Pre-hospital Resuscitation – Video Enhanced Nontechnical skills Training
There is an increasing emphasis on the importance of nontechnical skills (NTS) for high acuity resuscitation teams, although little direct evidence exists to demonstrate the relationship between NTS and the quality of technical performance. NTS include situational awareness, decision making, teamworking and leadership.
Dr Alistair Dewar is currently in a two-year out-of-programme post as a clinical teaching fellow in Emergency Medicine. He has embarked on an MD program of work examining NTS in the prehospital resuscitation team, in order to develop novel interventions to augment NTS and improve clinical outcomes.
Alistair summarised his project this way: “We aim to demonstrate a link between improved NTS, technical performance and patient outcomes in OHCA and investigate the most effective tools for optimising team NTS.”
This project is carried out in conjunction with the NHS Lothian Directorate of Medical Education, and will be co-supervised by Dr Gareth Clegg (RRG) and Dr Simon Edgar (Director of Medical Education, NHS Lothian).
3RU showcased as ‘trailblazers’ at the Scottish Ambulance Service Annual Review 2014.
Master of Ceremonies Geoff Holt from the Scottish Health Council said, “If you always do what you always did, you’ll always get what you always got—these people are stepping out there and trying to push it forward”
See the videocast of the Annual Review including Colin Crookston’s great presentation of the work of the 3RU team here.
Matt Reed, Steven Short and a faculty of ED ultrasound practitioners put the 3RU team through their paces. Ultrasound is a useful tool in the ED during resuscitation after OHCA, but how will it translate into the ‘perfect 10’ workflow? The team had a great day learning at the feet of the masters – now to put it all into practice… Watch this space.
Thanks to the faculty, Becks Cranfield, Emma-Beth Wilson, Mike Wilson, Doug Murray, Rav Kishen, Graeme McAlpine, Katy Letham and Shirin Brady. Also a big thank you to the team of ‘subjects’, Sarah Langlands, Connor Bowbeer, Yeo Hui, and Jasmine Shen.
Untreated ventricular fibrillation is lethal, a patient’s probability of survival ebbing away at around 10% per minute.
Bystander CPR is key initial link in the chain of survival and will buy time until a life-saving defibrillatory shock can be delivered. The interactions between the 999 call-maker and the ambulance service call-taker influence the time taken for this initial CPR to begin. There is great variability in the time taken up by call-maker/call-taker interaction prior to CPR starting and we wanted to know why this is the case, and how we could minimise this time.
RRG enlisted the help of Professor Holly Branigan (Chair in Psychology of Language and Cognition) and Dr Ellen Bard (Reader in Psychology and Linguistics) at the University of Edinburgh. Scott James – medical student member of the RRG – began by transcribing the audio recordings of fifty non-trauma, adult cardiac arrest calls and mapped them onto the key stages of the AMPDS dispatch protocol. We identified two stages where the calls commonly become ‘trapped’ – determining whether the patient was breathing and attempting to move the patient onto a hard surface. Current work is focussed on dissecting the reasons for this, and developing solutions.
Read the paper published in Resuscitation here: http://www.resuscitationjournal.com/article/S0300-9572(13)00451-6/fulltext
In an original article published in this months EMJ – Scott Clarke, Richard Lyon, Steven Short, Colin Crookston and Gareth Clegg describe the TOPCAT2 project which birthed the Resuscitation Rapid Response Unit (3RU) in Edinburgh.
A specialist, second-tier response to out-of-hospital cardiac arrest: setting up TOPCAT2
Emerg Med J 2014;31:5 405-407 Published Online First: 30 January 2013
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A squad of 12 paramedics from the Scottish Ambulance Service make up 3RU.
A project to investigate the association between non-technical skills performance and technical performance during OHCA resuscitation