Advertisement

Improper defibrillator pad usage by emergency medical care providers for children: an opportunity for reeducation

Published:November 18, 2013DOI:https://doi.org/10.1016/j.ajem.2013.11.016

      Abstract

      Purpose

      Approximately 14 000 pediatric out-of-hospital arrests occur annually. With this significant number and the diversity in the training backgrounds of medical providers, correct choice and placement of defibrillator pads are imperative to ensure maximum efficacy.

      Methods

      One hundred fifty-two emergency medical care providers from 6 medical fields were recruited for the study. Each participant answered a series of questions to ascertain baseline knowledge of correct defibrillator pad choice and placement in 2 scenarios with mannequins weighted less than 15 kg and more than 15 kg. After the testing, each participant received an educational intervention. Six months after the first phase, participants received a questionnaire to ascertain knowledge retention.

      Results

      In the primary study phase, for correct pad choice for mannequins weighing less than 15 kg and more than 15 kg, overall results were 98% (95% confidence interval [CI], 94.1%-100%) and 38.8% (95% CI, 31.4%-46.8%), respectively. In the second phase, pad choices for mannequins weighing less than 15 kg and more than 15 kg were 77.3% (95% CI, 68.6%-84.2%) and 60% (95% CI, 47.7%-71.1%). The rates of correct pad placement during the initial phase for mannequins weighing less than 15 kg and more than 15 kg were 5.8% (95% CI, 2.8%-11.2%) and 25.7%, respectively (95% CI, 19.4%-35.7%). Rates for correct pad placement (<15-kg and >15-kg mannequins) improved in the second phase to 68.2% (95% CI, 56%–78.4%) and 71.2% (95% CI, 62.8%-81.5%).

      Conclusion

      Pediatric emergency providers have poor understanding of pad choice and placement. Emergency medical care providers for children who are educated about the correct defibrillator pad choices and placement have improved knowledge and can retain that knowledge for at least 6 months.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Donoghue A.
        • Nadkarni V.
        • Berg R.A.
        • et al.
        Out of hospital pediatric cardiac.
        Ann Emerg Med. 2005; 46: 512-522
        • Young K.D.
        • Seidel J.S.
        Pediatric cardiopulmonary resuscitation: a collective review.
        Ann Emerg Med. 1999; 33: 195-205
        • Hickey R.W.
        • Cohen D.M.
        • Strausbaugh S.
        • et al.
        Pediatric patients requiring CPR in the prehospital setting.
        Ann Emerg Med. 1995; 25: 495-501
        • Mogayzei C.
        • Quan L.
        • Graves J.R.
        • et al.
        Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes.
        Ann Emer Med. 1995 Apr; 25: 484-491
        • Bradley R.N.
        • Sahni R.
        Early defibrillation. National Association of EMS Physicians, Standards and Clinical Practice Committee.
        Pre Hosp Emerg Care. 2000; 4: 358
        • Kleinman M.E.
        • Chameides L.
        • Schexnayder S.M.
        Pediatric advanced life support.
        Circulation. 2005; 112: IV-167-IV-187
        • Kleinman
        • Chair Monica E.
        • Chameides Leon
        • Schexnayder Stephen M.
        Pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care American Heart Association Guidelines for CPR and ECC.
        Circulation. 2010; 2010: S639-S946
      1. Spectrum Equity Investors. Available at: www.surveymonkey.com, Accessed October 2011.

        • Heames R.
        • Sado D.
        • Deakin C.
        Do doctors position defibrillation paddles correctly?.
        Observational Study British Medical Journal. 2001; 322: 1393-1394
        • Kleinman M.E.
        • Caen A.R.
        • Chameides L.
        • et al.
        Special report—pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.
        Circulation. 2010; 122: S468-S515
        • Lakhotia M.
        • Pravesh J.
        • Sanjeev S.
        • et al.
        Placement of defibrillator paddles—how correct are we?.
        Journal Indian Academy of Clinical Medicine. 2003; 4: 200-204
        • Andresen D.
        • Arntz H.R.
        • Grafling W.
        • et al.
        Public access resuscitation program including defibrillator training for laypersons: a randomized trial to evaluate the impact of training course duration.
        Resuscitation. 2008; 76 (151): 419-424
        • Yokel M.E.
        Retention of cardiopulmonary resuscitation skills among nursing personnel: what makes the difference?.
        Heart Lung. 1989; 18 (152): 520-525
        • Kobayashi M.
        • Fujiwara A.
        • Morita H.
        • et al.
        A manikin-based observational study on cardiopulmonary resuscitation skills at the Osaka Senri Medical Rally.
        Resuscitation. 2008; 78: 333-339
        • Myerburg R.J.
        • Kessler K.M.
        • Castellanos A.
        Sudden cardiac death: epidemiology, transient risk and intervention assessment.
        Ann Intern Med. 1993; 119: 1187-1197
        • Gombeski Jr., W.R.
        • Effron D.M.
        • Ramirez A.G.
        • et al.
        Impact of retention: comparison of two CPR training programs.
        Am J Public Health. 1982; 72: 849-852