What's the 4-1-1 on the first five?
Frederick J. Tasota MSN, RN
Amy Clontz MSN, RN
Melanie Shatzer MSN, RN
Tom Dongilli

April 2010 
Volume 40  Number 4
Pages 55 - 57
  PDF Version Available!

CAN YOU HANDLE a cardiac emergency until the medical emergency team (MET) arrives? To improve crisis response, our facility developed a program to prepare first responders to intervene appropriately. Here's why and how we did it.Clinical observation, mock codes, and code reviews demonstrated that non-MET personnel—often the first to identify and respond to medical emergencies—weren't consistently prepared to provide key interventions, including early defibrillation with an automatic external defibrillator (AED).To date, the emphasis in our institution has been on the MET, with well-developed initiation criteria, sustained use over time, a crisis team-teaching course at an affiliated simulation center, and in-house mock codes (cardiac arrest) to evaluate team response.But non-MET first responders are key. Research shows that early problem recognition, rapid responder activation, appropriate initial intervention, and rapid defibrillation are key components in the chain of survival for hospitalized patients in cardiac arrest.1 Unfortunately, in-hospital delays in defibrillation are common nationwide, with more than 30% of patients with lethal cardiac dysrhythmias not defibrillated until more than 2 minutes after recognition.2Also, a high percentage of cardiac arrests occur outside ICUs (180 in our institution in 2006), and patient survival hinges on first-responder actions.2 Direct observation and review of responses by non-ICU staff in our institution revealed opportunities to: * standardize first-responder behaviors before MET arrival * review nurse-initiated AED use * standardize mock code teaching to improve staff performance in crisis situations.Little objective data on performance and teaching for first responders exists. However, the importance of educated personnel performing basic life support (BLS) and initiating early defibrillation is well documented. AED use should be considered a routine skill for all nurses after appropriate classroom

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