Out-of-hospital cardiac arrest is a leading cause of premature death worldwide. If your agency is asking how it can do better, implementing a high-performance CPR EMS training program is a huge step in the right direction — but not without some careful thought and preparation.
High-performance or HP-CPR is a means to improve cardiac survival rate with a precise, highly coordinated team approach. This method relies on specific metrics — proper compression depth and rate, full recoil, and limited pauses, which equate to higher CPR fraction times and proper ventilation (rate and volume) — to save lives. Rescue teams must perform flawlessly and without interruption to achieve optimal patient outcomes.
Based on firsthand experience and observations, here are some tips and resources for getting a new HP-CPR training program off to the strongest possible start.
Create a sense of urgency
- EMS results for VF witnessed cardiac arrest survival are dismal, with many large U.S. cities averaging less than 10%.
- Seattle and King County, Washington report over 60% survival (the highest in the world). How? Using HP-CPR.
- Only 40 communities in the U.S. rigorously measure and report cardiac arrest survival rates.
Involve your chain of operation
From the very start, HP-CPR is all about teamwork. That means you need buy-in from your entire agency. Start with your medical oversight — a physician needs to evaluate and approve any deviations from your current CPR process before you can make changes. Factors like approved compression/ventilation ratio, rate of compression and the amount of shock/pause must be agreed upon before launching a new training program.
But medical oversight is just the first step. Success means strong support from leadership as well as the troops — fire chiefs, EMS workers, division chiefs, training officers and field practitioners. Everyone needs to understand what’s being undertaken and why. Change is one of the most difficult processes to manage, so be patient and persistent.
With any initiative, organizational buy-in is rarely immediate — and never absolute, with key stakeholders often attaching conditions to their support. Focus on the problems HP-CPR training will help solve, and the value it will drive in your organization as well as your community. Consider suggesting a small pilot project before jumping into a full-on training program.
Know what to measure
HP-CPR requires highly specific performance metrics, kept top-of-mind with a simple DVD-R acronym:
- Depth of compressions (2-2.4 inches for an adult)
- Ventilation (300-400 mls per vent)
- Decompression (100% chest recoil)
- Rate of compression (100-120 per minute)
Additionally, the Resuscitation Academy takes HP-CPR one step further, rounding out the metrics with CPR fraction time — the amount of time a responder is actually on the patient’s chest during a two-minute CPR interval. Also known as flow time, high fraction time (think 90%+) is an absolute indicator of survival. To achieve 90% fraction in two minutes, you can be off the chest for just 12 seconds.
Take a programmatic approach to implementation
HP-CPR training begins with benchmarking your agency’s current level of skill, because it’s only through measurement that we can make informed decisions, replicate best practices and measure improvement.
Start by testing your team and recording the results, then provide practical skills training until they reach 100% compliance on the above metrics while in training mode. Continue measuring during actual calls, and review outcomes frequently to ensure consistently high rate of performance. Plan for quarterly refresher training at a minimum to keep your team sharp.
Here’s where the use of technology can have a huge impact. An instrumented manikin is a valuable tool to measure performance, identify skill gaps and track improvement during training. In the field, QCPR pucks provide immediate feedback so responders know exactly where improvement is still needed.
Using this approach, agencies in Chelan and South Douglas counties in central Washington state nearly doubled survival rates from roughly 30% to 57% over a six-year period, according to EMS medical director Dr. Lance Jobe. When it comes to driving improvement, he stresses that how you deliver performance feedback is just as important as the data itself.
“When we review a case, we make it clear that we’re not placing blame or beating anyone up,” says Jobe. “We’re all in this together, trying to create a culture of improvement. Our goal is to make providers more aware, more in tune with what’s happening in the moment. It’s human nature to want to do well, and nobody ever makes the same mistake twice.”
Train like you work
Chances are, you won’t be performing life-saving CPR in the safe confines of a classroom or the sterile walls of a hospital room. Be sure to train in the environments and under the same conditions as real-life emergencies. For example, practice using a mechanical chest compression device without costly delays like having to move the patient.
Even for professionals, it can be a struggle to reconcile what’s taught in the classroom versus actual requirements for work performance. The more realistic the training, the better the chances of favorable outcomes in the field.
Resuscitation Academy: Your HP-CPR resource partner
Launching a high-performance CPR program is a noble goal — somewhat complex as you can tell from the information above, but more than worth it when you play a role in sending a loved one back to their family.
We’re always here to help, so look to the tools and resources available through the Resuscitation Academy. From in-person events to digital toolkits, training instruction and more, you’ll find an array of helpful materials to help smooth the way to successful HP-CPR implementation.