Does the change of educational strategy for chest compression based on the change of guidelines affect on the quality of prehospital chest compression?

Background and Aims. International guidelines for cardiopulmonary resuscitation (CPR) changed their strategy with respect to the rate of chest compression (CC) and ventilation from 15:2 to 30:2. The object of this study was to clarify the effect of this change on the quality of CPR. Subjects and Methods. We recorded the frequency of CC and ventilation performed by Emergency Life Support Technicians (ELSTs) during CPR in ambulances, and compared the period when ELSTs performed 15:2 CPR with that when they performed 30:2 CPR. Results. During the first period, ELSTs actually performed CCs 15 times per 7.2 sec (128.1 times per minute), and performed 2 ventilations per 4.5 sec. Thirty-six percent of patients received appropriate CCs (100-120/min), while 43% received high-frequency CCs (120-150/min) and 13% received CCs that were too fast (more than 150/min). During the second period, ELSTs performed CCs 30 times per 18.1 sec (101.6 times per minute), and performed 2 ventilations per 4.3 sec. Conclusions. The change in the CC-to-ventilation ratio for CPR in the international guidelines from 15:2 to 30:2 can improve the exactness of the frequency of CCs. However, ELSTs may not be able to perform CCs exactly as recommended. It is important to evaluate the exact frequency of CCs by ELSTs or paramedics in ambulances and to evaluate the relationship between the frequency of CCs and patient outcome

Does the change of educational strategy for chest compression based on the change of guidelines affect on the quality of prehospital chest compression?

Background and Aims. International guidelines for cardiopulmonary resuscitation (CPR) changed their strategy with respect to the rate of chest compression (CC) and ventilation from 15:2 to 30:2. The object of this study was to clarify the effect of this change on the quality of CPR. Subjects and Methods. We recorded the frequency of CC and ventilation performed by Emergency Life Support Technicians (ELSTs) during CPR in ambulances, and compared the period when ELSTs performed 15:2 CPR with that when they performed 30:2 CPR. Results. During the first period, ELSTs actually performed CCs 15 times per 7.2 sec (128.1 times per minute), and performed 2 ventilations per 4.5 sec. Thirty-six percent of patients received appropriate CCs (100-120/min), while 43% received high-frequency CCs (120-150/min) and 13% received CCs that were too fast (more than 150/min). During the second period, ELSTs performed CCs 30 times per 18.1 sec (101.6 times per minute), and performed 2 ventilations per 4.3 sec. Conclusions. The change in the CC-to-ventilation ratio for CPR in the international guidelines from 15:2 to 30:2 can improve the exactness of the frequency of CCs. However, ELSTs may not be able to perform CCs exactly as recommended. It is important to evaluate the exact frequency of CCs by ELSTs or paramedics in ambulances and to evaluate the relationship between the frequency of CCs and patient outcome

Influence of socioeconomic factors on medically unnecessary ambulance calls

<p>Abstract</p> <p>Background</p> <p>Unnecessary ambulance use has become a socioeconomic problem in Japan. We investigated the possible relations between socioeconomic factors and medically unnecessary ambulance calls, and we estimated the incremental demand for unnecessary ambulance use produced by socioeconomic factors.</p> <p>Methods</p> <p>We conducted a self-administered questionnaire-based survey targeting residents of Yokohama, Japan. The questionnaire included questions pertaining to socioeconomic characteristics, dichotomous choice method questions pertaining to ambulance calls in hypothetical nonemergency situations, and questions on the city's emergency medical system. The probit model was used to analyze the data.</p> <p>Results</p> <p>A total of 2,029 out of 3,363 targeted recipients completed the questionnaire (response rate, 60.3%). Probit regression analyses showed that several demographic and socioeconomic factors influence the decision to call an ambulance. Male respondents were more apt than female respondents to state that they would call an ambulance in nonemergency situations (p < 0.05). Age was an important factor influencing the hypothetical decision to call an ambulance (p < 0.05); elderly persons were more apt than younger persons to state that they would call an ambulance. Possession of a car and hesitation to use an ambulance negatively influenced the hypothetical decision to call an ambulance (p < 0.05). Persons who do not have a car were more likely than those with a car to state that they would call an ambulance in unnecessary situations.</p> <p>Conclusion</p> <p>Results of the study suggest that several socioeconomic factors, i.e., age, gender, household income, and possession of a car, influence a person's decision to call an ambulance in nonemergency situations. Hesitation to use an ambulance and knowledge of the city's primary emergency medical center are likely to be important factors limiting ambulance overuse. It was estimated that unnecessary ambulance use is increased approximately 10% to 20% by socioeconomic factors.</p