Optimal paramedic numbers in resuscitation of patients with out-of-hospital cardiac arrest: A randomized controlled study in a simulation setting
Journal
PLoS ONE
Journal Volume
15
Journal Issue
7
Date Issued
2020
Author(s)
Abstract
Background 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. Methods 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. Results 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). Conclusion 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. ? 2020 Public Library of Science. All rights reserved.
SDGs
Other Subjects
epinephrine; epinephrine; adult; advanced life support; Article; chest compression fraction; controlled study; emergency care; emergency treatment; endotracheal intubation; female; hands off time; heart ventricle fibrillation; human; job performance; middle aged; out of hospital cardiac arrest; outcome assessment; paramedic crew size; paramedical personnel; patient care; randomized controlled trial; rescue personnel; resuscitation; simulation; teamwork; time; time to treatment; emergency health service; emergency medicine; heart ventricle fibrillation; intensive care; intubation; male; out of hospital cardiac arrest; paramedical personnel; pathology; pathophysiology; procedures; resuscitation; Adult; Allied Health Personnel; Cardiopulmonary Resuscitation; Critical Care; Emergency Medical Services; Emergency Medical Technicians; Emergency Medicine; Epinephrine; Female; Humans; Intubation; Male; Out-of-Hospital Cardiac Arrest; Ventricular Fibrillation