title: Recommendations on ambulance cardiopulmonary resuscitation in basic life support systems.
abstract: OBJECTIVE
  Cardiopulmonary resuscitation (CPR) during ambulance transport can be a safety risk for providers and can affect CPR quality. In many Asian countries with basic life support (BLS) systems, patients experiencing out-of-hospital cardiac arrest (OHCA) are routinely transported in ambulances in which CPR is performed. This paper aims to make recommendations on best practices for CPR during ambulance transport in BLS systems.
  
  
  METHODS
  A panel consisting of 20 experts (including 4 North Americans) in emergency medical services (EMS) and resuscitation science was selected, and met over two days. We performed a literature review and selected 33 candidate issues in five core areas. Using Delphi methodology, the issues were classified into dichotomous (yes/no), multiple choice, and ranking questions. Primary consensus between experts was reached when there was more than 70% agreement. Questions with 60-69% agreement were made more specific and were submitted for a second round of voting.
  
  
  RESULTS
  The panel agreed upon 24 consensus statements with more than 70% agreement (2 rounds of voting). The recommendations cover the following: length of time on the scene; advanced airway at the scene; CPR prior to transport; rhythm analysis and defibrillation during transport; prehospital interventions; field termination of resuscitation (TOR); consent for TOR; destination hospital; transport protocol; number of staff members; restraint systems; mechanical CPR; turning off of the engine for rhythm analysis; alternative CPR; and feedback for CPR quality.
  
  
  CONCLUSIONS
  Recommendations for CPR during ambulance transport were developed using the Delphi method. These recommendations should be validated in clinical settings.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Marcus Eng
authors.initials: ME
authors.lastname: Hock Ong
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.forename: Soon Swee
authors.initials: SS
authors.lastname: Sung
authors.forename: Hideharu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Matthew
authors.initials: M
authors.lastname: Huei-Ming
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishiuchi
authors.forename: Benjamin Sieu-Hon
authors.initials: BS
authors.lastname: Leong
authors.forename: Sarah Abdul
authors.initials: SA
authors.lastname: Karim
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Lin
authors.forename: Hyun Wook
authors.initials: HW
authors.lastname: Ryoo
authors.forename: Hyun Ho
authors.initials: HH
authors.lastname: Ryu
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kajino
authors.forename: Patrick Chow-In
authors.initials: PC
authors.lastname: Ko
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Lee
authors.forename: Nathida
authors.initials: N
authors.lastname: Sumetchotimaytha
authors.forename: Robert
authors.initials: R
authors.lastname: Swor
authors.forename: Brent
authors.initials: B
authors.lastname: Myers
authors.forename: Kevin
authors.initials: K
authors.lastname: Mackey
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
mesh_terms: D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D003697:Delphi Technique; D004632:Emergency Medical Services / Q000592:standards*; D006801:Humans; D008021:Life Support Systems; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*