Australian Resuscitation Council Research Articles

Comparison Between the Advanced Cardiac Life Support and Adult Advanced Life Support Protocols: A Simulation-Based Pilot Study.

Introduction: Cardiac arrest is a public health concern associated with unfavorable disease outcomes. Cardiopulmonary resuscitation (CPR) of optimal quality is widely acknowledged as an indispensable technique in restoring spontaneous circulation. In order to perform advanced cardiac life support (ACLS), chest compression must be paused twice: once to assess the rhythm and again to administer the shock. Australian advanced life support (ALS) recommends that the defibrillator needs to be precharged in order to administer the shock during a solitary interval in chest compressions. While performing chest compressions, precharging defibrillators can decrease hands-off time without posing a risk of injury. Aim: To compare chest compression fraction (CCF)-which is the cumulative time spent providing chest compressions divided by the total time taken for the entire resuscitation-by calculating the hands-off time duration in cardiac arrest between the Australian Resuscitation Council (ARC) and American Heart Association (AHA) protocols for CPR. Methods: A simulation-based pilot study was designed using a Laerdal Resusci Anne mannequin and a LIFEPACK 20 defibrillator. The study included six participants recruited from King Khalid University Hospital in Riyadh, Saudi Arabia, where three participants were certified ACLS providers and there were certified ALS providers. Participants were divided into two groups, ALS and ACLS, each following one protocol. For each scenario, a random job was assigned to each participant, regardless of their role as assistant, team leader, or performer of CPR. Each case's shockable and nonshockable rhythms were hidden from the team leader and the chest compressor. Ten trials of CPR were performed, each for four cycles with a total time of 8 min. The simulation was video recorded for hands-off time counting. Comparison between CCF (seconds) per cycle between the two protocols was performed using an independent sample t-test. A p value of 0.05 was used to measure statistical significance. Results: Comparing CCF in shockable rhythms between ARC and AHA protocols, it was observed that the CCF of ALS-ARC was significantly higher than ACLS-AHA in all cycles; the first cycle: t = 3.782, p=0.004; the second cycle: t = 3.380, p=0.007; the third cycle: t = 3.803, p=0.003; and the fourth cycle: t = 4.341, p=0.001. Conclusion: Precharging a defibrillator before a rhythm check during chest compression, in anticipation of a potentially shockable rhythm, reduces the time required for defibrillation and limits interruptions in chest compression during CPR. This practice effectively enhances the CCF. Enhancing the continuity of chest compressions can potentially improve survival rates in ARC.

Effectiveness of an educational intervention on first-year nursing students’ knowledge and confidence to perform basic life support: a quasi-experimental study

Background Knowing how to respond effectively to an acutely deteriorating patient is a National Safety and Quality Health Service Standard and a requirement for nurse registration with the Australian Health Practitioner Regulatory Authority. Literature has highlighted that a lack of knowledge, skills and confidence in healthcare professionals to perform basic life support may be a contributing factor to the high mortality and morbidity rates associated with cardiac arrest in the hospital setting. Aim To explore first-year nursing students’ knowledge and confidence to perform basic life support according to the Australian Resuscitation Council guidelines before and after watching an online video lecture. Method A quantitative quasi-experimental pre- and post-test design to measure changes, if any, in first-year nursing students’ knowledge and confidence to perform basic life support at an Australian university in 2021. Findings The collected data were analysed using Stata, a statistical software for data sciences. Participants’ mean knowledge score increased from 9.3 (SD: 2.5) in the pre-test to 13.9 (SD: 3) (p < 0.001) in the post-test (maximum possible score: 19). Participants’ mean confidence score increased from 17.0 (SD: 6.3) in the pre-test to 24.5 (SD: 4.4) (p < 0.001) in the post-test (maximum possible score: 30; p < 0.001). Discussion The most significant improvement in knowledge was observed in chest compression rate, breathing/ ventilation and checking patient response. The study found that the video lecture is an effective teaching method to increase students’ confidence to perform basic life support. Conclusion An online video-recorded lecture can increase undergraduate student nurses’ knowledge and confidence to perform basic life support. This is one educational strategy that universities can use to improve students’ knowledge and confidence to perform this essential skill for practice.

Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration

IntroductionThis retrospective observational study aims to create a comprehensive database of the circumstances of drowning (including care provided and outcomes of care) to report against the Utstein style for drowning...

