Paeds BVM for adult resus

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

A comparison between two sizes of self-inflating resuscitation bags revealed improved adherence to resuscitation guidelines with the smaller bag. Student paramedics were more likely to produce suboptimal tidal volumes and ventilation rates with a 1500ml bag than a 1000ml bag during simulated ventilation of an artificial lung model.

BMC Emerg Med. 2009 Feb 20;9:4

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Ad hoc resus teams less effective

During simulated cardiac arrest resuscitations, a comparision was made between those run by teams that had had time to form before the arrest, and those that had to be assembled ad hoc after the arrest occurred. 99 teams of three doctors, including GPs and hospital physicians were studied. ACLS algorithms were less closely followed in the ad hoc formed teams, with more delays to therapies such as defibrillation. Analysis of voice recordings revealed the ad hoc teams to make fewer leadership utterances (eg. ‘we should defibrillate’ or ‘the next countershock will be 360J’) and more reflective utterances (eg. ‘what should we do next?’). The authors suggest that team building is therefore to be regarded as an additional task imposed on teams formed ad hoc during CPR that may substantially impact on outcome. No surprise to those of us who banned ‘cardiac arrest teams’ from our emergency department resuscitation rooms many years ago!


Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial

BMC Emerg Med. 2009 Feb 14;9:3

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Population density & use of ambulance services

Does ambulance use differ between geographic areas? A survey of ambulance use in sparsely and densely populated areas

A lower use of emergency department health care services by rural residents as compared with urban residents has previously been described. This Swedish study examined the use of ambulance services in relation to geography, showing that patients from sparsely populated areas were sicker. required more treatment, and were assessed as not needing prehospital care less than half as often as their urban counterparts (16% vs 39%). Take home message is that population density is related to inappropriate use of ambulance services.

Am J Emerg Med. 2009 Feb;27(2):202-11

72000 retrievals by Flying Doctors

Over twelve years in Queensland the RFDS undertook over 72000 fixed wing retrievals, including over 4000 critically ill patients. Trauma was the commonest diagnostic category. There were only 90 primary retrievals, from locations without healthcare facilities – less than one per month on average. This fascinating service covers vast distances, low population density, and a high number of indigenous people.

Aeromedical retrieval for critical clinical conditions: 12 years of experience with the Royal Flying Doctor Service, Queensland, Australia

J Emerg Med. 2009 May;36(4):363-8

NIV for weaning

Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review

The growing evidence base in support of liberating patients from invasive mechanical ventilation by means of non-invasive weaning is summarised in this systematic review of 12 randomised trials. Non-invasive weaning was associated with decreased mortality, ventilator associated pneumonia, length of stay in intensive care and hospital, total duration of mechanical ventilation, and duration of invasive ventilation. It should be noted that most of the trials exclusively enrolled patients with exacerbation of chronic obstructive pulmonary disease; benefits in other types of ventilated patients remain to be firmly proven.

BMJ. 2009 May 21;338:b157


Tibial vs humeral intraosseous approaches

An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO

Emergency physicians at Singapore General Hospital found flow rates to be similar when comparing the tibia with the humerus as sites for adult IO access. The EZ-IO had a very high insertion success rate. It took about 12 minutes to infuse a litre of saline, which drops to about 6 minutes if a pressure bag is used.

Am J Emerg Med. 2009 Jan;27(1):8-15

Prehospital airway equipment on UK HEMS

Prehospital airway management on rescue helicopters in the United Kingdom

26 of 27 identified UK rescue helicopter bases responded to a questionnaire sent by German anaesthesiologists on the airway equipment they carried. The take home message is that there were some important gaps: not all carried equipment for establishing a surgical airway and not all had a means of capnometry. Pull your socks up guys the Germans are watching.

Anaesthesia. 2009 Jun;64(6):625-31

Trauma scissors vs the Rescue Hook

Trauma scissors vs the Rescue Hook, exposing a simulated patient: a pilot study

American military investigators compared traditional trauma scissors with the ‘rescue hook’ (a hooked knife with the cutting edge on the inside of the hook) in rapidly removing the clothes from a simulated casualty. An army desert combat uniform and boots were removed more quickly with the rescue hook, which was favoured by the combat medics employed in the study. We don’t have data on how it would work on denim, leather, or belts, but it looks pretty good. I just want to know if it’ll go through a sternum before I trade in my trauma scissors.

J Emerg Med. 2009 Apr;36(3):232-5