Abstract 59: Assessing Capabilities and Attitudes among Paramedics during CPR on Manikins with Different Chest Stiffness
Introduction: We have recently shown that quality of CPR performed by professionals is substandard even with automated feedback on actual performance. We hypothesized that inadequate chest compressions are not due to physical capabilities but other human factors.
Materials and methods: Study subjects were paramedics and EMTs in London and Akershus ambulance services. Forty pairs of volunteers were asked to give five minutes of CPR on Laerdal Skillmeter Anne manikins with computer assisted feedback similar to the feedback provided by the defibrillator in our previous clinical study. Each pair was tested on four modified manikins with different chest properties set to represent the chest stiffness found in the patient population. They were given breaks between all four sessions and were allowed to switch places whenever they desired within one session. At the end they were given a questionnaire with statements relating to chest compressions which they scored from totally disagree till totally agree. Demographic data were also collected.
Results: All study subjects performed CPR well within Guidelines recommendations on all four manikins in contrast to what was achieved during ACLS on patients. Mean compression depth was 44 ± 3 mm vs. 38 ± 6 mm, mean compression rate 101 ± 3 min−1 vs. 109 ± 12 min−1, and 7 ± 2 ventilation min−1 vs. 11 ± 4 ventilation min−1 on manikins vs. patients. Sixty percent of the study subjects believed that too deep chest compressions could cause serious patient injury, and 43 % thought that compressions within Guidelines limits could cause such damage. A fourth meant that the potential benefits of compressing till Guidelines depth did not justify the injuries it could cause. Seventy-six percent stated that it was their personal sense of correct depth that determined the depth they used. Breaking ribs made 54 % feel very uncomfortable.
Conclusions: EMTs and paramedics in both London and Akershus were physically capable of compressing till Guidelines depth even on the stiffest chest in contrast to what they achieved on patients. They were afraid to injure the patient by compressing too deep, and trusted their own opinion of what is correct compression depth more than the feedback.