By AMERICAN HEART ASSOCIATION NEWS
Here’s what happened:
You ran into Michael Jordan, the pride of North Carolina, at a casino. Now he is in cardiac arrest. You have four minutes to save him.
Can you do it?
In 3, 2, 1 … CPR!
That was the situation given to Paul Nowell and his team of paramedics from Northampton County, North Carolina. It was the start of Day 2 of the EMS World Expo in Las Vegas and the group was at the American Heart Association’s booth for a second and final attempt to showcase their lifesaving skills in the High-Quality CPR Challenge.
The event is a fun, lively competition held at healthcare conferences, like this one for emergency medical service personnel and another for nurses. These trained professionals test their ability to work as a team to provide emergency treatment to someone who has collapsed and needs resuscitation.
It’s fun because everyone knows it is for training. Beyond the faux situation, there’s the setting: a booth in an exhibit hall customized to evoke a pit stop at a car racing event. The tie-in works because of the similarity in the need for speed, precision and teamwork in high-risk, high-consequences environment.
But make no mistake – this is a serious competition.
The lure is not the prizes. All that’s available are plastic trophies for the top three teams, none bigger than a Big Gulp cup. The intensity comes from the challenge itself: Competitive people trying to prove how good they are at a task in which every second could mean the difference between life and death.
That passion for perfection is what brought Nowell and crew to the booth for another try.
On Day 1, their squad, the “Northampton Paramagic,” scored a 93. Later that night and the next morning, they talked over how they could be better. They showed up at the booth eager to see if they were, and curious how they would stack up with everyone else.
Nowell and four others rushed to their places, surrounding the lifeless “Michael Jordan” in an arc from hip to hip around his head.
The two guys on either side of the ribs handled chest compressions. Two guys near the head were in charge of ventilation. Nowell was near the head, too, overseeing everything and manning the defibrillator.
The guy on the right side began compressions while his counterpart on the left watched and waited. Nowell placed two wired pads on the chest, connecting it to the defibrillator. About every six seconds, the ventilation tandem did their thing – one guy squeezing a bag, the other keeping the mask firmly in place and the head tilted to ensure air flowing directly into the lungs.
“Clear,” Nowell announced, alerting everyone he was about to press the shock button on the defibrillator. The others cleared from the body for their safety while the jolt was delivered. When they resumed compressions, the guy on the left took over compressions and the original pusher rested.
“Watch the recoil,” Nowell said gently. “Doing good. Recoil is good, rate is good.”
At the two-minute mark, Nowell fired the defibrillator again and the original guy doing compressions took over again.
Anyone can be a lifesaver. If you see someone suddenly collapse and they are unresponsive and not breathing normally, push hard and fast in the center of their chest. Better still, do it to the beat of “Stayin’ Alive” as the aptly named disco song happens to provide perfect timing for Hands-Only CPR.
Even a poor attempt improves a patient’s odds of survival. Of course, doing it with proper technique drastically raises those odds. The better the technique, the better the odds.
This is why trained professionals constantly refine their skills. Much like baseball players taking batting practice before every game, paramedics often practice CPR before their shifts.
To improve patient outcomes, the American Heart Association began a campaign in 2013 for high-quality CPR by healthcare providers. Going beyond brochures or seminars, AHA leaders came up with this event, which often goes by the informal name of “CPR Throwdown.”
“By doing this, not only are they having some fun being competitive, they’re really getting some valuable information on how they can do better high-quality CPR,” said Mark Venuti, one of the judges at this year’s event and the director of Guardian Medical Transport at the Flagstaff Medical Center in Arizona.
“Historically, we’ve all thought, `Oh yeah, I do great compressions, I do great this and that,’ but once you get the feedback that we’re seeing, you can say, `Oh, gosh, yeah I’m going deep enough, but I’m not recoiling far enough, I’m not letting off the chest.’ And that can make the difference in survival.”
Here’s how the competition works:
- Teams of between two and six people are given a cardiac arrest situation, then rush to perform CPR on the patient – a manikin wearing a navy blue sweat suit.
- The first compression triggers a four-minute countdown timer.
This is one of many sensors inside the manikin. Other sensors measure the depth of each compression (how far they push down) and the recoil (how high they come up afterward). Sensors also know whether the hands are pushing in the correct spot.
Data goes into software created for this competition, with the details reading out on a nearby monitor that the competitors can see. The computer also tracks the rate of compressions, measured per minute; the goal is 100-120.
- Breaths are given with a bag mask device.
Sensors record how often the bag is squeezed and how much air enters the lungs. This is the quality of the ventilation and it’s based on several factors. It also plays a big role in scoring.
In addition to how much the bag is squeezed (the goal is enough to cause chest rise), it also requires a good seal around the mouth (to make sure no air is lost) and the airway being opened properly (that is, tilting the head far enough for a clear path to the lungs).
This is also detailed on the monitor.
- The defibrillator is used when indicated.
At EMS World 2015, teams could choose from three defibrillators so they could have something close to what they usually use. They didn’t actually deliver a shock, but they were required to place the pads on the chest and for everyone to clear away when the button was pushed.
Four minutes went by slowly for the competitors with even the fittest paramedics sweating and breathing hard.
Most teams had two people taking turns giving compressions. They often swapped while the defibrillator was activated, sometimes swapping sides, too.
Such coordination requires good communication among the teammates and that was factored in, too. Not by the software, but by the judges.
