Central Nine Fire & EMS

Does the BVM you use have any way of controlling for volume, pressure, or frequency during manual ventilation?

Why are these 3 factors important?
Without ventilation feedback mechanisms complications occur:
- Stomach insufflation with subsequent aspiration
- Damage to lung parenchyma including pneumothorax
- Hemodynamic and pulmonary compromise
- Decreased oxygenation to tissues
- CO2 retention and hyperventilation

A group of EMS researchers from Memphis conducted a study to look at how EMS professionals utilize a BVM?

The study was conducted at the EMS World Expo (New Orleans, Louisiana, October 14–19, 2019) and EMS Today (Tampa, Florida, March 2–6, 2020) conferences to evaluate 199 EMS clinicians performing ventilation with a BVM connected to an ET Tube. The average experience ventilating with a BVM was 16.2 years.

What did they find?
*82.9% of clinicians delivered breaths over the gastric insufflation threshold of 22 cmH2O or a breath that exceeded the recommended 560 mL.

*15% of clinicians delivered at least one breath at a peak pressure over 50 cmH2O (over 50 cmH2O is associated with increased risk of alveolar rupture during mechanical ventilation).

*Clinicians using two hands ventilated 115 mL more and at a pressure 8.9 cmH20 higher than those using one hand.

*Professional experience, hand size, and grip strength did not affect ventilation performance.

Read the full study here:
http://ow.ly/VhBu50JxGpE

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MEDICAL HANDOFFS: a critical event and yet rarely emphasized in the role of patient resuscitation, care and management.

The handoff is a moment, when completed correctly is used to pass on pertinent...

1. Information
2. Interventions
3. Mechanisms of injury
4. Other key details

It sets the stage for continued resuscitation.

TEACHING POINTS:
1. When EMS call ahead, it allows a trauma team enough time to assemble. I know sometimes this isn't feasible, but when done it's tremendously valuable. As a reusc team lead, any info before hand helps me start to create an differential diagnosis, call supporting consulting specialists, and/or prepare equipment (airway kits, chest tube trays, belmont, notify blood bank etc).

2. The hand off should be done in a realistic as possible calm and collected environment. Some of the best resuscitations happen almost in an quiet controlled chaos.

3. Resusc team roles should be identified prior to handoff.

4. The handoff should be clear and assertive. I personally am looking for a "one liner" that gives age, gender, mechanism of injury, chief complaints and then into prehospital interventions.

5. Team lead should make some eye contact with handoff individual.

6. It's valuable if pictures of the scene are taken and available. It helps me to see the wreckage, mechanism of injury etc.

7. Gathering med bottles or lists if available helps.

8. Taking notice of the scene is also valuable....drug paraphernalia, smells, stains, chemicals etc.

9. Make sure your interventions and concerns for any possible life threat are relayed.

10. Stick around for a bit if able. Most docs will appreciate having you there if any additional info is needed.

Thank you to all the prehospital first responders. Please don't take patient handoffs for granted! These moments matter.

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