title: For how long can two emergency medical technicians perform high-quality cardiopulmonary resuscitation?
abstract: OBJECTIVE
  To determine the duration and obstacles to prolonged on-scene cardiopulmonary resuscitation (CPR), and establish how long a pair of emergency medical technicians (EMTs) can provide high-quality CPR.
  
  
  METHODS
  Intermediate-level EMTs in Gyeonggi-do Province, Republic of Korea completed a survey regarding on-scene CPR. EMTs undergoing routine training took part in a simulation using mannequins. Parameters including compression depth, total number and rate of compressions; occurrence of incorrect hand position and incomplete chest recoil were collected over 16 2-min cycles of CPR (32 min total), with EMTs working in pairs.
  
  
  RESULTS
  The simulation study included 43 EMTs. The median duration of on-scene CPR was 3.7 min. Fear of decrease in performance was the main obstacle to continued CPR (n = 188/254 [74.0%]). Standards for high-quality CPR were met at each of the 16 steps of the simulation. Compression rate increased significantly with time. There were no significant changes in any other parameter.
  
  
  CONCLUSIONS
  Pairs of EMTs maintained high-quality CPR for 16 cycles (32 min) with no decrease in performance. Our findings could provide evidence to recommend guidelines for duration of on-scene CPR for cardiac arrest, particularly in countries where the level and number of ambulance crews are limited.
authors.affiliation: Department of Emergency Medicine, Inje University College of Medicine and Seoul Paik Hospital, Seoul, Republic of Korea.
authors.forename: Chu Hyun
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Ajou University College of Medicine and Ajou University Hospital, Suwon, Republic of Korea flyingguy0202@daum.net flyingguy@aju.ac.kr.
authors.forename: Gi Woon
authors.initials: GW
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Samsung Medical Centre, Seoul, Republic of Korea.
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.affiliation: Department of Emergency Medicine, Ajou University College of Medicine and Ajou University Hospital, Suwon, Republic of Korea.
authors.forename: Bo Ra
authors.initials: BR
authors.lastname: Kang
authors.affiliation: Department of Emergency Medicine, Dongguk University College of Medicine and Dongguk University Ilsan Hospital, Ilsan, Republic of Korea.
authors.forename: Han Ho
authors.initials: HH
authors.lastname: Do
authors.affiliation: Department of Emergency Medicine, Dongguk University College of Medicine and Dongguk University Ilsan Hospital, Ilsan, Republic of Korea.
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Seo
mesh_terms: D015992:Body Mass Index; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D003198:Computer Simulation; D004634:Emergency Medical Technicians / Q000592:standards*; D006801:Humans; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: CPR time; Cardiopulmonary resuscitation; cardiac arrest; chest compression; performance