnout, said Mitch Newton, manager of protective services for Lac La Biche County.

Plamondon, about 200 kilometres northwest of Edmonton, took on sole responsibility for a 150-kilometre stretch of Highway 63 in July, one month after the Wandering River fire department suspended highway service.

In 2009, the Wandering River department had 52 calls for service on the highway.

When Plamondon took over, its volunteers saw their traditional monthly workload of eight hours each double, and in some cases triple, Newton said.

The decision was prompted by the onset of winter driving conditions and a failure to reach a service agreement with Athabasca County, which would see Plamondon alternate Highway 63 responsibility with Athabasca departments on a monthly basis.

The suspension means the remaining fire departments will be spread thinner and response times will be slower, said Arnie Derko, former fire chief for Grassland Fire Department.

Derko, who remains a member with Grassland, stepped down from the position in August after 10 years when the job became too stressful.

Early Wednesday morning, the Grassland department spent eight hours covering a collision between two semi-trailers on Highway 63. A lumber truck lost control and slammed into a tanker made to carry ammonia hydroxide.

The tanker was empty but the truck's cab caught fire. Derko said the crash highlights how regional fire departments are expected to respond to hazardous material calls when they don't have the proper equipment.

And after working all night on the highway, volunteer firefighters still have to go to their day jobs.

"You get burnout because you're not resting," Derko said.

"If you're at horrific scenes, there's other things. It becomes a lot to ask of your regular Joe to go out and do this -- to be on this highway."

Regional fire departments have mutual aid agreements with surrounding areas, and the loss of one has a domino effect on others. When Grassland is out at collisions on Highway 63, they have to rely on the Boyle Fire Department to protect their community.

Trent West, fire commissioner for the Alberta Emergency Management Agency, said that's a common occurrence across the province, and is the reason mutual aid agreements exist.

He said Wandering River brought the issue with Highway 63 to light in June, and the AEMA was working with fire departments to improve volunteer recruitment and retention, and was encouraging departments to share successful strategies.

Derko said the province's efforts weren't good enough.

"They say they'll help us with recruiting, but these are small towns," he said. "Where are we supposed to get the people for recruiting?"

Brian Cornforth, president of the Alberta Fire Chiefs Association, said the province is expecting too much of volunteer firefighters.

"We're struggling to maintain systems with volunteers, and they expect these people to take on all these extra responsibilities," he said. "We need to take a more serious look at this."

Cornforth said the province's 10,000 volunteer firefighters struggle to find funding for training and equipment. While West said the province has grants for emergency services and gives funding to municipalities, Cornforth said that money has been drying up over the years.

Volunteers are required to have higher levels of training for highway response than in the past, including traffic control and extracting people from vehicles. But while training costs have gone up, Cornforth said funding has gone down.

"It's extremely discouraging when you're a volunteer and you have to buy your own equipment to serve your community," he said.

Read more: http://www.edmontonjournal.com/life/Highway+takes+toll+volunteer+fire+crew/3956549/story.html#ixzz18InN1JFZ

Bonnyville Volunteer Firefighters Walk After Safety Concerns

Workplace inspectors are in Bonnyville, Alta. Thursday investigating concerns of volunteer firefighters over the safety of their equipment.

Thirty volunteer firefighters walked off the job last week.

The equipment is old and doesn't meet safety standards, said firefighter James Sharun.

“For us to go back there is going to have to be large scale changes made,” he told CBC News.

“At the end of the day it isn't the Bonnyville Regional Fire Authority that fights fires, it's the volunteers that fight fires.”

Last week Sharun wrote a letter to the fire authority board detailing the firefighters' grievances.

After sending the letter Sharun was fired from his volunteer job, he said.

The letter, signed by 14 firefighters, describes problems with maintenance or replacement of breathing gear and protective clothing.

"We got millions of dollars in shiny new trucks in our halls,” said Shrun. “We look great going to the scene but unfortunately when we get there we aren't protected in a lot of cases."

Two Occupational Health and Safety inspectors are in Bonnyville investigating the complaints.

