Circle of Life cardiac resuscitation system
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- Опубліковано 14 бер 2016
- Inspired by Formula One racing the ‘pit crew concept’ is designed to bring increased efficiency and structure to the way the London Ambulance Service treats patients in cardiac arrest. Each member of the team knows exactly what to do, when to do it and how to do it. Key aspects of the pit crew concept include ensuring there is 360 degree access to the patient (this may involve physically moving the patient a short distance), calm and concise communication at all times, the use of a ‘cardiac arrest checklist’, identifying a ‘team leader’ to manage the cardiac arrest team and members of the team adopting pre defined positions around the patient in order to deliver different elements of resuscitation efficiently and effectively.
Hello Nick! I'm Mick... this is Dick and this is Rick. We got here quick!
xD
In a lick mate.
We'll give 'em a stick and a prick then we'll have 'em up in for a kick.
😂
This is rick. and he’s a dick!
Brilliant, love it 😆
So nice and polite, was expecting someone to break out a cup of tea.
Afterwards, at hospital!
That's actually part of the resuscitation scene once you've got more then enough crew, and a manager turns up! There's nothing extra they can offer, and it makes a world of difference for the relatives to have the resuscitation process explained over a cup of tea, so they're fully aware of how much is being done to save the patient (but not actually witnessing it unless they feel the need to). Sounds mad, but it's really helpful for the family to slowly come to terms with the 1 in 10 odds of survival.
With the right words everyone has a realistic view of how serious things are, and even in the worst outcome, their memory of that day will be "they did everything they could to save him/her". Some people are hysterical and need calming down, others the person has just passed out, and don't quite grasp how serious cardiac arrest is. Even as an ex-EMT, it made a massive difference to talk to a mutual friend in the ambulance service when my friend died last year: he spoke to the crew who attended, and had all the details. The extra closure I got by going over the whole resus, ETCO2 readings etc was quite remarkable. It's still kinda hilarious, "let's make a cup of tea" is literally part of a British at-home cardiac arrest when time allows.
Dam they are so nice to each other "thank you" "lovely" "please"
It makes the scene much more relaxed in my opinion, if the paramedics would scream at each other, and don't say thank you or please at all, it's possible to lose the focus, so doing everything calm and perfect is the way to go. :)
Welcome to Britain
41 Zar u
I agree (even across the pond in the USA LOL), I worked an arrest the other night and said please and thank you and it was soooo smooth. It makes you breath and stay calm.
We always say please/thank you...... Would you mind passing me the size 7 NG please. It makes an arrest much more calm, then a boss comes in all guns blazing and fucks the atmosphere.
This is Brilliant. Everyone is keeping Calm and knows what to do.
3 2 1 ventilate ventilate
Someone make that into a song
Ventilate type beat
I attended a resuscitation last week, our Trust has just taken on the "Pit Crew" ALS Protocol and this works incredibly well, very smooth and very concise.
Luckily we no longer have many single-man RRVs in our trust so whenever we attend an OHCA we're almost always guaranteed at least 4 people on scene; Having the extra man makes all the difference concerning coordination.
That’s great! In the US we have ourselves, our partner, and then the fire department responds to all cardiac arrests. Oftentimes our firefighters are paramedics so it’s very helpful to have them there.
.amazing work you're crews do for the capital keep up the good work LAS :) thumbs up!
The Paramedics are very nice to one another. Explaining what is happening. Catherine had very good CPR RYTHUM
That's the number one thing with paramedic training, is commutation. Especially when handing the patient over to ER nursing/ doctors. It's critical.
I had a resuscitation team, as I had 40 minutes of CPR 6 defibrillator shocks 2 shots of adrenaline and a shot of amiadarone, still years later amazing team work amazing people I had 2 paramedic teams and a critical care doctor and air ambulance doctor, so lucky to have them, apparently when I was dead I was getting up and fighting them off, I believe its due to lack of oxygen to the brain
It's actually the opposite! There is something called CPR induced awareness. It really only happens when there is good oxygen flow to the brain!
You're a walking miracle. I'm so happy your outcome was a great one.
An app CARMA for Life would be perfect for the guy at the feet to help run the code and document. This is a great concept
Great Team work and very polite.
Really enjoyed watching that 👍🏻
Superb effort.
impressive!
CRM as its best!
good cpr from the bystander and there are proper ventalation
I've never seen that Lucas Device before, has it been around for long! Great work to the LAS by the way!
+Sam Garrett-Brown Yea it isn't the newest device, but there's the Lucas and the Lucas 2.
Sxrth Li I think the actual device has been around for a while but of course the NHS doesn’t straight away role out these sort of pieces of equipment until through testing.
Well done you are hero
Beauty.
Good model, 'Stay Calm' ......
That mechanical compression machine looks brutal.
The LUCAS could save a life as it allows the paramedics to do other things
It is, but I’m always happy to see a TL or HEMS rock up with one!
