Bob Elling, MPA, EMT-P
(Part 1 of a 6-part series)
Introduction to the 2015 Guidelines Changes
If there is one thing we can rely on in the medical field, it is change. Because many of the treatments we provide are often being evaluated in scientific studies, it has come to be an expectation that evaluation of the evidence will help guide our practice. When I was in my initial paramedic course, the physician who taught us made this statement: “About a third of what you are learning will be considered wrong in 10 years. The problem is we do not know which third.” Most of us who have practiced for a few decades can see the truth in that statement.
At 5-year intervals, experts in resuscitation from across the world publish a consensus on what the science of resuscitation tells us. It is that publication, and the process that leads up to its development, that rolls out in the United States as the “Guidelines.” The resulting documents were recently published in two peer-reviewed journals.
Resuscitation and Circulation
As you know, major changes were made to CPR and ECC practices in the 2005 Guidelines. The emphasis turned to improving the quality of chest compressions and strengthening the links in the chain of survival in every community. These changes were reinforced in 2010. The 2015 version of the Guidelines has just been published. So what does the first half of 2016 have in store for us as these updates roll out?
The good news is that clearly those communities that have implemented the spirit of the 2010 Guidelines are on the right track and are seeing success in terms of lives saved. I would sum up the 2015 Guidelines as a combination of defining limits, emphasizing teamwork, and focusing on high quality.
Looking at the new Guidelines from a “10,000-foot level” my initial impressions are as follows:
- There are not a lot of major changes, so incorporating the Guidelines into practice should be relatively “painless.”
- Because ILCOR and AHA are both working on first aid guidelines, there are a number of recommendations in this topic area (ie, naloxone for overdose, glucose for hypoglycemia, assisting with a bronchodilator, giving ASA to heart attack patients, no more pressure points or elevation for bleeding control, no more occlusive dressings for open chest trauma, assessing for stroke, spinal motion restriction and no collar for laypersons).
There are now maximums on both the rate of compression (100 to 120) and the depth of compression (2 to 2.4 inches).
- There is a difference between the links in the chain of survival for out-of-hospital care versus in-hospital care. In-hospital care now stresses prevention.
- There is no longer any reason to carry vasopressin, because it has no advantage over epinephrine and should not be used in pregnant women.
- Although TTM (targeted temperature management) post ROSC is a Class I intervention, it should be done in the hospital and not with cold IV fluid in the field.
- Trendelenburg position is back for nontraumatic causes of shock.
- The Guidelines state several times that the frequency of training should be more often than once every 2 years.
The ECSI team of authors and editors is working very hard to update its instructor network, and to update any and all of our materials so that everyone who uses our valuable products can continue to train students to save lives.
Over the next five segments of this blog series, many of the specific recommendations will be listed. These specific topics will be covered:
Part 2: Systems of Care and Continuous Quality Improvement
Part 3: Adult Advanced Cardiac Life Support and ACS
Part 4: Special Circumstances of Resuscitation
Part 5: Pediatric Basic and Advanced Life Support and Cardiopulmonary Resuscitation Quality
Part 6: First Aid
Each recommendation in the Guidelines has a “class of recommendation” that corresponds to the strength of the recommendation and the quality of the scientific evidence that backs up the recommendation. The classes include:
Class I: strong
Class IIa: moderate
Class IIb: weak
Class III: moderate and provides no benefit
Class III: strong and causes harm
It is important to note only topics that changed are listed. Note also that I have not listed the levels of evidence, ethical issues, alternative techniques and ancillary devices to CPR, education, and neonatal topics. If you want to read all the details and background, take a look at the Supplement to Circulation, volume 132, number 18, supplement 2, November 3, 2015.
See you in the streets!