Assessing student paramedics' measurements of fatigue and quality of cardiopulmonary resuscitation on a simulated cardiac arrest case

ObjectiveThe International Liaison Committee on Resuscitation (ILCOR) and the Australian Resuscitation Council (ARC) recommend that high-quality cardiopulmonary resuscitation (CPR) is the key to performance outcomes, emphasising compression and rotation through this process. The proposed study has a two-stage approach to evaluating cardiopulmonary resuscitations effectiveness by out-of-hospital practitioners. The first stage aimed to evaluate the influence of providing real-time biofeedback using the Q-CPR system on the provision of CPR by student paramedics. Secondly, the study quantified the effects of physical fatigue on maintaining quality cardiopulmonary resuscitation performed by paramedic students. MethodsForty paramedic students completed cardiopulmonary resuscitation on an instrumented manikin with and without audio-visual biofeedback (Q-CPR within the Phillips MRx defibrillator) in a balanced cross-over fashion. To quantify the quality of cardiopulmonary resuscitation concerning the percentage of applied compressions that meet the current ARC guidelines in terms of rate, depth, and recoil time, a manikin feedback system (SimMan 3 G; Laerdal, Norwegian) was used. ResultsWhen using the Q-CPR prompt with bio-feedback, overall, the depth and fatigue levels increased significantly, highlighting a correlation between correct depth and increased fatigue. ConclusionsAudio prompts improved compression depth; however, fatigue levels increased. The depth during manual compression compared to the Q-CPR prompt was not statistically significant.

In this October issue

Intubation is arguably the most important intervention done in an ED. We publish papers that discuss it in some detail. (a) A group from Melbourne conclude that structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety. (b) A group from NSW describe current airway management practices after a failed intubation attempt in Australian and NZ EDs as well as factors associated with second attempt success. (c) A group from Queensland report that implementation of an evidence-based care bundle and audit of practice has created a safe environment for trainees to learn the core critical care skill of rapid sequence intubation in the ED. In an editorial linked to the above paper from Melbourne, Victoria Brazil and her colleagues highlight the importance of hot debriefing in the ED. Staff are enthusiastic about team conversations after clinical encounters – to defuse high emotion, promote learning and reflect on ways to improve future care. They argue that clinical event debriefing should be a cornerstone of healthcare team reflexivity but can only result in change if embedded within a larger ‘improvement ecosystem’ that synthesises, analyses and reacts to the data from the coal face. The topic of debriefing is also discussed in detail in the Trainee Focus section. Every year 25 000 Australians experience a cardiac arrest in the community, but only 12% survive. The faster CPR and defibrillation starts, the greater the chance of survival. Currently, only half of Australian adults are trained in Basic Life Support (BLS). The Australian Resuscitation Council and key stakeholder organisations believe the best way to ensure all Australians know how to save a life is by mandating BLS education and training in schools. We publish an ‘Aussie KIDS SAVE LIVES’ Position Statement outlining a strategy to help facilitate the introduction of a programme of regular BLS training into the Australian school curriculum. The August issue profiled this paper on its front cover. In doing so we inadvertently used an acronym for Aboriginal and Torres Strait Islander peoples that is disrespectful and does not embrace cultural diversity. Once we realised the problem, the acronym was changed immediately online; unfortunately, it was too late to change the cover of the print edition. No disrespect or offence was intended. We apologise unreservedly. A group from South Australia give us a retrospective analysis assessing whether the introduction of point of care Rotational Thromboelastometry (ROTEM) influenced blood product transfusion and coagulation management in an Australian level 1 trauma centre. The authors conclude that ROTEM introduced in the ED, altered blood product transfusion practices for major trauma patients with an ISS >12, leading to a potentially safer transfusion strategy and cost savings for key blood products. Another paper from South Australia reports the incidence of Acute Traumatic Coagulopathy (ATC) in trauma patients presenting to the Royal Adelaide Hospital. The conclusion is that prehospital blood transfusions are given to the most severely injured trauma patients and the incidence of ATC in this group is more than 80%. There is an association with prehospital blood transfusion and increased ATC in part related to patient selection and severity of trauma, with the contribution of red cell transfusions to ATC unclear. This association should allow earlier identification of patients at increased risk of ATC to ensure rapid correction of coagulopathy to decrease the morbidity and mortality of trauma. Since 2018, the Australasian College for Emergency Medicine has collaborated with Swinburne University of Technology on a research project to understand and enhance the leadership capacity of emergency physicians, beginning with Australasian Directors of Emergency Medicine (DEMs). This research has revealed the complexity of leadership in emergency medicine, illuminating the strengths and limitations of extant research and suggesting promising new directions for emergency medicine leadership and leadership development research. This program has also shed new light on the knowledge, skills and abilities that DEMs need to develop to catalyse change in the systems where they work. The authors argue that an approach to leadership development that reflects the complexity of leadership in emergency medicine will go a long way to enhancing the sophistication, effectiveness and impact of leadership in emergency medicine.

