Pre-Hospital Questions & Resources

St John Ambulance (6DS), AMS, RFDS etc. Frequencies, callsigns and discussion.

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munchkin1981
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Post by munchkin1981 » Wed Apr 02, 2008 5:38 am

also what the say if u ring for a ambulance here in wa and u get asked do u know cpr if u dont they just get u to do compressions instead of confusing u with giving breaths
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Ambul8
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Post by Ambul8 » Wed Apr 02, 2008 11:28 am

Sounds good, but to state that compressions only resuscitation is the way to go is brave.

Both the UK and Australian Resuscitation Councils agree that compressions only resuscitation works. The caveat being the in the case of a person completely untrained in resuscitation, compression only IS BETTER than no resuscitation at all.

Compressions coupled with rescue breaths at a ration of 30:2 are still the gold standard. The changes that were brought about a few years ago increased the rate of compression and decreased the rate of recue breaths. This was due to the fact that we were loosing people through an over emphasis on rescue breaths. Studies around the world found this was due to inadequate tissue perfusion, especially of the brain. The crux of the matter dealt with needing to maintain a certain blood pressure, to achieve perfusion of vital organs. By continuing to stop for rescue breaths (after every 5 or 15 compressions) we were not keeping the BP above the threshold. Hence why the emphasis is now on compressions. And lets face it, 4 breaths per minute is adequate intake, especially when there is always going to be some gas exchange due to the mechanical efforts of compressions on the lungs.

Since the changes in CPR out of hospital cardiac arrest survival rates, particularly in the ambulance setting, have increase. Add into the equation the effects of a defibrillator and you are giving someone the best chance of survival.

Ask your self this: If it is your wife/husband/partner/parents lying, dying on the floor – will you do compressions only resuscitation or will you do compressions/rescue breaths? I know my choice!!

That being said, for the manky looking person lying on the side of the road that I don’t know, I also know what my choice would be.

This from the ARC website www.resus.org.au check at the FAQ & research links on the home pages:

“COMPRESSION ONLY CPR
Many may be aware of a recent Japanese study that examined the outcomes of cardiac arrest patients who received compressions only. The authors concluded that compression only CPR was preferable than conventional CPR with survival rates being 6% versus 4% for compression only and conventional CPR respectively. For those not receiving any CPR the survival rates were significantly worse compared with those receiving any CPR.
This was an observational study which means there is some inherent weakness in the study purely associated with the study design. In addition the study was conducted in 2002 – 2003 before the compression:ventilation ratio changed from 15:2 to 30:2 which results in a significant increase in compressions. It is unknown if the results would have been different if lay people in the study had given conventional CPR using 30:2.
Although compression only CPR may be adequate in the first few minutes following the onset of cardiac arrest caused by heart disease, ventilation is required in these cardiac arrests having longer duration or if caused by drowning, drug overdose or in children.
The ARC guidelines recommends compression only CPR for out of hospital cardiac arrest where the rescuer is unable or unwilling to give mouth to mouth ventilation. It is also recommended for ambulance services when providing CPR instructions over the phone. This is because “any CPR is better than no CPRâ€
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Post by PFO » Sat Apr 05, 2008 9:34 am

you may just find that the rate for infants and paeds may revert back to 15:2
It is a hot topic with the ARC at the moment whereas in adults i believe it will probably eventually increase even further as when the heart under normal contraction ejects approx 70ml of blood whereas under cpr only 30ml which was a contributing factor for the first increase. But you are correct in that keeping the pressure up so that effective oxygen exchange can occur at the
capillaries is essential. interesting how things are progressing though, and who knows where treatment guidelines will end up in 10 - 20 years time
:D :?:
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Post by Ambul8 » Sat Apr 05, 2008 9:38 am

PFO wrote:you may just find that the rate for infants and paeds may revert back to 15:2
It is a hot topic with the ARC at the moment whereas in adults i believe it will probably eventually increase even further as when the heart under normal contraction ejects approx 70ml of blood whereas under cpr only 30ml which was a contributing factor for the first increase. But you are correct in that keeping the pressure up so that effective oxygen exchange can occur at the
capillaries is essential. interesting how things are progressing though, and who knows where treatment guidelines will end up in 10 - 20 years time
:D :?:
The Ambulance Service still does 15:2 or 5:1 for peadiatric patients and neonates.

Remember kids arrest for different reasons than adults.
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Post by PFO » Sat Apr 05, 2008 9:44 am

[quote="Ambul8"][quote="PFO"]you may just find that the rate for infants and paeds may revert back to 15:2
It is a hot topic with the ARC at the moment whereas in adults i believe it will probably eventually increase even further as when the heart under normal contraction ejects approx 70ml of blood whereas under cpr only 30ml which was a contributing factor for the first increase. But you are correct in that keeping the pressure up so that effective oxygen exchange can occur at the
capillaries is essential. interesting how things are progressing though, and who knows where treatment guidelines will end up in 10 - 20 years time
:D :?:[/quote]

The Ambulance Service still does 15:2 or 5:1 for peadiatric patients and neonates.

Remember kids arrest for different reasons than adults.[/quote]yes but i wouldnt percieve that the reasons for them staying put isnt because of mechanism but more of a mechanical setup, ie surface area of lungs, resp
rates, easier to maintain pressures etc
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Post by PFO » Sat Apr 05, 2008 10:05 am

CPR better with more chest compressions
Helen Carter
ABC Science Online


Friday, 31 March 2006

CPR dummy

New guidelines recommend 30 chest compressions to every two breaths to improve blood flow to the heart and brain (Image: iStockphoto)

New advice on how best to perform cardiopulmonary resuscitation (CPR) suggests doubling the number of chest compressions, Australian emergency medicine experts say.

