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PROCEDURE NO: PROC‐
DATE ISSUED: 6/
DATE REVISED: 7/
DATE TO BE REVIEWED: 7/
APPROVED:
Nancy A. Lapolla, MPH, EMS Director Greg H. Gilbert, MD, EMS Medical Director
High Performance CPR
Triangle of Life Procedure
The following outlines the procedure for High Performance (HP) CPR with two, three, four, and five‐ person response crews.
2‐Person Rescuer Response (Ambulance only first)‐assumes EMT & Paramedic.
Rescuer 1 : (EMT) Shake & shout, no pulse check, open airway, move to floor in an area where a 5‐ person crew would have adequate space, and begin compressions.
Rescuer 2: (Paramedic) Activate metronome at 110 bpm, cut shirt, attach defibrillator pads, charge, analyze and defibrillate if needed. Assemble BVM with EtCO 2 and deliver ventilation with every 10 th compression on the upstroke. While analyzing the monitor, switch with the compressor. Defibrillate immediately if shockable rhythm (needs to be a paramedic). Switch doing compressions with Rescuer 1 every 2 minutes.
3‐Person Rescuer Response (Engine or Truck Company first)‐assumes only one Paramedic; crew discretion if more than one.
Rescuer 1: (EMT) Shake & shout, no pulse check, open airway, move to floor in an area where a 5‐ person crew would have adequate space, and begin compressions. Continue setup of approved mechanical compression device.
Rescuer 2: (EMT) Activate metronome at 110 bpm, cut shirt, attach defibrillator pads. Deliver ventilation every 10th^ compression on the upstroke. May initiate setup of an approved mechanical compression device. Complete transition to the mechanical compression device on second or third switch. Switch doing compressions with Rescuer 1 every 2 minutes.
Rescuer 3: (Paramedic) Assemble BVM with EtCO 2 , use 2‐thumbs up technique to maintain mask seal, and coach compressions. Defibrillate immediately if shockable rhythm (needs to be a paramedic). Paramedic should assess for fatigue in the compressor role.
4‐Person Rescuer Response (At least two Paramedics).
Rescuer 1: (EMT) Shake & shout, no pulse check, open airway, move to floor in an area where a 5‐ person crew would have adequate space, and begin compressions.
Procedure ‐ High Performance CPR‐Triangle of Life Page 2 of 3
Rescuer 2: (EMT) Activate metronome at 110 bpm, cut shirt, attach defibrillator pads. Deliver ventilation every 10th^ compression on the upstroke. Switch doing compressions with Rescuer 1 every 2 minutes.
Rescuer 3: (Paramedic) Assemble BVM with EtCO 2 , use 2‐thumbs up technique to maintain mask seal, and coach compressions. Defibrillate immediately if shockable rhythm (needs to be a paramedic). Paramedic should assess for fatigue in the compressor role.
Rescuer 4: (Paramedic) Follows direction of Rescuer 3. ALS: IV/IO, medications, advanced airway as needed, BLS airway may be fine. If intubating, do not stop compressions. Gather pertinent information and medications from witnesses/family. May need to rotate into compressor role.
5‐Person Rescuer Response (At least two paramedics).
Rescuer 1: (EMT) Shake & shout, no pulse check, open airway, move to floor in an area where a 5‐ person crew would have adequate space, and begin compressions.
Rescuer 2: (EMT) Activate metronome at 110 bpm, cut shirt, attach defibrillator pads. Deliver ventilation every 10th^ compression on the upstroke. Switch doing compressions with Rescuer 1 every 2 minutes.
Rescuer 3: (Paramedic) Assemble BVM with EtCO 2 , use 2‐thumbs up technique to maintain mask seal, and coach compressions. Defibrillate immediately if shockable rhythm (needs to be a paramedic). Paramedic should assess for fatigue with the compressor role.
Rescuer 4: (Paramedic) Follows direction of Rescuer 3. ALS: IV/IO, medication, advanced airway as needed, BLS airway may be fine. If intubating, do not stop compressions. Gather pertinent information and medications from witnesses/family. May need to rotate into compressor role.
Rescuer 5 or Additional Rescuer either EMT or Paramedic: Follows direction of Rescuer 3. Gather pertinent information and medications from witnesses/family. May need to rotate into compressor role.
TEAM PRIORITIES
Know your role. Coach others on their role as needed, especially Rescuer 3. Rescuer 3 should assess for fatigue in the compressor role. Initially move the patient to a place where resuscitation can be performed. Make sure patient is in a place that can accommodate 5 Rescuers. Do not stop chest compressions for more than 3 seconds. Proper positioning with the triangle of life. Continuous chest compressions using a metronome set at 110 bpm. Synchronized ventilations of approximately 100 mL during the 10 th^ upstroke of compressions. Charge the defibrillator during the 18 th^ cycle of CPR ‐ this will allow time to be ready to defibrillate at the 2‐minute cycle. Dump the charge if a non‐shockable rhythm. 30 minute resuscitation on scene unless pulses present. Monitor perfusion with capnography.
