title: Chest compressions by ambulance personnel on chests with variable stiffness: abilities and attitudes.
abstract: BACKGROUND
  Quality of cardiopulmonary resuscitation (CPR) performed by professionals is reported to be substandard even with automated corrective feedback. We hypothesised that lack of quality is not due to physical capabilities.
  
  
  METHODS
  Eighty ambulance personnel from the same services where the quality of clinical CPR was investigated, performed two-rescuer CPR with similar corrective feedback for 5min on each of four manikins with different chest stiffness. The personnel also scored their agreement with statements on clinical CPR performance.
  
  
  RESULTS
  All study subjects performed CPR well within Guidelines recommendations on all four manikins with mean compression depth 44+/-3mm, compression rate 101+/-3min(-1), and 7+/-2 ventilations per minute. Three quarters stated that during CPR on patients their personal sense of correct depth and force determined their performance. Fifty-five percent believed that too deep chest compressions could cause serious injury to the patient, and 39% that compressing to Guidelines recommended depth may often result in severe patient injury. A quarter felt that the potential benefits of compressing to the Guidelines depth could not justify the injuries it would cause. Breaking ribs made 54% feel very uncomfortable.
  
  
  CONCLUSIONS
  Ambulance personnel were physically capable of consistently compressing to the Guidelines depth even on the stiffest chest. These laboratory results cannot be directly compared to the clinical out-of-hospital ALS situation, but strongly indicate that the inadequate chest compressions found in our clinical study were not due to lack of physical capability. We speculate that this may at least partly be explained by their fear of causing patient injury and trust in their own opinion of what is the correct compression depth and force in preference to the feedback.
authors: University of Oslo, Faculty Division Ulleval University Hospital, N-0407 Oslo, Norway. silje.odegaard@studmed.uio.no
authors: Silje
authors: S
authors: Ødegaard
authors: Jo
authors: J
authors: Kramer-Johansen
authors: Allan
authors: A
authors: Bromley
authors: Helge
authors: H
authors: Myklebust
authors: Jon
authors: J
authors: Nysaether
authors: Lars
authors: L
authors: Wik
authors: Petter Andreas
authors: PA
authors: Steen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods*; D017408:Guidelines as Topic; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008348:Manikins; D011312:Pressure; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D035441:Thoracic Wall