Aussie KIDS SAVE LIVES: A position statement from the Australian Resuscitation Council and supported by stakeholders.

Every year 25 000 Australians experience a cardiac arrest in our community, but only 12% survive. The faster cardiopulmonary resuscitation and defibrillation, known as basic life support (BLS), is commenced, the greater the chance of survival. Currently, only half of the Australian adults are trained in BLS. The Australian Resuscitation Council and key stakeholder organisations believe that the best way to ensure all Australians know how to save a life is by mandating BLS education and training in our schools. This ‘Aussie KIDS SAVE LIVES’ position statement outlines our strategy to help facilitate the introduction of a programme of regular BLS training into the Australian school curriculum.

Safety briefing and visual design key to protecting health care personnel during the COVID-19 pandemic

The COVID-19 pandemic has led to widespread changes as countries echo the call for millions to stay at home in an attempt to limit transmission of SARS-CoV-2, the virus that is responsible for the COVID-19 infection. Health care personnel (HCP), on the other hand, continue to serve on the front line. With their being a limited, human resource, it is paramount that the safety of HCP is not compromised.1Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. doi: 10.1001/jama.2020.3972. Accessed July 17. 2020Google Scholar At our health service in Victoria, Australia, we have implemented a human factor-centric education model with the aim to maximize safety through key messages and clear communication. Our health service, Monash Health is Victoria's largest public health service network and includes three major metropolitan hospitals. Our education model is based on providing consistent and clear safety messages to all HCP, regardless of role and hospital site. It is modelled on the principles of pre-flight safety announcements used in the aviation industry; another high-stakes sector. Infographics (Fig 1), video summaries and pre-shift briefings are part of the education model.2COVID19AsOne. Sourcing non-medical grade personal protection equipment (PPE) for use in healthcare worker (HCW) training. 2020. Available at: https://www.covid19asone.com/sourcing-ppe-1. Accessed May 20, 2020.Google ScholarFig. 1.Visual design for safety briefing at the start of the shift and at clinical areas.View Large Image Figure ViewerDownload Hi-res image Download (PPT) This model encompasses 6 key messages to:1.Reinforce the importance of identifying the virus as the predominant danger2.Include personal protective equipment (PPE) in response to danger3.Focus on hand hygiene4.Reinforce social distancing5.Encourage HCP wellness and teamwork6.Maximize communication, ensure understanding, and provide an opportunity for feedback and questions The importance of cognitive aids for education of HCP is important to maximize their safety. As countries transition to an endemic phase of COVID-19 and the rate of asymptomatic carriage increases, we aim to use these aids to reduce danger to HCP, patients and the community. We believe it is important to reinforce the need to consider all potential dangers when managing COVID-19 patients (“The D [danger] comes first”). The DRSABCD mnemonic actively used in critical care and resuscitation is displayed to relay the acuity of the situation.3Australian Resuscitation Council. ARC flowcharts. 2016. Available at: https://resus.org.au/guidelines/flowcharts-3/. Accessed April 7, 2020Google Scholar This will encourage the health care team to respond (“R” in DRSABCD) appropriately by applying PPE. Hand hygiene compliance has been effective in reducing hospital-acquired infections,4Grayson ML Stewardson AJ Russo PL et al.Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study.Lancet Infect Dis. 2018; 18: 1269-1277Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar and remains vital during a pandemic to reduce viral spread in HCP and patients with known, suspected or unknown COVID-19. Through active and passive social distancing, we aim to reduce the risk of COVID-19 transmission between HCP, patients and community. The reinforcement of adherence to PPE and double-checking PPE fit with a co-worker minimizes risk a virus transmission to other HCP and patients. The briefing is designed to be multidisciplinary and inclusive of the whole HCP team. Part of the safety model is the wellness check for HCP. Finally, closed loop feedback and communication allows for active updates to our education model to ensure continued relevance for all HCP staff. With the use of human factors, our education model aims to become a cognitive aid for all HCP to maintain safety during the pandemic. A recent study identified suboptimal hand hygiene and long duty hours as risk factors for COVID-19 transmission to HCP.5Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk factors of healthcare workers with corona virus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China. Clin Infect Dis. doi: 10.1093/cid/ciaa287. Accessed July 17. 2020Google Scholar Therefore, one must consider other factors apart from PPE to prevent transmission of COVID-19. The use of easily identifiable infographics with simple and consistent shift briefings allows for the rapid communication of information to HCP across multiple hospitals, while maintaining message recognition. A culture of safety and confidence among HCP during this pandemic will not only ensure their safety, but also that of their patients and the community.

