This lesson focuses on the team approach to CPR when three or more responders or healthcare professionals are involved.
There are three main takeaways from this section:
- It's important to establish who the team leader is in any team approach to life support. The team leader is the orchestrator for everyone else in the rescue process and directs all the action.
- It's important for all involved to communicate effectively, and to use what's known as closed-loop communication. Closed-loop communication refers to a command (from the team leader) that has been heard by the team member executing that command and repeated back. This establishes that each command is understood and about to be executed.
- It's also important to take notes and log times. This includes all facets of the rescue attempt – when chest compressions begin, when the first shock is executed, what drugs are being administered and when, etc.
The Role of Team Leader
The team leader is orchestrating the actions of the other team members – who is doing what and when – but also monitoring the others for quality assurance. If the team leader sees that something is being done incorrectly or could be improved upon, it's his or her job to point out the intended improvement or change in rescue care and encourage that team member through positive reinforcement.
A Typical Division of Duties in a Three-Team-Member Approach
Responder one:
Begins performing the correct number of chest compressions based on the size of the patient and counting out loud.
Responder two:
Takes a position at the victim's head and readies the bag valve mask for use, performing two rescue breaths after a round of compressions have been completed and making sure that the chest rises and falls each time.
Responder three:
Takes notes of responder one and two's actions and times of each action. Responder three will also assist in some other aspect of care, if needed, including getting the AED ready. Responder three is also ready to jump in elsewhere when the switch occurs – when the compressor's two minutes are up and responder one switches places with responder two or three.
All three responders are communicating all vital information to the rest of the team while they work. The team leader will indicate when a switch is about to occur, who is taking over for whom, if an IV should be established, what drugs will go into the IV, as well as dosages, and other important information and directives.
A good team approach is vital in a rescue situation. It ensures that everyone is doing his or her job to the highest standards of care. In short, good practices and habits in a team approach leads to more saved lives.
A Word About Advanced Airways
If a patient has an advanced airway such as a supraglottic airway device or an endotracheal tube, CPR will be performed a little differently.
A supraglottic airway device, which allows for improved ventilation, is an advanced airway that does not enter and directly protect the trachea like an endotracheal tube. When using a supraglottic airway device, like a laryngeal mask airway, a minimum of two responders must be present.
Responder one provides one ventilation every six seconds, which is about 10 ventilations per minute. At the same time, responder two is performing compressions at the normal rate of between 100 and 120 compressions per minute. It's important to note that there is no pause between compressions or ventilations, and responders do not use the standard 30:2 compressions to ventilations ratio.
Advanced airway devices provide a continuous delivery of compressions and ventilations without any interruptions.
