Abstract
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.
Highlights
Out-of-hospital cardiac arrest (OHCA) is one of the most critical situations that both paramedics and patients can experience in the prehospital setting
A crew size of ≧4 paramedics can shorten the time of advanced life support (ALS) interventions, while teams with 5 paramedics will have the best teamwork performance
The chest compression fraction (CCF) in manual cardiopulmonary resuscitation (CPR) periods were significantly high in teams with 5 paramedics (58.4%, 61.8%, 68.9%, 72.4%, and 68.7%, P
Summary
Out-of-hospital cardiac arrest (OHCA) is one of the most critical situations that both paramedics and patients can experience in the prehospital setting. Over 176,100 cardiac patients were treated by emergency medical service (EMS) personnel in the United States annually.[1] In Taiwan, 9,815 OHCA cases per year were reported between 2000 and 2012, with an average survival rate of 9.8% at 180 days.[2] Recent studies found that chest compression fraction (CCF) during cardiopulmonary resuscitation (CPR) is strongly associated with survival rate, [3,4] and the widely adopted mechanical CPR (M-CPR) machine, which provides continuous chest compression, has the potential to increase the CCF during the entire course of resuscitation in the prehospital setting.[5] Previous studies showed the different effects of several advanced life support (ALS) interventions, such as intubation or adrenaline (epinephrine) administration, on OHCA patients.[5,6,7] As the aforementioned interventions were performed by paramedics in the prehospital setting, the number of paramedics in the scene will certainly have a potential influence on the performance of these interventions. 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
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