A panel of AHA experts scored each team on eight items, such as whether the team leader was clearly identified, whether CPR was of subjectively high quality and whether they minimized “peri-shock pauses” (the time between stopping compressions and pressing the shock button, and between that and starting compressions again). The raw percentage from the sensors can go up or down based on the scores from the judges. Perfection is 100.
Most teams were truly teams – people who traveled together for the conference. But not all. Sometimes groups of two or three would add someone who happened to be nearby. They didn’t always speak the same language, adding to their degree of difficulty.
Another colorful element was team names. Though most played off their hometown or country, some got creative, like the “Sexy Green Team,” “Team Wolf Den” and “Team Leatherheads.” Two girls and one guy went with, well, “2 Girls, 1 Guy.”
A handful came dressed for the occasion. Plenty wore their work clothes, with those from foreign countries often featuring flags on their arms, chest or back. The most eye-catching was a squad from Amsterdam, with their green-highlighter tops and darker green pants that featured two strips of reflective material between their shins and shoes; for further flair, they used gloves. A guy from another team pulled on purple gloves.
The consensus opinion was that the environment offered a solid testing ground. The biggest difference from a real-life event is the lack of complicating factors: no obstructed airways, no medications to be delivered or other obstacles.
Since this is essentially a game, strategy could come into play, especially when teams returned for a second turn. But those who made adjustments rarely did so strictly aiming for a better score. They were looking for improvements they could take with them into the field.
Nowell’s crew is a perfect example.
The first time around, he only supervised while someone else handled the defibrillator and one person did the ventilation. The monitors clearly showed that ventilation was their weakness, so they decided to put two people on it.
They’ll be doing that at home, too.
“From now on, if we have an extra person, we’re going to have them keep that airway open and keep a seal on the mask,” Nowell said.
Practical advice like that often came from the judges. Other common themes of their comments involved communication (either praising or encouraging more), coming off the body on recoil (“Enough to slide a credit card; think of it as cashing in,” Venuti often said) and reminding them that too little of a squeeze of air is better than too much.
Some teams used their cellphones to record a video of the comments, not just for posterity but to be able to review it later, hopefully even with colleagues who weren’t here.
With a minute left, Paramagic changed compressors one last time. The second compressor took over for a second time.
About 10 seconds later, Nowell coached the pusher with a single word: “Deeper.”
A few compressions later, Nowell began chopping his right arm like a band leader making sure everyone stayed in rhythm.
“Keep it up,” he said.
Josh Macuga, an actor-comedian from Los Angeles, emcees these contests. He’s great at keeping the atmosphere loose and lively, mixing encouragement and guidance with jokes and instructions. He also keeps the theme by wearing a pit-crew-esque fire suit.
Perhaps his greatest contribution is the scenarios he creates for each team. Most are tied to sports or pop culture references stemming from the competitors’ hometown or home country.
Yet for the first group of this event – “Team Ramrod” from the fire department in Longview, Washington – Macuga offered an homage to being in Las Vegas, telling them that Britney Spears collapsed during a concert they were attending. Can they save her?
With a score of 98.8, they probably would’ve. To appreciate how good that is, their competition-opening score topped the winning performance of 98.2 at the 2014 EMS World Expo.
“To be honest, when we walked up, I thought it was a NASCAR event,” said David Lamb, one of the Longview paramedics.
Lamb and Tucker Williams usually work the same shift. Dan Jones mostly works a different shift, but they’ve worked together enough to form a cohesive team.
“I thought it was a really great way to test our skills and see where we’re at,” Jones said. “We’ve been trying to roll out high-quality CPR with our department and we’ve had a lot of great success instituting this kind of pit crew approach. So it was really confirming for us to see that, yeah, we are doing exactly what we’re supposed to be doing.”
When time expired, the team from Northampton stood and walked to the judges.
The monitor showed a raw score of 98 percent, a nice improvement from the day before. Now they were going to find out whether that score would go up or down.
“Wow,” said judge Rod Kimble, a senior account manager for the AHA who’s been involved in EMS for about 25 years, working in West Virginia as a paramedic with critical care and flight paramedic experience. “I saw a switch that was less than a second. The choreography of it and everyone knowing their role was perfect. Great job.”
“The only thing I will say is you had a couple of ventilations that were well over 700 milliliters and points were deducted by the computer for overinflation,” said Russell Griffin, the AHA’s program director for Resuscitation Quality Improvement. “But I mean, hands down, excellent job.”
Paramagic scored 98.96, vaulting them almost to the top of the leaderboard. They were a mere 0.04 behind the score posted by a team from Mulhouse, France.
That’s how the competition finished, with the French squad taking the title and Paramagic second. The guys from North Carolina still went home as the best from the U.S.
A team from Mexicali, Mexico, finished third, followed by squads from Amsterdam, the Netherlands, and Copenhagen, Denmark.
That’s right, the top five were from five different countries, embodying the international flavor of this event and the universality of the theme. While CPR was invented in the United States more than 50 years ago, it is being refined and perfected around the world, from the biggest cities to small counties like Northampton.
“We’re very rural,” Nowell said. “We do not have a hospital in our county so we utilize everything we possibly can to help someone in cardiac arrest. So we practice this every day. We have a high resuscitation rate and a high hospital discharge rate.”
He proudly added that they once gave CPR for 50 minutes, one of the longest cases in North Carolina history.
“The guy survived and walked out of hospital,” Nowell said.
So if Michael Jordan did ever visit …
“Hey,” Nowell said, smiling, “we’ll welcome him.”