This study aimed to improve basic life support (BLS) skills through simulation, feedback, and intensive coaching. Sixteen emergency medical technicians and paramedics participated, completing initial BLS assessments followed by coaching sessions. Participants were then reassessed. Results showed improvements in key BLS metrics like compression rate, depth, fraction and hands-off time after coaching. This pilot study indicates high-quality CPR training through immersive simulation, coaching and feedback can improve performance.

1. Simulation, feedback and intensive coaching to
improve BLS skills performance
Alan Batt

2. • Alan Batt
– Clinical Educator, National Ambulance LLC, UAE
– Associate Researcher, Centre for Prehospital Research, Graduate Entry
Medical School, University of Limerick, Ireland
– Research Committee Member, National Association of EMS Educators
– Editor-in-chief, prehospitalresearch.eu
– No financial conflicts
Conflict of interest statement

3. Realistic?

4. • Inappropriate or inadequate skill performance at a particular time (Kohn,
Corrigan & Donaldson 2000)
• Inappropriate or inadequate team performance and communication (AHRQ
2003)
• Human factor issues: conflict between humans and equipment (Reason 2000)
• Combination of the above
Inadequate performance

5. Meet “Steve”

6. • Pilot study, manikin based
• Self-selection, voluntary
• Objective assessment of BLS quality as initial
baseline using Ambu Cardiac Trainer manikin
(Ambu GmbH, Hesse, Germany) and Lifepak 15
Monitor-Defibrillator (Physio-Control Inc, USA)
• Coaching session delivered utilising immersive
simulation techniques, feedback and high-quality
CPR methods
• Re-assessment of BLS quality to gauge
effectiveness of educational intervention
Methods

7. • EMTs and Paramedics with previous BLS training and certification
• 8 teams of 2 providers (n=16)
• Mixed BLS and ALS providers
Population

8. • Teams were debriefed
after initial evaluation of
skills
• Coaching was provided
focused on 6 key points of
high-quality CPR
• Teamwork was
emphasised with clearly
defined roles and plans.
• “Pit-crew” CPR
Coaching

10. • No skill sheet used, no time limit enforced
• Full body manikin used with ability to generate cardiac rhythms and
palpable pulse
• Equipment used as per in-field equipment
• Manikin on ground in collapsed position
• No interaction from assessor
• Immersion in clinical environment has been shown to simulate stressful
conditions encountered by personnel. LeBlanc et al. (2005) found a
decrease in drug calculation performance during stress.
Immersion

12. Compression rate
• Mean compression rate pre-intervention: 118 bpm (SD 9.19)
• Mean compression rate post-intervention: 126 bpm (SD 6.29)

13. • Mean compression fraction pre-intervention: 40.37 % (SD 3.85)
• Mean compression fraction post-intervention: 56 % (SD 3.81)
Compression fraction

14. • Mean compression depth pre-intervention: 52.25mm (SD 7.18)
• Mean compression depth post-intervention: 57.37mm (SD 5.42)
Compression depth

15. • Mean hands-off time pre-intervention: 7.12 secs (SD 2.79)
• Mean hands-off time psot-intervention: 2.87 secs (SD 1.12)
Hands off time

16. • Mean time to first shock pre-intervention: 85.37 secs (SD 35.88)
• Mean time to first shock post-intervention: 47.5 secs (SD 9.3)
Time to first shock

17. • A combination of immersive simulation, intensive coaching and feedback
resulted in:
• Higher compression rate
• Deeper compressions
• Less hands-off time
• Higher compression fraction
• Decreased time to first shock
• These are all components of high quality CPR described by ILCOR and the
American Heart Association.
Results

18. • Non-randomised
• Non-blinded due to nature of
intervention
• Significant potential for Hawthorne
effect
• All providers had previous experience
of BLS
Limitations

19. Bottom Line
• Training matters!
• Simulation makes it better!
• Immediate feedback and focused intensive coaching improves
performance.
• Our pilot study indicates that high-quality CPR training can be
implemented through immersive team-based simulation,
coaching and feedback.

20. • Agency for Healthcare Research and Quality. (2003). AHRQ’s patient safety initiative: Building foundations, reducing risk.
Interim Report to the Senate Committee on Appropriations. AHRQ Publication No. 04-RG005, December 2003. Retrieved
January 5, 2015, from http://www.ahrq.gov/qual/pscongrpt/
• Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Free Executive Summary.
Washington, DC: National Academies Press.
• LeBlanc, V. R., MacDonald, R. D., McArthur, B., King, K., & Lepine, T. (2005) Paramedic performance in calculating drug dosages
following stressful scenarios in a human patient simulator. Prehospital Emergency Care : Official Journal of the National
Association of EMS Physicians and the National Association of State EMS Directors, 9(4), 439–44.
• Reason, J. (2000). Human error: Models and management. BMJ, 320, 768-770.
• Yu, T. (2002). Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation. Circulation, 106(3),
368–372. doi:10.1161/01.CIR.0000021429.22005.2E
References