It is my understanding that most services now permit crews to cease resus
after a period of time and / or in certain circumstances eg head in one
corner - body in another. Appreciate need for H&S in the back of the wagon
and also have done CPR one handed on occasion in such curcumstances (with
occasional success) - but should it be advocated - especially if the other
hand is holding onto the patient and BVM? I suspect not!
With regard not transporting patients to A&E in arrest - I think that very
suspect clinically - yes I know - survival low, efficacy poor etc etc but
some do survive and it is often likley to be socially unaccepatable to the
punters. What do the A&E wallahs think? I certainly know of some who say
that ALL patients have not had the full works until the A&E boys have had
their fun.
Iain
----- Original Message -----
From: A S Lockey <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, April 23, 2000 11:00 PM
Subject: RE: Single handed CPR
> The sooner we allow paramedics to pronounce death in cases other than
> extremes (e.g. "head distinct from body"!!) at scene, the sooner we can
> reduce this nonsense of CPR on the move. It is nonsense that only a doctor
> should pronounce death and now that nurses are allowed to do it, why can't
> paramedics? An acceptable solution would be to allow Clinical
Leaders/Field
> Based Assessors/Senior Paramedics (the names differ but you know what I
> mean) to pronounce death at scene, thus allowing the family the dignity of
> grieving at home with friends and family rather than the pointless hope of
> the blue light dash. As has already been mentioned, CPR in a moving
> ambulance is not easy (and hence not very effective), and also a health
risk
> to the person doing it. Surely we should therefore limit that sort of
> transfer to the cases that actually need it. The phrase "risk management"
> springs to mind!
>
> There is a school of thought that says that ventilation during CPR is
> wasting valuable cardiac compression time and that sufficient oxygenated
air
> is entrained into the lungs during compressions. An extension of that
> argument would be that, in the non-intubated patient, it would be safer
and
> as effective to do continual 1 handed compressions (whilst steadying
> yourself with the other hand) and ditch the BVM.
>
> Andy
>
>
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Michael Bjarkoy
> Sent: 23 April 2000 21:08
> To: [log in to unmask]
> Subject: RE: Single handed CPR
>
> Sorry Iain I didn't answer your specific questions...
>
> Single handed CPR - yes experiance (see previous posting)
> The way you described it - no this is not acceptable practice
> No holding onto BVM at same time - no
> Not routinem - never seen it.
> No this is not safe working practice
> No it is not as effective after a long period of time (or even a short
> period of time) and should only be perfromed when H&S dictates one holds
> onto something in the truck for safety.
> No references that I have found - checked usual electronic search
> databases - I think that as it is an infrequent and non-effective
technique
> it is not advocated for research on 'real' patients on blue lights going
> into AEU - It would be difficult to compile enough evidence for or against
> this because of reason.
> Mike Bjarkoy
> ps Hi Iain - long time no hear, are you enjoying Surrey?
>
>
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Iain McNeil
> Sent: 23 April 2000 09:21
> To: [log in to unmask]
> Subject: Single handed CPR
>
>
> I have recently come across a situation where ambulance crews have been
> taught to do chest compressions with one hand, on adults, when working on
> their own. Essentiailly they do chest compressions with one hand and hold
on
> to the mask of the BVM with the other while the vehicle is mobile to
> hospital. This is taught in preference to the standard two handed chest
> compression technique.
>
> Does any one have experience of this?
> Is it acceptable practice?
> Does any one else do this as a routine?
> Do you think the practice of holding onto the patients mask with one hand
> whilst doing CPR in a moving vehicle is safe?
> Do you think one handed CPR is effective after a period of time? ( I am
> assured that on skill meters it is as good - but for how long I know not)
> Are there any references that you know of?
>
> I am not keen on the process at all but am willing to be persuaded if
there
> is evidence to support its efficacy.Any thoughts would be gratefully
> recieved.
>
> Iain McNeil
>
>
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