Survival in Seattle: the Cardiac Arrest Survival Summit

Survival in Seattle: the Cardiac Arrest Survival Summit

Pre-Hospital Advanced Life Support Resuscitation Training: A Pilot of An Evidence-Based Curriculum

Introduction There is a broad evidence base to support advanced life support (ALS) education for healthcare professionals being structured, realistic and inclusive of a range of human factors. This paper outlines the results of a pilot ALS resuscitation course tailored for providers working in pre-hospital resource-limited settings. The focus on the pre-hospital ALS environment, team mix, techniques, skills and equipment are important because actions taken by pre-hospital healthcare professionals have a critical impact on the likelihood of patient survival. Methods A pre-hospital ALS course was piloted following research into the need for a course and development of a pre-hospital-specific curriculum, based on Australian Resuscitation Council (ARC) guidelines. There were 13 pilot courses run, involving 66 participants. Participants all worked in the pre-hospital environment and held qualifications ranging from a Certificate IV in Healthcare through to postgraduate paramedicine qualifications. The pre-hospital ALS course consisted of theory and practical elements, pre-reading and a pre- and post-course quiz. Feedback was sought from course participants and an expert panel was consulted on the findings. Results Participants and the Expert Panel indicated that a pre-hospital ALS course should follow current recommendations of the ARC and be delivered to persons with sufficient underpinning knowledge of ALS resuscitation. The course should include pre-reading on ALS protocols and a pre-test followed by one day of face-to-face teaching using equipment reflective of the pre-hospital environment. Scenarios should be relevant to the pre-hospital setting and involve varying numbers of responders. Participants should be assessed on a continual basis during the course. Conclusion To improve participant confidence in the delivery of ALS and maximise the likelihood of patient survival, pre-hospital ALS resuscitation education for pre-hospital providers should follow ARC guidelines, include pre-course reading and practical simulation that reflects participants’ day-to-day employment.

Pre-Hospital Advanced Life Support Resuscitation – a Curriculum for Pre-Hospital Education

Introduction There is a broad evidence base to support advanced life support (ALS) education for healthcare professionals being structured, realistic and inclusive of a range of human factors. This paper outlines a curriculum for ALS resuscitation education for providers working in the pre-hospital or resource-limited settings. The focus on pre-hospital ALS education is important because actions taken by pre-hospital healthcare professionals have a critical impact on the likelihood of patient survival. Methods The pre-hospital ALS curriculum developed in this research was derived from a survey and interviews with pre-hospital healthcare professionals and first responders, and input from resuscitation, medical and education experts. Following completion of the interviews an expert panel of resuscitation experts was consulted. Results Information collected indicated that a pre-hospital ALS course should follow current recommendations of the Australian Resuscitation Council and that the course should be delivered in a mixed mode comprising of online pre-reading and a quiz followed by one day of face-to-face teaching. Equipment should reflect that used in the pre-hospital environment and a pre-hospital ALS course should include scenarios relevant to the pre-hospital setting involving varying numbers of interprofessional healthcare teams as well as first responders and lay persons. Candidates should be assessed on a continual basis and certificates of participation be valid for 2 to 3 years. Conclusion To improve pre-hospital resuscitation education and maximise the likelihood of patient survival, ALS education for pre-hospital providers should follow Australian Resuscitation Council guidelines, include pre-course reading, case studies and practical simulation in situations that are likely to be encountered by pre-hospital professionals.

