title: The "delay effect" of donning a gown during cardiopulmonary resuscitation in a simulation model.
abstract: OBJECTIVE
  We sought to determine whether the use of currently issued gowns delays initiation of chest compressions and ventilations during cardiopulmonary resuscitation and whether simple gown modifications can reduce this delay.
  
  
  METHODS
  Firefighter defibrillation instructors were allocated into pairs and videotaped while performing standardized cardiac arrest scenarios. Three scenarios were compared: "no gown," "standard gown" and "modified gown." Key time intervals were extracted from videotaped data.
  
  
  RESULTS
  Ninety-five scenarios were analyzed. Mean time interval to chest compression was 39 seconds (95% confidence interval [CI] 34-43) for "no gown" scenarios, 71 seconds (95% CI 66-77) for "standard gown" scenarios and 59 seconds (95% CI 54-63) for "modified gown" scenarios (p < 0.001). Time to first ventilation was 146 seconds (95% CI 134-158), 238 seconds (95% CI 224-253) and 210 seconds (95% CI 198-223) in the 3 groups, respectively (p < 0.001). Post hoc testing showed that the time differences between all groups were statistically significant.
  
  
  CONCLUSIONS
  Standard gowns protect front-line care providers but cause significant delays to chest compressions and ventilations, potentially increasing patient morbidity and mortality. Minor gown modifications, including pre-tied neck straps and longer waist ties that tie in front, allow for easier use and shorter delays to time-critical interventions. Future research is required to reduce care delays while maintaining adequate protection of emergency medical service providers from infectious disease.
authors.affiliation: Emergency Medicine Residency Program, University of Toronto, Toronto, Ontario.
authors.forename: Leah
authors.initials: L
authors.lastname: Watson
authors.forename: William
authors.initials: W
authors.lastname: Sault
authors.forename: Randy
authors.initials: R
authors.lastname: Gwyn
authors.forename: P Richard
authors.initials: PR
authors.lastname: Verbeek
mesh_terms: D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D004867:Equipment Design; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D008348:Manikins; D009864:Ontario; D011446:Prospective Studies; D011481:Protective Clothing; D011482:Protective Devices; D012141:Respiratory Tract Infections / Q000150:complications / Q000635:transmission; D013997:Time Factors