@@michealkerr4060 Not really. It´s more a safer way to perform CPR while transporting the patient with the ambulance.
@@PeterNichtlustig0815 yes, although you shouldn't transport someone currently in arrest
@@Izak213 Why?
Brilliant video of the Circle of Life. Paramedics our so very polite.
You can see how the focus on meds has shifted
Jakob Schopen
Yeah. I don’t know much about how the UK does it; I work in the US and it’s very compression-focused.
Same in the UK, it's very compression focused
In the US paramedics give epinephrine and other meds
Hi they do that everywhere there’s advanced life support
@@andrewterry6538 The paramedic in pos 2 or pos 3 ould then take over drug administration, so would most likely push 2 things; Adrenaline 1 in 10,000 and Amiodarone (since I heard them mention vfib)
Wow they are so nice
Roger, Roger, do we have clearance Clarence?
I can now understand why two ambulances arrive, at the same time!
Did the paramedic in position 1 place 2 NPAs and 1 OPA?
silo
Yes
I thought that was odd because normally I'd use either or although you could put an iGel or LMA down in near enough the same time. Plus then they could do asynchronous CPR. Interesting video tho
Chris Shaw I think they were just cascading the airway, the OP and dual NP gave good chest rise with a decent waveform so they stuck at it, I tend to forego the NP and go i-Gel, I just like them.
Interesting
For chest compressions, isn't your palms supposed to be placed on the center of the chest rather than on one side only? The lady was doing chest compressions on only one side at 1:48
well she is a bystander in the scenario so probably simulating poor quality CPR.
Quizá porque es una civil, y no hay peor compresión que la que no se da.
you will mostly be centre of it drifted off the left slightly due to the anatomical position of the heart.
The point is that she’s an untrained member of the public doing CPR until the emergency services arrive.
why hospitals still don't have this machine
What did he insert right after the guedel tube?
That was a nasopharyngeal airway, it does the same as guedel airway, just through the nose. Really effective if you can get one in, but they don't always fit (and tend to work much better when lubricated, people often get very dry airways after a few minutes in cardiac arrest).
Surprising how long before they start administering drugs, though I suppose this is quite old now and might be out of date.
Quick question. Why deliver a shock without checking for VF/VT first?
because the AED does it for you, no need to be looking at screens even the LP15 , or Zoll et al have this facility
MARTIN SHEA he can't tell if it's in vf though. The member of the public was still doing compressions when the machine was checking.
Because its acting. They would have performed a rhythm check if it were real.
Because the VF VT alarm went off and to charge the LP15 you would naturally glance at the screen
Some trusts teach you to charge the defib before the two minutes are up then when it's charged you stop for the rhythm check you deliver the shock of its shockable or dump it if it isn't. It means there's less time off the chest
It seems like this is the case, it's not this calm. It's real life. You're with someone who is dying and their family is there and it's up to you to save their life. It's never this calm,
.
Most of the cardiac arrests I've done are this calm. The first thing you learn in the ambulance service from the burnt out old-school paramedics is "no one ever survives cardiac arrest". It's not strictly true, but it given that roughly 1 in 10 people survive, you very quickly get used to the reality that your patient won't make it. There's no need for panic or anxiety that your patient might die, because they probably will... no matter how hard you try. When you're still new to cardiac arrests, you just act calm, no matter how high stress the scene is, and get on with running a really good resuscitation. Your crewmate is (usually) calm, and they're helping you out while you learn. Perhaps being super polite is a British coping mechanism, but it certainly works!
When you've done enough cardiac arrests, you genuinely are calm inside too, but until you've got that experience you just act calm. If you act calm, people assume you are calm, and before long, everyone is just... calm. I found simulated cardiac arrests more stressful, because I personally get really anxious when two plus people are watching my every move with clipboards, and are going to dissect every action afterwards. Out on the road there's no one nitpicking inane little details, and you're free to run the arrest how you see fit.
To be quite honest, if you and your crewmate enjoy acute medical/trauma jobs, cardiac arrests are what you look forward to! They're not scary, they're absolutely fascinating... you learn how to use chronography effectively, and understand how often defibrillation or IV fluids works. Yes, people are sometimes screaming and crying, but you don't have to share their emotional state. You're there to do the best you can, and occasionally people do survive, so no matter what happens, your patient had the best chance they could.
The vibe at a properly run cardiac arrest is so chilled out that once you're settled into a good routine, you're on autopilot. It's like driving, you don't have to think, you're just paying attention to what's going on and reacting. It's almost like a little social gathering when good crew back you up, you can all nerd out trying to make sense of what's could have happened to the patient, when HEMS are going to do if they turn up, or try using a unique piece of resus equipment that you rarely have access to (mechanical ventilation or mechanical CPR devices and the like). You keep the tone very professional, and ultimately the patient benefits from it. Plenty of people hate cardiac arrests because of the effort, massive cleanup and mountains of paperwork... but that's a personal preference. The best shift I ever had was two cardiac arrests in a row, which ate up almost a whole 12 hour shift, and left only enough time to do one more really easy "Let's go to hospital" job.
