Journal Article

Optimal paramedic numbers in resuscitation of patients with out-of-hospital cardiac arrest: A randomized controlled study in a simulation setting

Sun, Jen-Tang, Hsieh, Ming-Ju, Kao, Tsung-Chi, Tsai, Bing Min, Ma, Matthew Huei-Ming, Chen, Lee-Wei, Wen-Chu, Chiang, Lin, Yu-You

2020

Overview

The effect of paramedic crew size in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. We hypothesised that teams with a larger crew size have better resuscitation performance including chest compression fraction (CCF), advanced life support (ALS), and teamwork performance than those with a smaller crew size. We conducted a randomized controlled study in a simulation setting. A total of 140 paramedics from New Taipei City were obtained by stratified sampling and were randomly allocated to 35 teams with crew sizes of 2, 3, 4, 5, and 6 (i.e. 7 teams in every paramedic crew size). A scenario involving an OHCA patient who experienced ventricular fibrillation and was attached to a cardiopulmonary resuscitation (CPR) machine was simulated. The primary outcome was the overall CCF; the secondary outcomes were the CCF in manual CPR periods, time from the first dose of epinephrine until the accomplishment of intubation, and teamwork performance. Tasks affecting the hands-off time during CPR were also analysed. In all 35 teams with crew sizes of 2, 3, 4, 5, and 6, the overall CCFs were 65.1%, 64.4%, 70.7%, 72.8%, and 71.5%, respectively (P = 0.148). Teams with a crew size of 5 (58.4%, 61.8%, 68.9%, 72.4%, and 68.7%, P<0.05) had higher CCF in manual CPR periods and better team dynamics. Time to the first dose of epinephrine was significantly shorter in teams with 4 paramedics, while time to completion of intubation was shortest in teams with 6 paramedics. Troubleshooting of M-CPR machine decreased the hands-off time during resuscitation (39 s), with teams comprising 2 paramedics having the longest hands-off time (63s). Larger paramedic crew size (≧4 paramedics) did not significantly increase the overall CCF in OHCA resuscitation but showed higher CCF in manual CPR period before the setup of the CPR machine. A crew size of ≧4 paramedics can also shorten the time of ALS interventions, while teams with 5 paramedics will have the best teamwork performance. Paramedic teams with a smaller crew size should focus more on the quality of manual CPR, teamwork, and training how to troubleshoot a M-CPR machine.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Allied Health Personnel - statistics & numerical data / Biology and Life Sciences / Cardiac arrest / Cardiopulmonary resuscitation / Cardiopulmonary Resuscitation - methods / Care and treatment / Communication / Compression / CPR / Crew size / Critical Care - methods / Drug dosages / Education / Emergency medical care / Emergency Medical Services - methods / Emergency Medical Technicians / Emergency Medicine - methods / Emergency services / Engineering and Technology / Epinephrine / Epinephrine - administration & dosage / Evaluation / Female / Fibrillation / Fire departments / Fires / Heart / Humans / Intubation / Intubation - methods / Male / Medicine / Medicine and Health Sciences / Methods / Out-of-Hospital Cardiac Arrest - epidemiology / Out-of-Hospital Cardiac Arrest - pathology / Out-of-Hospital Cardiac Arrest - prevention & control / Paramedics / Patients / Physical Sciences / Randomization / Resuscitation / Services / Simulation / Social Sciences / Studies / Teams / Teamwork / Troubleshooting / Ventricle / Ventricular fibrillation / Ventricular Fibrillation - physiopathology / Ventricular Fibrillation - prevention & control