Emergency nurses’ experience of adult basic and advanced life support workstations as a support strategy for clinical practice in the emergency department

BackgroundStandards endorsed by the Australian Resuscitation Council in 2014 recommend that healthcare providers trained in cardiopulmonary resuscitation should have their skills refreshed at least annually and for those who infrequently perform resuscitation, more frequent refresher training is advised. Emergency nurses were given the opportunity to attend workstations to refresh their knowledge and skills essential to resuscitation practice. The aim of this manuscript was to report the perception of the nurses’ experience following attendance at the workstations. MethodsLesson plans were developed for six workstations. Consented participants were invited to complete an on-line evaluation survey of their experience following programme participation and at 6-months following programme attendance. Thematic analysis and descriptive statistics were used to report outcomes ResultsA total of 143 nurses working in the Emergency Department consented to participate. Following attendance at the workstations, most reported increased knowledge and skills (93.7 %), increased confidence (91.9 %) and that they practiced skills (91.9 %) during workstation participation. At 6-months follow-up the majority of nurses (97.1 %) found the programme to be beneficial and 82 (80.4 %) reported using the knowledge and skills gained from the programme in their clinical practice. ConclusionsEmergency nurses felt more confident in delivering patient care following attendance at the resuscitation workstations. Ongoing education was highly regarded by emergency nurses.

First Aid Management of Hypothermia and Cold Injuries

Introduction:Best practice first aid management of accidental hypothermia and cold injuries in the prehospital setting is relevant for disaster management in cold environments as well as for wilderness and expedition medicine, and space medicine. In the Australasian context, guidance is currently taken from the Australian Resuscitation Council (“ARC”) Guidelines dealing with these issues.Aim:To review and update the recommendations of the ARC Guideline 9.3.3 Hypothermia: First-Aid Management (February 2009) and ARC Guideline 9.3.6 Cold Injury (March 2000).Method: The review is being undertaken through a combination of a focused literature review and expert opinion. Through the author’s membership of the International Commission for Alpine Rescue (“ICAR”) Alpine Emergency Medicine Commission, two northern-hemisphere experts on hypothermia have reviewed the guidelines and provided commentary and recommendations.Results:Much of the literature around accidental hypothermia and cold injuries (including frostbite, frostnip, and chilblains), relies on expert opinion and case studies. There are relatively few randomized controlled trials, and these are often confined to the laboratory setting. As a result, there is a heavier reliance on expert opinion than in any other areas of medicine.Discussion:This presentation will summarize the current best practice recommendations for the first aid management of accidental hypothermia and cold injuries through combining the existing ARC Guidelines with key advances identified through the literature review, and the key management recommendations stemming from expert opinion. This will provide attendees with a cohesive set of clinical practice recommendations which can be used in the field.

A Public Health Response to the Poor Outcomes in Out-of-Hospital Cardiac Arrests in Australia

The high incidence and poor outcomes for those who suffered out-of-hospital cardiac arrests, plus the knowledge that early bystander treatment improves outcomes, called for a public health response to this issue. The ‘Shock Verdict’ National CPR Campaign sought to improve the rates of bystander compression-only cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, through a social media public health awareness campaign. An 8-week social media campaign centred around an educational video based on a popular Australian comedy drama ‘Rake’ was designed and developed through a partnership between the Tasmanian Branch of the Australian Resuscitation Council and the University of Tasmania. To date, there have been over 1 million views on the various social media platforms. The campaign focuses on how untrained bystanders can perform compression-only CPR and use an AED in out-of-hospital cardiac arrest, to increase chances of survival. Baseline data collected from an online survey found approximately 50% of respondents rated their CPR knowledge and their confidence to perform CPR as good or fair. Participants were more likely to report a willingness to start hands-only CPR on strangers and unkempt individuals than standard CPR. The campaign provides an example of using social media to communicate a health message, and demonstrates the practicalities of planning such a campaign, including the design of content, and building partnerships. It highlights the importance of collaboration between academic research, health and marketing, and of applying a public health approach to improving clinical outcomes.

Post resuscitation management of cardiac arrest patients in the critical care environment: A retrospective audit of compliance with evidence based guidelines

BackgroundThere is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. The Australian Resuscitation Council (ARC) recommends protocol driven care to enhance chance of survival following cardiac arrest. Healthcare providers have an obligation to ensure protocol driven post resuscitation care is timely and evidence based. ObjectivesThe aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation. MethodA retrospective audit of medical records of patients who met the criteria for survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation and ventilation management, cardiovascular care, neurological care and patient outcomes. FindingsThe four major findings were: (i) use of fraction of inspired oxygen (FiO2) of 1.0 and hyperoxia was common during the first 24h of post resuscitation management, (ii) there was variability in cardiac care, with timely 12 lead Electrocardiograph and majority of patients achieving systolic blood pressure (SBP) greater than 100mmHg, but delays in transfer to cardiac catheterisation laboratory, (iii) neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients and (iv) there was an association between in-hospital mortality and specific elements of post resuscitation care during the first 24h of hospital admission. ConclusionEvidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so strategies to ensure effective guideline implementation are urgently required.

