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The Effect of Operator Position on the Quality of Chest Compressions Delivered in a Simulated Ambulance

Published online by Cambridge University Press:  09 December 2019

Scott Mullin ,
Sinéad Lydon  and
Paul O’Connor Open the ORCID record for Paul O’Connor [Opens in a new window]
Scott Mullin
Affiliation:
Department of Science and Health, Medicine Hat College, Medicine Hat, Alberta, Canada Emergency Medical Services, Alberta Health Services, South Zone, Alberta, Canada
Sinéad Lydon
Affiliation:
Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway, Ireland School of Medicine, National University of Ireland Galway, Co. Galway, Ireland
Paul O’Connor*
Affiliation:
Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway, Ireland Discipline of General Practice, National University of Ireland Galway, Co. Galway, Ireland
*
Correspondence: Paul O’Connor, PhD Discipline of General Practice 1 Distillery Road National University of Ireland GalwayCo. Galway, Ireland E-mail: [email protected]
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Abstract

Background:

Ambulances are where patient care is often initiated or maintained, but this setting poses safety risks for paramedics. Paramedics have found that in order to optimize patient care, they must compromise their own safety by standing unsecured in a moving ambulance.

Hypothesis/Problem:

This study sought to compare the quality of chest compressions in the two positions they can be delivered within an ambulance.

Methods:

A randomized, counterbalanced study was carried out with 24 paramedic students. Simulated chest compressions were performed in a stationary ambulance on a cardiopulmonary resuscitation (CPR) manikin for two minutes from either: (A) an unsecured standing position, or (B) a seated secured position. Participants’ attitudes toward the effectiveness of the two positions were evaluated.

Results:

The mean total number of chest compressions was not significantly different standing unsecured (220; SD = 12) as compared to seated and secured (224; SD = 21). There was no significant difference in mean compression rate standing unsecured (110 compressions per minute; SD = 6) as compared to seated and secured (113 compressions per minute; SD = 10). Chest compressions performed in the unsecured standing position yielded a significantly greater mean depth (52 mm; SD = 6) than did seated secured (26 mm; SD = 7; P < .001). Additionally, the standing unsecured position produced a significantly higher percentage (83%; SD = 21) for the number of correct compressions, as compared to the seated secured position (8%; SD = 17; P < .001). Participants also believed that chest compressions delivered when standing were more effective than those delivered when seated.

Conclusions:

The quality of chest compressions delivered from a seated and secured position is inferior to those delivered from an unsecured standing position. There is a need to consider how training, technologies, and ambulance design can impact the quality of chest compressions.

Keywords

ambulancecardiopulmonary resuscitationchest compressionsout-of-hospital cardiac arrestsimulation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 1 , February 2020 , pp. 55 - 60
Copyright
© World Association for Disaster and Emergency Medicine 2019

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