Team dynamics

Compressor

-Assesses the patient - stays next to the victims chest to perform chest compressions - rescuers should switch this role after every 5 cycles of CPR or about every 2 min, or sooner if tired

what are examples of effective team dynamics?

-clear roles and responsibilities -knowledge sharing -debriefing -constructive intervention

Team roles in high-performance teams

Team leader/ first rescuer on scene: establishes clear roles and responsibilities immediately - When all team members know their roles and responsibilities during a resuscitation attempt, the team functions smoothly - ideal situation: multiple rescuers work as a team to perform all the needed roles in a resuscitation attempt

6 possible team roles for resuscitation

team leader administer of medications compressor timer/recorder monitor/defibrillator/CPR coach air way - Some roles performed by advanced providers (team leader and medications) - If a team has fewer than 6 rescuers, some team members get more than one role - some roles are a higher priority than others - When only 2 rescuers are present, one takes the roles of airway and compressor and the other AED and team leader - If 3 rescuers are present, they take the 3 critical roles: compressor, airway, AED

Achieving a high chest compression fraction

- A high performing team achieves specific performance metrics, including a high chest compression fraction (CCF) Compressor: - CCF: amount of time spent doing high-quality chest compressions during cardiac arrest resuscitation attempt * you can only achieve high CCF by eliminating pauses during high quality CPR - The Resuscitation Outcomes Consortium Trials (ROC): showed that a 10% increase in CCF is roughly equal to an 11% increase in survival * pauses typically occur during intubation, rhythm analysis, pulse check, compressor switches and defibrillation - When compressions are paused, compressors should hover their hands over the chest and be prepared to resume AED - Advanced providers check for a pulse, precharge the defibrillator and prepare to deliver a shock about 15 seconds before pausing compressions at the end of each 2 min cycle * when using an AED, the prompts will instruct you when to pause (during rhythm analysis or shock delivery) Switching compressors - switch w/ the second compressor coming in from behind the first allowing the second compressor to have the same view of the team and of the AED - For seamless transitions, switching between cycles for every 2 min is best. - If a compressor needs to switch because of fatigue, coordinate a switch to happen as fluidly as possible ex) while delivering breaths Metronome Feedback Devices - best practice to use real-time feedback devices during CPR if available. If unavailable, a metronome can help establish proper rate _ If AED doesn't have a metronome, download one for your phone

Team leader

- rescuer assigns roles and makes treatment decisions - often at foot of the victim but may move around to observe and evaluate skills of the team and provides feedback when needed

AED/ monitor/ CPR coach

- rescuer focuses on team members performance of high-quality CPR to provide feedback as needed during resuscitation attempt

Timer/recorder

- rescuer keeps a record of the events including frequency and duration of interruptions in chest compressions, time of shock delivery, and medication administration

Airway

- rescuer positioned by victims head maintains an open airway and delivers breaths while watching for chest rise and avoiding excessive ventilation

assigning your team members to individual roles and outlining what each member needs to do during the resuscitation attempt is an example of what element of high-performance team dynamics?

clear roles and responsibilites

You and your team have initiated compressions and ventilation. The AED was attached, and "no shock" was advised. Your team has continued CPR for 1 minute. You tell your team in a respectful, clear, and calm voice " Leslie, during the next analysis by the AED, I want you and Justin to switch positions and I want you to perform compressions for the next cycle" Lesli replies, " Got it. Next time the AED analyzes, I will switch with Justin and assume the role of the compressor." This is an example of which element of high-performance team dynamics?

closed-loop communication

as team leader you notice that your compressor is pushing too fast. It is important to correct actions that are incorrect, but it is also important to be tactful when delivering this correction to a colleague. This is an example of what element of team dynamics?

constructive intervention

What action can you take as a team during and after a resuscitation attempt that helps individual team members perform better and brings awareness to system strengths and deficiencies?

debriefing