This should mean more sustained blood flow, especially to the heart and brain.

The move, which was announced recently by the Australian Resuscitation Council, is now in line with international consensus and best evidence, say the experts.

The new protocol recommends 30 chest compressions to every two breaths when resuscitating infants, children or adults.

The pattern of two ventilations then 30 compressions should continue, to achieve a rate of 100 compressions a minute, says council chair and University of Western Australia lecturer in emergency medicine, Associate Professor Ian Jacobs.

He hopes the one conversion rate for all basic life support rescue attempts and patients would be easier to remember and increase the likelihood people will at least try CPR.

The new protocol also recommends compressions be delivered faster and harder, people should visualise the centre of the chest and compress there, interruptions should be minimised, a defibrillator attached urgently, other ventilation avoided and says any attempt at resuscitation is better than no attempt.

Kelli Mitchener from the Australian College of Critical Care Nurses and a nurse at Melbourne's Austin Hospital, says the new ratio means better blood flow.

"By increasing the number of compressions it means there will be fewer pauses where blood circulation is not occurring, hopefully improving the patient's outcome," she says.

The changes are based on a review of published evidence which found giving more compressions may help save more lives and a consensus developed by the International Liaison Committee on Resuscitation published in the journals Resuscitation and Circulation.

"There are 30,000-35,000 cardiac arrests annually in Australia - due to a heart attack, drowning or drug overdose for example - but less than half receive CPR before an ambulance arrives and most [who don't] will die," says Jacobs.

The guidelines, which are available online, are for the public but include sections for doctors, hospitals and ambulance officers.

St John Ambulance begins teaching the new techniques in its first aid classes from April.
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PFO
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Post by PFO » Sat Apr 05, 2008 10:11 am

can any student paras tell me if sja are currently teaching 15:2 for infants and paeds, would be interesting to know what the reasons are, as this isnt what the arc are currently saying but are infact considering reverting to ?

cheers pfo

Munchkin what are they teaching you in uni?
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Post by PFO » Sat Apr 05, 2008 10:22 am

Ok just read ARCs take on things. So BLS 30:2 reguardless and ALS 15:2 for little ones. So where does this put SJA vollies and industrial medics who are not ALS trained?
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Post by Ambul8 » Sun Apr 06, 2008 10:45 am

PFO wrote:Ok just read ARCs take on things. So BLS 30:2 reguardless and ALS 15:2 for little ones. So where does this put SJA vollies and industrial medics who are not ALS trained?
WAAS rates - ALS components are completed to compliment these rates when available. But all ambos use this:

Neonates: 3:1 (90 compressions:30 Ventilations) where pulse <60bpm
to acheive 120 events/minute

Infant: 15:2

Child: 15:2 (up to 14 years, or beginning of puberty)

Adult: 30:2

EDIT: This comes from the WAAS Skills Manual 2008
Last edited by Ambul8 on Mon Apr 07, 2008 8:18 am, edited 1 time in total.
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munchkin1981
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Post by munchkin1981 » Sun Apr 06, 2008 7:42 pm

15:2 is what we get taught for kids and secoundly i aint in uni i just a voly
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Post by gkoutlis » Mon Apr 07, 2008 7:54 am

30:2 - Is the standard SJA are putting out - Regardless whether its a child, infant or an adult..... Its all the same - 30:2 - HOWEVER, compressions for an infant is done by using 2 fingers only and going a third of the depth of their body as they are still fragile...
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Ambul8
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Post by Ambul8 » Mon Apr 07, 2008 8:17 am

gkoutlis wrote:30:2 - Is the standard SJA are putting out - Regardless whether its a child, infant or an adult..... Its all the same - 30:2 - HOWEVER, compressions for an infant is done by using 2 fingers only and going a third of the depth of their body as they are still fragile...
yep, thats the rate they are teaching in first aid and for VFAS. But I believe the original question from PFO was more centered to the Ambulance Service.
munchkin1981 wrote:15:2 is what we get taught for kids and secoundly i aint in uni i just a voly
There is a distinct difference between Neonates, Infants and Paediatrics
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Post by PFO » Tue Apr 08, 2008 7:55 am

[quote="Ambul8"][quote="gkoutlis"]30:2 - Is the standard SJA are putting out - Regardless whether its a child, infant or an adult..... Its all the same - 30:2 - HOWEVER, compressions for an infant is done by using 2 fingers only and going a third of the depth of their body as they are still fragile...[/quote]

yep, thats the rate they are teaching in first aid and for VFAS. But I believe the original question from PFO was more centered to the Ambulance Service.

[quote="munchkin1981"]15:2 is what we get taught for kids and secoundly i aint in uni i just a voly[/quote]

There is a distinct difference between Neonates, Infants and Paediatrics[/quote] ambul8 is correct in this last statement but my question still hasnot been answered. As a volly working on road who dont have als
or an IP who dont have als what ratios are they working with, bearing in mind
what sja are teaching, How about patient transport?

There seems to be a few varying statements here, the arc guidelines are quite clear. Ambul8 states all ambos use 15-1 yet not all ambos are als trained? Are you als trained ambul8 ? or has the point im getting at been lost lol :D
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Post by PFO » Tue Apr 08, 2008 7:57 am

[quote="munchkin1981"]15:2 is what we get taught for kids and secoundly i aint in uni i just a voly[/quote] sorry munchy thought you were student :D
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Post by PFO » Tue Apr 08, 2008 7:58 am

[quote="gkoutlis"]30:2 - Is the standard SJA are putting out - Regardless whether its a child, infant or an adult..... Its all the same - 30:2 - HOWEVER, compressions for an infant is done by using 2 fingers only and going a third of the depth of their body as they are still fragile...[/quote] youll find thats at bls level
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