Letters to the Editor

Can We Achieve Perfect CPR?

In response to Angelo Salvucci’s column in the May issue,  “Literature Review: Real-time CPR Feedback and Return of Spontaneous Circulation,” I would have to disagree, at least in part. 

Having worked in EMS since 1986, I have performed CPR at both a BLS and ALS level.  During my 25 years, I have been a CPR instructor/trainer, an ACLS instructor/trainer,  and have held many other instructor and instructor/trainer certifications within the prehospital care arena.

The first issue I have with “real-time” feedback is a medical-legal one. Even with the best intentions, if we begin recording audio and visual feedback on our cardiac arrest patients, we are opening ourselves to an even higher risk of being sued.  In the prehospital setting, achieving “perfect” CPR is, at best, extremely difficult. We perform CPR in an array of conditions including times during which patients are being wheeled on stretchers and transported in moving vehicles. Such data does not appear, at least in the article, to be part of the study. I can, however, see a litigator offering the audio and visual documentation as evidence in a lawsuit against an ambulance service or EMS team as proof that CPR was not properly performed, even though the crew did their jobs “perfectly.”  In this way, I can only agree that feedback provided by real-time audio and visual recording of CPR would not improve the quality of CPR, at least to any degree that would outweigh the risk of the data being used against us.

The second issue is the expectation that EMS professionals should be trained until they can achieve the “perfect strip.” The study implies, at least in part, that the crews that participated in the study failed to provide “high quality CPR—immediately, consistently and continuously” all of the time.  I see no evidence of this. Even under the best conditions, there are many contributing factors that affect the quality of our CPR. It is very possible that these providers “did provide perfect CPR” each and every time, taking into consideration the particular conditions. 

The answer to improving the quality of CPR does include providing better training, but must begin with the American Heart Association and the ECC Committee that changes the guidelines every year or two, making it difficult for us to achieve “perfection” in the skill. It needs to begin with better layperson training, such as not omitting steps because people demonstrate difficulty in performing them correctly,   such as the pulse check. It needs to begin with making training materials more accessible and less expensive so trainers can keep course costs down and make courses more available. Finally, it needs to include all groups from door to discharge.  Increasing training for any skill will improve the quality of that skill, but it must include all levels of care and be standardized so we are all performing it the same.

Steven Lajoie, EMTP, I/C, Webster, MA

Saving Lives

Kudos to Thom Dick for his column “Time Warp” in the October issue. The article really struck a chord with me. 

A couple of weeks ago, we ran a fire in a patio home occupied by a single mother and her daughter. Due to financial stresses, they had no electricity and had been using candles. Their lives were saved by one of their dogs alerting them to the fire at 3 a.m. 

It became quickly apparent that both mother and daughter were animal lovers. One of the first things they asked us to recover from the home was a container holding the remains of their dog who had died earlier this year. It was my unpleasant duty to inform them that their cat did not survive the fire. Their immediate concern was how they were going to pay for the cremation of the cat.  When I told them that we (the department) would make the arrangements and cover the cost the mother hugged me very tightly and, through tears, expressed her sincere gratitude.

This was a wonderful opportunity to go outside our normal boundaries to help someone in need and has become a teaching moment in our transition to a values-based organization.  (That’s a lot harder than it looks in a fire department!)

My money is on the medic in your story. Thanks for sharing it with all of us!

Chief Russ Rakestraw, Lyndon Fire Protection District, Louisville, KY 

I just read Thom Dick’s “Time Warp” column and have a tear in my eye. What a great reminder as to why we do what we do. Too many times we forget the reason why God gives us the gift of taking care of people. I recently had a new EMT I was precepting say “This is not what I signed up for” while transporting a psych patient. “Then what did you sign up for?” I asked.  I got no response. I hope it made him think of the profession as a vocation and not just a paycheck.

Thank you for reminding me of the same.

Jeff Dostalek, via e-mail