일차반응자의 기본 소생술 교육에 따른 질 측정 변수의 분석

Abstract

Purpose: As an emergency medical system provider, cardiopulmonary resuscitation (CPR) quality for first responder is an important determinant of cardiac arrest outcome. However, feedback on their CPR performance is often lacking. In this simulation study, we analyzed their CPR variables after CPR training based on high-quality CPR requirements highlighted by the 2010 American Heart Association updated guidelines. Furthermore, we aimed to compare the CPR quality between first responders and emergency medical technicians. Methods: Firefighters employed at Seoul metropolitan fire and disaster headquarters in 2011 and 2012 were included in the study. The data were collected from a PC Skill reporting System (Laerdal, Norway) 5 hours after CPR training. Outcomes included compression variables (depth, rate,hand position, full release, delivered per minute, duty cycle),ventilation variables (volume, flow rate) and hands-off time variables (hands-off fraction, time for airway and breathing,automated external defibrillator (AED)). Results: Sixty-one members to the emergency medical technician group and 66 members to the first responder group were recruited and were tested after CPR training. Results of the first responder group were as follows: for average compression variables, depth 57.6 mm, rate 108.3 numbers/min, correct hand position 90.0%, full release 100.0%,and duty cycle 40.8%. For average ventilation variables, volume 526.2 ml and flow rate 316.8 ml/sec. These values were same for both groups and showed no statistical significance. The number of compressions performed per minute was better in the emergency medical technician group (74.4 versus 70.6, p<0.002), as was total hands-off time (65.5 sec versus 73.2 sec, p<0.000) and hand-off fraction (32.0% versus 35.2%, p<0.000). Time for operating AED was found to be same for both groups but time for airway and breathing management was shorter in the emergency medical technician group (41.0 sec versus 48.0 sec, p<0.000)Conclusion: The first responder group showed that through short-term CPR training, overall measured quality of CPR was in compliance with international consensus guidelines. But total hands-off time was longer in the first responder group and the time spent for airway and breathing management rather than operating AED was significantly different between the two groups. Appropriate training programs for first responder's airway and breathing skills are required to minimize interruption time.