Article

Proper performance of chest compressions in cardiopulmonary resuscitation

Correspondence 255

which revealed IgA deposition (Fig. 1A-C). Renal involve- ment is more common in adult HSP and can contribute to significant morbidity [3]. This case demonstrates the impor- tance of early recognition of HSP via biopsy, although the evidence of efficacy of early treatment with corticosteroid is still controversial.

Narat Srivali MD Patompong Ungprasert MD Saeed Ahmed MB, BS Wisit Cheungpasitporn MD Edward F. Bischof MD

Department of Internal Medicine Bassett Medical Center Cooperstown, New York 13326, USA

E-mail addresses: [email protected] [email protected] [email protected] [email protected] [email protected]

http://dx.doi.org/10.1016/j.ajem.2012.08.016

References

  1. Lim CJ, Chen JH, Chen WL, Shen YS, Huang CC. Jejunojejunum intussusception as the single initial manifestation of Henoch- Schonlein purpura in a teenager. Am J Emerg Med 2012 [Epub ahead of print].
  2. Watts RA, Carruthers DM, Scott DG. Epidemiology of systemic vasculitis: changing incidence or definition? Semin Arthritis Rheum 1995;25:28-34.
  3. Garcia-Porrua C, Calvino MC, Liorca J, Couselo JM, Gonzalez-Gay MA. Henoch-Schonlein purpura in children and adults: clinical differences in a defined population. Semin Arthritis Rheum 2002;32:149-56.

Proper performance of chest compressions in cardiopulmonary resuscitation?,??

To the Editor,

Sebbane et al [1] reported that an annual refresher course is an important factor for nurses and nurses’ aides to accurately perform chest compression depth while standing next to a stretcher. Several points of interest were raised by this article. First, we found that the participants

? Confticts of interest: None of the authors received financial support or have potential confticts of interest regarding this work.

?? Author contributions: All authors read the references and discussed about contribution of Sebbane et al. J. Oh and Y. Cho contributed equally to this letter, and all authors contributed substantially to its revision. H. Kang

who were trained on cardiopulmonary resuscitation (CPR) within the previous year performed CC at a rate of approximately 120 per minute with the patient either on the ftoor or on a stretcher, whereas others performed CC with 100 per minute on both surfaces [1]. Those who learned the 2005 CPR guidelines within the previous year might, therefore, have some knowledge of the 2010 CPR guidelines

[2] (ie, at least 5 cm of CC depth and a N 100/min rate) from Internet, books, or other media [3]. Therefore, this knowledge might inftuence the depth and rate of chest compression performed by the participants. Second, there were 44 females (69%) and 20 males (31%) in the reported study [1]. We would like to know their weights because it is difficult for lightweight trainees to accurately perform CC. Lightweight trainees require special attention during CPR training, with an emphasis on correct body posture and positioning of body mass to ensure CC are performed according to the 2010 CPR guidelines [4]. Third, approxi- mately half of the participants had administered CPR on a patient in the preceding year. This may indicate that they have more interest in learning about CPR than others who did not administer CPR. A refresher video clip shown on a mobile phone was found to be effective for knowledge retention by the CPR trainee at 3 months after the initial training [5]. High-handed and annual repetitive training might cause trainees to lose interest in CPR education. The inducement of voluntary and interesting participation in CPR education may also be important. Fourth, Sebbane et al focused on the type of training that may result in a significant difference in the efficiency of CC administered when kneeling on the ftoor or standing beside the manikin on a stretcher. We believe that the cause of this difference is not only the type of training but also mattress compression and bed frame displacement [6]. The performer should be aware of mattress compression and should perform deeper CC on soft surface than on the ftoor. To resolve the problems mentioned above, we agree with the recommendation of Sebbane et al regarding the use of a Feedback device during CPR. In addition, use of a backboard beneath the patient is required during CPR because the feedback device does not compensate for the mattress or bed displacement [6,7].

Jaehoon Oh1 Youngsuk Cho1 Hyunggoo Kang

Department of Emergency Medicine, College of Medicine Hanyang University, Seoul, South Korea E-mail address: [email protected]

http://dx.doi.org/10.1016/j.ajem.2012.08.035

takes responsibility for the article as a whole; we will assume that you will

not make reprints available unless you specify otherwise.

