I quite agree with you. There are national recommendations already set in
place for just this.
Sussex has a DNR/termination of resus protocol in place to reduce
unnessasary transportation. There are occasions when cardiac arrest is
necessary - reversible causes which cannot be addressed at scene or if the
patient remains in VF/VT algorhythm after full protocol has been performed.
I think these are the times when Sussex paramedics transport. I am sure this
would be the case with many services
Mike Bjarkoy
Paramedic Sussex

-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of A S Lockey
Sent: 23 April 2000 23:01
To: [log in to unmask]
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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