The fire authority was unavailable to comment

Read more: http://www.cbc.ca/canada/edmonton/story/2010/12/09/edmonton-bonnyville-firefighter-grievances.html#socialcomments#ixzz18ImPboRo

2yr Old Rescued From Vending Machine

Girl rescued from vending machine in Pa.

Press Association Mediapoint

ROBINSON TOWNSHIP, Pa. — A two-year-old girl spent 15 minutes stuck inside a toy crane vending machine in a Pittsburgh-area shopping center, authorities said.

Moon Run Fire Chief Paul Kashmer said the girl did not seem upset by the ordeal in the food court at the Mall of Robinson, in Robinson Township.

The girl apparently climbed up the chute into which the coin-operated crane drops prizes.

To view the video, click here http://www.firerescue1.com/rescue/articles/920605-Girl-rescued-from-vending-machine-in-Pa/

4yr Old Rushed To Children's Hospital After House Fire In Serious Life-Threatening Condition

Boy's condition upgraded to stable after house fire

A four-year-old boy was injured after a blaze broke out at this home on Falshire Dr. N.E. Friday, December 10, 2010.

Updated: Fri Dec. 10 2010 17:57:16

ctvcalgary.ca

A four-year-old boy is in hospital after a Friday morning fire in the northeast.

Crews were called to the blaze on Falshire Dr. N.E. around 10 a.m.

Nicola Lakusta, 35, was on the second-floor of the home and managed to jump out to escape the smoke.

But she was screaming that her son Dylan was in the basement and couldn't get out as flames were raging at the stairs.

Firefighters went into the home and brought out the child.

"We extinguished that fire while we were going about doing a search for the child," said Brian McAsey with the Calgary Fire Department.

"We were able to find him extremely quickly. He was semi-conscious when we found him. We were able to get him outside the building and deliver him up to EMS."

The boy was rushed to Alberta Children's Hospital in critical, life-threatening condition but is now in stable condition. His mother has been released from hospital after being treated for minor injuries.

Nicola's sister-in-law said the fire may have been started by Dillon playing with a lighter, but fire officials are still investigating and have not released an official cause.

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Elissa Carpenter reports on a four-year-old boy injured in a house fire

The four-year-old boy who was trapped in a house fire Friday morning is now out of hospital and back home with his family.

Dylan Lakusta was trapped in the basement when fire broke out in his home.

His mother Nicola was upstairs and unable to get to him.

She frantically called for help and when firefighters arrived, they fought a wall of fire to get to the boy.

Dylan was semi-conscious when rescuers found him.

He was taken to hospital in life threatening condition, but made an amazing recovery and was released Friday night.

The Lakusta's are now staying with family outside of Calgary until their home is fixed.

My Opinion

This is yet another story about how playing with fire is VERY dangerous. My heart goes out to the Lakusta's. I've known Nicola for a very long time. Heck, she used to babysit me when I was a little boy. With all the support here in Carseland, I'm sure they'll make a speedy recovery both physically and money-wise. I'm extremely glad to have seen Dylan tonight as I was talking to Nikki's brother Jason. He was standing in the doorway looking to see what Uncle was doing talking to the people in the truck, which was us of course. Now onto the other important stuff. Playing with fire can be extremely dangerous and statistics for around Christmas time show us that house fires go up during the holiday season, with the burning of fires in the fireplaces, and candles in the house. This time just as much as anytime we should be very careful of these sources of ignition. Not to mention the lighters and matches that go along with starting these. So let's be extra careful this holiday season and hopefully something like this doesn't happen again.

Bowstring Truss Collapse Reported By NIOSH

The NIOSH Fire Fighter Fatality Investigation and Prevention Program has released the investigation report of a California career firefighter seriously injured in a bowstring truss roof collapse

Read the Report:
Bowstring Truss Collapse Injures Firefighter

A-Side of fire building. (NIOSH/Adapted from Google Maps® satellite image.)

On May 21, 2009, a 36-year-old male career fire fighter was seriously injured while operating in a non-designated collapse zone of a commercial structure when an overhang of a bowstring truss roof system collapsed and struck him.

The first arriving company officer reported a working fire in a single story Type II warehouse. The officer looked under a steel roll-up door that was raised approximately three feet off of the ground and saw heavy fire towards the rear of the structure from floor to ceiling.

