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Background: Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of hospitalcardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island. Methods: The Basic Life Support (BLS) and Automated External Defibrillator (AED) skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given. Results: On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used by 80%. A mean compression depth of 40-50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min (SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal volume deviated significantly from the recommended (p = 0.01). During the rhythm analysis, 65% did not perform any visual or verbal safety check. Conclusion: The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers. [ABSTRACT FROM AUTHOR]

In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial, but are not supported by firm scientific evidence.

Introduction: In 2005, new international evidence-based guidelines for cardiopulmonary resuscitation (CPR) were published by the International Liaison Committee on Resuscitation (ILCOR). The aim of these new guidelines is to improve the quality of care and, thereby, the outcome from cardiac arrest. This necessitates that the guidelines are known and implemented in clinical practice. The purpose of this investigation is to elucidate the extent of implementation of Guidelines 2005 (G2005) among doctors on Cardiac Arrest Teams (CAT) one year after the publication. In addition, the date of implementation is examined among medical emergency services and major providers of basic life support (BLS) courses., Material and Methods: A telephone enquiry about CPR among CAT doctors on-duty. Ambulance services and BLS-course providers are contacted by e-mail., Results: Approximately 70% of the doctors were able to answer simple and essential topics on CPR, e.g. compression/ventilation ratio and the number of shocks in a sequence in accordance with G2005. The ambulance service, Falck A/S, implemented G2005 during 2007, while the other ambulance services implemented G2005 within six months after publication. The majority of BLS-course providers implemented the guidelines one year after their publication., Conclusion: One year after the publication of G2005, there is limited knowledge of the guidelines among doctors on duty. The study does not give any explanation for the lack of implementation. The barriers to implementation should be clarified, and future guidelines should be accompanied by an active strategy for implementation.

Intraosseous infusion is widely used in children, but its use in adults is much less common. This is probably because another vascular access can usually be achieved, and also because of lack of knowledge of the technique. Placement in adults is a quick procedure with a high rate of success. Drugs and fluids do not change the pharmacodynamics or pharmacokinetics of intraosseous administration, and anything can be given. Infusion rates have been achieved that in part make fluid resuscitation possible. Its uses are many and the contraindications few; complications are rare when simple guidelines are followed.