1 Jaehoon Oh and Youngsuk Cho contributed equally to this letter.

256 Correspondence

References

  1. Sebbane M, Hayter M, Romero J, et al. Chest compressions performed by ED staff: a Randomized cross-over simulation study on the floor and on a stretcher. Am J Emerg Med 2012.
  2. Berg RA, Hemphill R, Abella BS, et al. Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S685-705.
  3. Bohn A, Van Aken HK, Mollhoffc T, et al. Teaching resuscitation in schools: annual tuition by trained teachers is effective starting at age

10. A four-year prospective cohort study. Resuscitation 2012;83: 619-25.

  1. Krikscionaitiene A, Stasaitis K, Dambrauskiene M, et al. Can lightweight rescuers adequately perform CPR according to 2010 resuscitation guideline requirements? Emerg Med J 2012 http:// dx.doi.org/10.1136/emermed-2011-200634.
  2. Ahn JY, Cho GC, Sohn YD, et al. Effect of a reminder video using a mobile phone on the retention of CPR and AED skills in lay responders. Resuscitation 2011;82:1543-7.
  3. Oh J, Song Y, Kang B, et al. The use of dual accelerometers improves measurement of chest compression depth. Resuscitation 2011;83:500-4.
  4. Perkins GD, Kocierz L, Smith SCL, McCulloch RA, Davies RP. Compression Feedback devices over estimate chest compression depth when performed on a bed. Resuscitation 2009;80:79-82.

The impact of a mass gathering events with an on-site medical management team on municipal 911 emergency medical services

To the Editor,

Mass gathering medical care is defined by the National Association of Emergency Medical Physicians as “organized emergency health care services provided for spectators and participants in which at least 1000 persons are gathered at a specific location for a defined period of time” [1]. Health care providers at these events care for patients presenting with a variety of complaints, from mild heat illness and Ankle sprain to cardiac arrest and multiple trauma. These events include many different settings and patient populations including football games, concerts, and festivals with relatively young, mixed age, and elderly groupings of persons.

One of the goals of on-site medical management is to avoid overreliance on municipal emergency medical services (EMS) (ie, EMS responding to the general community needs) to respond to patient complaints at Mass gatherings. Oftentimes, thousands of attendees come from outside the primary area to attend an event–this transient increase in the regional population can produce a temporary increase in EMS utilization [2]. Previous reviews have studied the effect of on-site mass gathering medical management on ED census, yet the impact on local EMS specifically has not been studied. Thus, we investigated the impact of large events with mass gathering medical staff present on municipal EMS (ie, 911 service) call volume.

This retrospective study used data collected by the Special Event Medical Management (SEMM) team at the University of Virginia in Charlottesville. Event types included university football games, other spectator sporting events, popular music concerts, steeplechase horse racing, graduation cere- monies, and other large gatherings of people. Patient care events at the mass gatherings were recorded and reviewed for study purpose; EMS call data were collected from a dispatch database and divided into 24-hour segments–time segments were then identified as involving or not involving a mass event with SEMM staffing. Data were further divided to evaluate weekends (Friday, Saturday, and Sunday) separately from a full 7-day week.

Over the 8-month period of study, the average number of EMS calls was 53.8 EMS calls/24-hour period. The average number of EMS calls on SEMM event days was 56.8, and on days without SEMM events, it was 53.2 (P = .053 comparing event to nonevent days). In an analysis of weekend-only days, the SEMM event average was 59.7 EMS calls; on weekend days without SEMM events, the average was 54.8 EMS calls (P = .047 comparing event to nonevent weekend days).

This study found a statistically significant increase in call volume on weekend days with SEMM events compared with nonevent weekend days. We also found an increase in call volume on all SEMM event days compared with nonevent days that approaches significance. Both of these comparisons demonstrate an increased utilization of EMS on event days, which is consistent with our expectations given the inftux of people on these days. Communities should be aware of scheduled large events and potentially increase EMS and on-site teams to appropriately cover the increased patient demand. The increase in Number of calls averaged 3 to 5 more calls per day on event days. If considered over a 24-hour period, this modest increase in call volume likely would not stress a public safety system. If these calls occurred during a more focused period of large event activity, then such an increase could strain resources for a short period.

Although this study did not demonstrate a lower call

volume with SEMM on-site presence, we suggest that the number of EMS calls on event days would be much higher were there no on-site medical management present. It is likely that SEMM presence at mass gatherings helps to reduce the overall burden of a large event on municipal public safety resources, such as 911 EMS call volume. Future research should focus on identifying features of mass gatherings that contribute to the increased call volume to EMS centers. One way to control for event presence could involve identifying all “event-related” EMS calls, whether they involve a patient attending the event, participating in the event, or traveling to or from the event. These calls could then be compared directly with all “non-event-related” calls to form a clearer picture of the relationship between large events and EMS utilization.

Leave a Reply

Your email address will not be published. Required fields are marked *