Neonatal resuscitation with no detectable heartbeat.

Shah et al.1 recently published a study on the long term outcomes for infants with Apgar scores of 0 at 10 minutes and concluded that long-term outcomes for survivors may not be universally poor as suggested by previous studies.2 The decision to stop resuscitation can be very challenging even for experienced paediatricians. The major clinical question is what proportion of these infants survive without major neurological sequelae if resuscitation proceeds beyond the 10 minutes advised by the Australian Resuscitation Council.3 Therapeutic hypothermia treatment for neonatal hypoxic ischaemic encephalopathy (HIE) reduces mortality without increasing major disability in survivors.4 The authors argued that the current resuscitation guidelines are based on old observational data before therapeutic hypothermia became standard treatment for HIE. Thirteen infants were included in the study. Four out of the five surviving infants (30.7% of all the infants in the study) had normal formal infant developmental scores on follow up although one of them was treated with hearing aids for sensorineural deafness. Only one out of the five survivors had severe neurological sequelae in the form of spastic quadriplegia. Eight infants did not survive to discharge. Despite the small number of infants included in this study, it generates fresh debate on the need for more and larger studies to answer the question of long-term neurological outcomes of infants with undetectable heart rates at 10 minutes and raises the question of whether we need to review current resuscitation guidelines on when to stop resuscitation given the wide usage of therapeutic hypothermia.

Ian Jacobs - Resuscitation leader, educator and researcher.

Ian Jacobs BAppSc (WAIT), DipEd (Murd), PhD (WAust), RN, FRCNA, FACAP, FERC, Chairman of the Australian Resuscitation Council and co-chair of the International Liaison Committee On Resuscitation died suddenly on the 19th October 2014. He collapsed due to a cerebral haemorrhage while on the job, having delivered a critically ill patient to the Emergency Department of the Royal Perth Hospital, sadly he did not recover. This article reveals something of his enormous influence on and contributions to nursing, pre-hospital and emergency medicine, critical care and resuscitation on a national, and international scale.

Pain from bluebottle jellyfish stings.

An 11-year-old girl presented to the emergency department with severe pain after a jellyfish sting at a New South Wales beach. Bluebottle (Physalia) jellyfish was deemed the most likely cause considering her geographical location. The Australian Resuscitation Council Guideline (2010) suggests immersing in water as hot as can be tolerated for 20 min for treating pain from jellyfish stings. This guideline was written based on past case reports, books and randomised controlled trials (RCTs). We performed a search to assess the most current evidence for relief of pain from Bluebottle jellyfish stings, which yielded two systematic reviews and seven RCTs. Both systematic reviews had similar conclusions, with one of the RCTs used in both reviews showing the most relevance to our presenting patient in terms of demographics, location and jellyfish type. This journal club article is an appraisal of this RCT by Loten et al. and the validity of its conclusion that hot water immersion is most effective for the relief of pain from Bluebottle stings.

Dialysis plus do not resuscitate--not a contradiction.

44. Jacobs I, Nadkarni V, Bahr J, et al; International Liaison Committee onResuscitation; AmericanHeart Association; EuropeanResuscitation Council; Australian Resuscitation Council; NewZealand Resuscitation Council; Heart and Stroke Foundation of Canada; InterAmericanHeart Foundation; Resuscitation Councils of Southern Africa; ILCORTask Force on Cardiac Arrest and Cardiopulmonary ResuscitationOutcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of theUtstein templates for resuscitation registries: a statement for healthcare professionals froma task force of the International Liaison Committee onResuscitation (AmericanHeart Association, EuropeanResuscitation Council, Australian Resuscitation Council, NewZealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmericanHeart Foundation, Resuscitation Councils of SouthernAfrica).Circulation. 2004;110(21):3385-3397.

Reply to Australian Resuscitation Council and Lord Letter

This letter replies to the issues raised in the letter by A/Prof Morley and Lord.

Board #152 - Research Abstract Man vs. Machine

HypothesisThe delivery of effective chest compressions is the single most important factor in positive patient outcomes (Kern et al, 2002; Iwami et al, 2012). Recent changes to Australian, American and European Resuscitation Council guidelines reinforce the need to deliver quality, uninterrupted che