Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews

Background: Little is known regarding circumstances, outcomes and quality of cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) performed by operational lifeboat crews. Our aim is to evaluate circumstances, outcomes and quality of CPR performed by the Royal Dutch Lifeboat Institution (KNRM) in out-of-hospital cardiac arrest (OHCA). Methods: The internal KNRM database has been used to identify and analyse all OHCA cases between July 2011 and December 2017. A limited set of AED data was available to study the quality of CPR. Results: In 37 patients the lifeboat crew members have performed CPR, of which 29 (78.4%) occurred under hostile conditions. The median response time to arrive at the location was 15 min. In 11 (29.7%) patients return of spontaneous circulation was achieved at any moment during CPR and 3 (8.1%) patients were still alive after one month. The lifeboat AED was used in 12 patients. Their recordings show a high median compression frequency (120, IQR 111–131) and prolonged median interruption periods (pre-analysis pause 11s (IQR 10–13), post-analysis pause 4s (IQR 3–8), pre-shock pause 24s (IQR 19–26), post-shock pause 6s (IQR 6–11), ventilation pause 6s (IQR 4–8) and other pauses 9s (IQR 4–17)). Conclusions: Compared to most out-of-hospital resuscitations, resuscitations by lifeboat crews have a low incidence, occur under difficult circumstances and in a younger population. AED's on lifeboats have not contributed to any of the survivals. Analysis of AED information can be used to study the quality of CPR and provide input for improving future training of lifeboat crews

Developing process guidelines for trauma care in the Netherlands for severely injured patients: Results from a Delphi study

Background: In organised trauma systems the process of care is the key to quality. Nevertheless, the optimal process of trauma care remains unclear due to lack of or inconclusive evidence. Because monitoring and improving the performance of a trauma system is complex, this study aimed to develop consensus-based process guidelines for trauma care in the Netherlands for severely injured patients. Methods. A five-round Delphi study was conducted with 141 participants that represen

The role of bystanders during rescue and resuscitation of drowning victims

Background: Bystanders make a critical difference in the survival of drowning victims. Little information on their role before arrival of the Emergency Medical Services (EMS) is available in the scientific literature. In a descriptive study, this role is investigated. Methods and results: We studied 289 rescue reports (1999-2004) available from the Dutch Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning), an organisation that, since 1767, acknowledges awards to bystanders who have contributed to the survival of a drowning victim. There were 138 variables retrieved from these reports. The Utstein Style for Drowning (USFD) was used as a guideline. Of the 26 USFD parameters on victim and scene information, 21 were available for analysis. Eight non-USFD parameters, defined by the authors of this research, were available in >60% of the cases. There were 343 victims, rescued by 503 rescuers. 109 victims were resuscitated by bystanders. Of the 18 victims who first received resuscitation from bystanders and then consequently from pre-hospital professionals, 14 survived. Rescues often occurred in dangerous circumstances: multiple victims (n = 90/343), cold or ice-cold water (n = 295/341), deep water (n = 316/334), swimming to the victims (n = 262/376), young age of rescuers (the youngest rescuer was 5 years of age). Conclusions: Bystander rescue and resuscitation of drowning victims seems to contribute to a positive outcome. Bystanders are prepared to take responsibility to rescue a drowning victim in spite of significant dangers. The USFD is helpful in understanding the role of bystanders in drowning situations, but may need modification to become more instrumental. (C) 2010 Elsevier Ireland Ltd. All rights reserved

Dealing with citizen response and evacuation during large scale flooding in industrial societies

The challenges that large-scale floods pose are beyond the organisational capabilities of governments and the emergency services of most states to handle. More people experience flooding than any other natural hazard with on average nearly 97 million people affected annually between 1980 and 2008 [1]. While most of those affected are in the developing world, significant economic and infrastructural damage is also wrought by flood in modern industrial societies who share a long history of exposure to such risks [2]. Dealing with floods, therefore, calls for close cooperation between citizens, public bodies and private actors. The effectiveness of governmental response to flooding is even largely dependent on the rational complying citizen. Large-scale evacuations, for instance, can only succeed when citizens cooperate. This need for cooperation has important implications for the preparation and response to floods, especially since governments privatise and subcontract formerly state-provided services [3]. Very few emergency management plans take citizen response into account, where the latter encompasses the actions taken by citizens in preparation for and in response to flooding with the intent to limit its effects to themselves or others [4]. Flood management planning overly dwells on the risks posed by panic and looting [4]. This preoccupation contrasts the scientific literature that depicts most citizens confronted by flood as calm in the face of danger, self-reliant and rarely if ever looting [5, 6]

Dealing with citizen response and evacuation during large scale flooding in industrial societies

Contains fulltext : 112246.pdf (publisher's version ) (Closed access)The challenges that large-scale floods pose are beyond the organisational capabilities of governments and the emergency services of most states to handle. More people experience flooding than any other natural hazard with on average nearly 97 million people affected annually between 1980 and 2008 [1]. While most of those affected are in the developing world, significant economic and infrastructural damage is also wrought by flood in modern industrial societies who share a long history of exposure to such risks [2]. Dealing with floods, therefore, calls for close cooperation between citizens, public bodies and private actors. The effectiveness of governmental response to flooding is even largely dependent on the rational complying citizen. Large-scale evacuations, for instance, can only succeed when citizens cooperate. This need for cooperation has important implications for the preparation and response to floods, especially since governments privatise and subcontract formerly state-provided services [3]. Very few emergency management plans take citizen response into account, where the latter encompasses the actions taken by citizens in preparation for and in response to flooding with the intent to limit its effects to themselves or others [4]. Flood management planning overly dwells on the risks posed by panic and looting [4]. This preoccupation contrasts the scientific literature that depicts most citizens confronted by flood as calm in the face of danger, self-reliant and rarely if ever looting [5, 6]