Advanced life support (ALS) is arguably one of a paramedic’s most important skills. The public expect us to ‘bring their relatives back to life’, and when we walk in the door at a cardiac arrest there is a huge amount of pressure to perform this skill well. But it IS nerve inducing, I have not yet been despatched to a ‘Red’1 where I haven’t felt a surge of adrenaline that I don’t get when the despatch information is a ‘non-injury fall’.
When we were first introduced to ALS, the look on our faces was similar rabbit in headlights. The whole thing is daunting to learn and daunting to perform in front of peers and colleagues, so imagine how it feels to have to do it in a room full of filming equipment with a camera stuck to your head, knowing that it will be posted online for anyone to see!
This video is intended as a learning tool, something for other students to watch alongside teaching of ALS in order to gain a little perspective and apply some context to the skill. We are fortunate enough to have access to a simulation house at our university in which we can practice this skill in a realistic environment, which I understand not all student paramedics are able to do.
I am probably my harshest critic when watching this video back, but taking part in this project allows me to reflect upon my practice which I feel is incredibly important in my development as a future paramedic. First of all, all universities and training institutions have different approaches to teaching ALS. If the way I have timed my interventions is different to the way you have been taught, it doesn’t mean that mine is wrong. This equally means that mine is not necessarily right; part of becoming a registered professional is finding the right balance between what you have been taught as gold standard, what works for you and most importantly what is right for the individual patient according to the current evidence base.
And on that note, a little bit of analysis…
Things that I would change:
I feel like I am really quiet in the video, which makes me question my communication with crewmates out in practice. In this instance, I think this is partially due to the fact that my crewmate is firstly one of my best friends and secondly also a student paramedic, meaning she knows what move I will be making next and there is a definitely a degree of non-verbal communication going on!
I didn’t confirm with my crewmate my second dose of adrenaline.
Somehow I managed to get 1130 and 1200 mixed up when stating the time the second adrenaline was given…meaning on reflection I look a bit daft!
I dropped the alcohol steret on the floor. Ordinarily I would start again, however in a time-pressured ALS scenario I think anyone would agree that time is of the essence.
Based on this video it looks like my future crewmates would have to have the fitness of an Iron Man competitor, having to do chest compressions for 12 minutes non-stop. This is not something that I would advocate as best practice with evidence suggesting that after 2 minutes a responder’s compressions will become inefficient. This is just one approach to performing ALS that I have been taught and we will be soon producing another ALS video discussing methods to ensure continuous high quality CPR and early defibrillation when indicated.
A note from the Paramedd-Jr Team:
Blue 22g cannulas were all that we had available in the training bag at the time. A larger gauge cannula may well have been warranted in this situation.
The relative seen early on was taken out of the scenario. Therefore the role of a distressed bystander and history taking does not feature. This is because we wanted to focus on the clinical element of cardiac arrest management. Crew Resource Management and Human Factors are something we will hopefully be producing a video on soon!
The management of this patient is based on RCUK Advanced Life Support Guidance - https://www.resus.org.uk/EasySiteWeb/GatewayLink.aspx?alId=771