Per department procedures, the first arriving companies went into a “Fast Attack” mode.

Crews attempted but were unable to enter the structure because the steel roll-up door wasn’t functioning and the man door was heavily secured. The department’s Deputy Chief arrived on the scene 9 minutes after the initial crew and determined that the fire should be fought defensively, however, this command was not relayed over the radio or verified with all crews.

A crew was operating a 2 ½-inch handline just outside the structure approximately 20 minutes after the first apparatus arrived when the overhang collapsed and trapped the nozzleman.

Key contributing factors identified in this investigation include: scene management and risk analysis, a well-involved fire in a structure with hazardous construction features, and fire fighters operating within a potential collapse area.

NIOSH investigators concluded that, to minimize the risk of similar occurrences, fire departments should:

• ensure that they have consistent policies and training on an incident management system
• develop, implement and enforce written standard operating procedures (SOPs) that identify incident management training standards and requirements for members expected to serve in command roles
• ensure that the incident commander conducts an initial size-up and risk assessment of the incident scene before beginning fire fighting operations
• ensure that the first due company officer establishes a stationary command post, maintains the role of director of fireground operations, and does not become involved in firefighting efforts
• implement and enforce written standard operating procedures (SOPs) that define a defensive strategy
• ensure that policies are followed to establish and monitor a collapse zone when conditions indicate the potential for structural collapse
• train all fire fighting personnel on building construction and the risks and hazards related to structural collapse
• conduct pre-incident planning inspections of buildings within their jurisdictions to facilitate development of safe fireground strategies and tactics

Florida Firefighter Wins Award For Mustache

Fla. firefighter wins top mustache award Winning firefighter recently founded local mustache group to promote firefighter fatality awareness and funds

By FireRescue1 Staff

Photo American Mustache Institute Firefighter Brian Sheets is presented the Mustached American of the Year award for his contributions to the mustache and charity world.

Related Resource: Firemen with Mustaches Related content sponsored by:

ORLANDO, Fla. — America's top mustache belongs to a firefighter in Florida. Brian Sheets earned 22 percent of more than 500,000 votes to claim the title of the Robert Goulet Memorial Mustached American of the Year.

The firefighter, EMT and EMT instructor from the Orlando area beat out high profile candidates including governors, journalists, athletes, movie stars and city mayors.

Firefighter Sheets was presented the award at the American Mustache Institute's annual 'Stache Bash charity benefit on Saturday.

The charity benefit raised money for cancers that affect men, such as prostate cancer. The fundraiser worked through Movmber, an international charity that encourages men to grow mustaches.

"Winning is a great honor for me, as well as for all the firemen who have served under the influence of the mustache," Firefighter Sheets told the American Mustache Institute.

"A man without a mustache — is he really a man? I believe not, considering the command presence and extraordinary power that comes with one. And this great honor tells me my beliefs are taking me in the right direction."

Firefighter Sheets founded Firemen with Mustaches, which builds awareness about firefighter fatalities and seeks to raise funds for the families of fallen colleagues.

The Goulet Award is not a "best mustache" award, but recognizes the person who best-represents or contributes to the Mustached American community.

NY Fire Chief Suspended For Testicles On Fire Truck

NY fire chief suspended for 'testicles' on fire truck. Acting on public complaints two months ago, Freeport Mayor Andrew Hardwick told volunteer Chief Daniel Fee to castrate the truck

By Kieran Crowley
The New York Post

NEW YORK — The mayor of a Long Island village has suspended its fire chief for 30 days - because he refused to remove a crude set of plastic testicles from a fire truck.

The item is a novelty $24.95 pair of "Bumpernuts" — colored bright blue — that had been affixed to the rear end of the rig.

Acting on public complaints two months ago, Freeport Mayor Andrew Hardwick told volunteer Chief Daniel Fee to castrate the truck.

But last week, Hardwick took a tour of the firehouse and noticed that while the cojones had been removed from the outside of the vehicle — they were relocated inside the cab, still clearly visible.

"The gesture was offensive, insensitive and unprofessional," said Hardwick, who added that Freeport residents "expect better" from their volunteers.

Fee, 47, could not be reached for comment.