Quicknotes: Interlock the fingers: lady vs. professionals. Indication for LUCAS? Lifepak metronome 100 per minutes, real compresion speed was very close bellow 100 per minutes - there are studies about best cardiac output in average 120 per minute, others machines can setup this metronome setting, Lifepak NOT.
I believe some chest compressions are better than none........
what about 121
Current ERC guidelines demand chest compressions at a rate of 100-120/min. Both lower and faster showed to lead to worse outcome in large-scale trials.
Ergo: put your internal metronome on 110 bpm
21st Century British Emergency Services.
i know its a practice but those compressions are atrocious
Shes too slow in compressions,but i love how courteous they are
The point is that she’s an untrained member of the public doing CPR until the emergency services arrive.
@@itsweb1584 Indeed, but the paramedics should instruct her on doing better CPR.
No entendí😔
JESUS
is this the new LAS Uniform with all the white writing and white names on the front? :)
It's part of the nhs charter, inspired by dr Kate Grainger "hello my name is" all ambulance trusts have slightly different uniform these days
No, this uniform is only given to management or those that recruit. Actual front line staff do not have any writing on the back and do not have names on their uniform. Management get a better uniform despite not being front line operational. Funny that
Ineffective chest compression.
One person can max. 2 minutes effectively compress.
We typically rotate more if someone was getting tired, like they mentioned in the video. The longest I've paced myself for, with swaps of course, was an hour and a half. At that point, everyone is getting tired regardless. Still, anything is better than nothing when it comes to compressions.
I'd much rather a bystander attempted chest compressions than not.
So British...
i hate my mind
That chic had no recoil really bad cpr and it was not 1/3 of the chest
If you also look closely, the actor was also made from plastic.
Can you explain why any medical personel would let a civilian perform cpr in a real life or death situation?
laurens vansw Because CPR is simple enough that basically anyone can do it with quite little training, it doesn't really matter if it's a civilian or a medical professional. If there aren't enough professionals (and in most cases there isn't) on the scene at the first minutes, paramedics can't do all the things they need to do without help from civilians. So if there is a civilian who clearly is able to give compressions the paramedic can concentrate in attaching the defib pads and securing the airway, which saves valuable time. Of course if the civilian has been giving CPR for 8 minutes and is alredy comptelely exhausted when the ambulance arrives it might not be a good idea.
Furthermore, research shows that even totally untrained people can quite easily be instructed to perform chest compressions by an emergency call operator via the phone, so no problem with that straight on the scene as long as there's only a single responder professional. No matter how well trained you are, you've still got only two hands, so why not asking someone to assist with procedures that can quite easily be delegated...
CPR is like sex....even bad sex better then no sex. Plus he's by himself doesn't take much to tell someone to press on a chest
We let bystanders who start CPR continue until we are ready to take over. I am in a sprint vehicle and will many times arrive long before the pump crew or the medic unit. I let them do CPR until I get the monitor attached. If no shock needed I have them start up CPR again while I deploy the Lucas. I have had the patient intubated and the IV going with the second round of meds in before the medic unit arrives. But we service about 1000 square miles of area and sometimes the closest unit is not available.
Very good question. If I can assess that the civilian is doing fast, deep, accurate, and overall effective compressions then I wouldn’t have an issue with them continuing, especially if I was the first medic on scene.
once you shock the AED you wait for a pulse. If there is none THEN you continue to do CPR
That's wrong! You never wait, you quickly continue doing compressions. Even if the patient get's an rhytm you continue the CPR until the next cycle.
Ares no that’s for like if you don’t check at all, I’m saying you shock and then Right after you continue, you shock check pulse continue, or get IV fluids in him ASAP
@@Fellerr No. Even if a viable rhythm is restored from the shock, it's highly unlikely a pulse will be palpable at that point, so it's needless time off the chest. Pulse checks happen with rhythm analysis every 2 minutes.
Catherine is hawt.
"Crucifix Position"
Wtf ?!!
The guys dying, don't let him die thinking he is being forced into a fake religion. That's just cruel !!
This is a joke I assume?
You do realise that when in cardiac arrest you will generally lose consciousness? Who thinks of that in a religious sense anyway wtf it's a fking medical emergency not a crucifixion.
@@polpol571 I don't think she is joking.....
If you've had a cardiac arrest you are dead, not unconscious. Cardiac arrest literally means stopped heart
Crucifix position is just a way of saying to put the arms out on both sides.
"Team, move the patients arms so they are at a 90 degree angle to his torso"
or
"Team, crucifix position."
Clear and concise. A quick history lesson, Crucifixion was a common way of torture- it is just not about religion.
horrible breaths.