We’ve all heard controversies about cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confusing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation, this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in different EMS systems. Getting past the “Headlines,” attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”

3. Doubting Double Defbrillation

8. DATA FROM
EMS IS
SUMMARIZED
IN STARTLING
REPORT!
New information
released today shows
conclusively that
prehospital cardiac
resuscitation when
performed according to
current guidelines is
without a doubt… (cont’d)
ADORABLE PUP SAVES OWNER
WITH SNOUT TO MOUTH CPR (page 14)
EMS:
Excellent
Medical
Service
or
Earn Money
Sleeping?
“I always knew it!”
In finally verifying what
everyone has known for
a long time, this long-
awaited report is said to
finally allow EMS
providers to focus on
the next top priority,
“Where to stop and get
something to eat.”

22. LISTEN
LISTEN

26. (Wo) Man vs Machine
THE DAILY THUMP
WORLD’S FAVORITE RESUSCITATION NEWSPAPER THE MOST CIRCULATION
Terminator?
It has long been the
taught in EMS that
virtually every patient
without a pulse must
receive all efforts of
resuscitation even when
those efforts are clearly
futile.
“I’d rather let the
machine ‘thump it out’…

30. MEDIC MORNING NEWS
PALEONTOLOGISTS DISCOVER
REASON T-REX WENT EXTINCT
Scientists from the Museum of Natural
History and Resuscitation have recently
theorized that the reason that the dinosaur
known as Tyrannosaurus Rex went extinct
is that his arms were too darn short to
perform effective CPR compressions.
Date today Tuesday, September 20, 2022
PATIENTS STOP TAKING
CARDIAC ARREST LYING DOWN!

31. Lobodzinski, S. (2011). Combined active
compression-decompression cardiopulmonary
resuscitation and inspiratory impedance
threshold devices may improve survival after out-
of-hospital cardiac arrest. Cardiology Journal

37. VENTILATION KILLS PATIENTS!
Putting the
Squeeze on
airway and
breathing in
cardiac arrest
Are paramedics and
EMTs going far
enough push air
into victims of
cardiac arrest? How
much does it help?
Does it hurt the
patient’s chances of
recovery?
Local Conference
Saves Lives
This month EMS
responders from all
over the state and
surrounding areas
converged on the…
A BREATH OF FRESH AIR Weather for the Weekend: WIND!
MORNING GASP

43. INTUBATION IMPROVES OUTCOME!
ADVANCED AIRWAY USE
IN PREHOSPITAL
CARDIAC ARREST
RESUSCITATIONS
Endotracheal intubation is
considered the gold
standard for their way
maintenance in hospitals,
but does the same holds
true for EMS providers?
And investigative report by
the tubing times reveals the
shocking results of a
definitive scientific study of
the use of advanced air
ways during the hospital
cardiac resuscitation
attempts. (cont’d page 2)
The Tubing
Tribune
TAKING AMERICA’S BREATH AWAY SINCE 1895
INTUBATION KILLS!!!
CPR PAUSES AS PARAMEDIC INTUBATES A CARDIAC ARREST PATIENT

48. Source: Annals of Emergency Medicine 2012; 59:165-175.e1 (DOI:10.1016/j.annemergmed.2011.10.002 )
Copyright © 2012 American College of Emergency Physicians Terms and Conditions
>94%
<90%
<70%

68. MISPLACED MEDICS MORTIFIED!
MIGHT MORTIFY ADVANCED LIFE SUPPORT
It turns out that the advanced care
that is supposed to help during
cardiac arrest doesn’t seem to
help at all.
Might the all of the advanced tools
and techniques of paramedic
practice actually hinder the
application of skills that really
make a difference in cardiac arrest
situations? Actually, some science
says the answer is that you may
be better of with EMTs than
paramedics when it comes to
cardiac resuscitation.
ALS TODAY
In Touch With You - THE HEARTBEAT OF AMERICA - Since 1969

74. A descriptive analysis of defibrillation vector change
for prehospital refractory ventricular fibrillation
M. Davis
1,2
, D. Schappert1,2, K. Van Aarsen2, J. Loosley3, S. McLeod4, S. Cheskes5
1
Southwest Ontario Regional Base Hospital Program, London Health Sciences Centre, London, Canada
2
Division of Emergency Medicine, Department of Medicine, The University of Western Ontario, London, Canada
3Middlesex London Paramedic Service, London, Canada
4Schwartz/Reisman Emergency Medicine Institute, University of Toronto, Toronto, Canada
5Rescu, Sunnybrook Centre for Prehospital Medicine, University of Toronto, Toronto, Canada
• Patients in ventricular fibrillation (VF) who do not
respond to standard Advanced Cardiac Life Support
treatments are deemed to be in refractory VF (rVF)
• The ideal prehospital treatment for patients with rVF
remains unknown
• Double sequential external defibrillation (DSED) has
been proposed as a viable option for patients in rVF
• Although the mechanism by which DSED terminates
rVF remains unknown, one theory is that the change
in defibrillation vector that occurs may contribute
Introduction
• To describe clinical outcomes for patients presenting
in rVF during out-of-hospital cardiac arrest (OOHCA)
for those who underwent vector change defibrillation,
compared to those who received standard treatment
Methods
• Retrospective chart review of adult (≥18 years)
patients presenting in rVF during OOHCA over 15
months beginning in March 2016
• Vector change defibrillation defined as a change in
pad position (anterior-anterior to anterior-posterior)
after 3 or more consecutive shocks
• Termination of rVF was defined as the absence of
VF after a vector change or standard shock during
the next rhythm analysis
Conclusions
• This is preliminary evidence that vector change defibrillation in
patients with rVF may result in VF termination
• A randomized controlled trial is warranted to test whether or not
vector change has a role in the termination of rVF
Results
Objective
Vector Change
(n=16)
No Vector Change
(n=9)
Age
Median [IQR]
62.0 [53.5-69.2] 63.0 [28.0-76.0]
Sex
Male n (%)
13 (81.3%) 8 (88.9%)
Total # Defibrillations
Administered
Median [IQR]
5.50 [4.0-7.0] 5.0 [4.5-7.0]
Total # Defibrillations Prior
to Vector Change
Median [IQR]
3.0 [3.0-4.0] N/A
Time to Vector Change (min.)
Median [IQR]
8.8 (7.1-11.1) N/A
Termination of VF after 4th
Defibrillation
n (%)
8 (50%) 0 (0%)
Achieving Prehospital ROSC
n (%)
6 (37.5%) 3 (33.3%)
Survival to Hospital Discharge
n (%)
5 (31.3%) 3 (33.3%)
372 OOHCA
25 (6.7%) in rVF
16 Vector
Change
(64.0%)
9 No Vector
Change
(36.0%)

77. RESUS MEDICATIONS SAVE LIVES
LOCAL AMBULANCE
RUNS ONLY ON
EPINEPHRINE AND IS
JUMP STARTING WITH
DEFIBRILLATOR
ALL THE NEWS TO GET YOUR HEART PUMPING EMS EXCLUSIVES
US Med Report

88. BICARB

91. Paramedics Prevent Pedi Procrastination
Parents Praise Prehospital Professionals
When it comes to kids the right choice is
to “stay and play” with them. Avoiding
delays in effective cardiopulmonary
resuscitation is the key to both
successful return of spontaneous
circulation and survival discharge
neurologically intact pediatric patients.
These kids need effective the hospital
resuscitation, not an unrestrained ride to
the hospital as fast as possible.
While it’s true that kids tend to have
respiratory issues that put them into
cardiac arrest, it’s also true that, just like
adults, they need both effective
ventilation and circulation for successful
resuscitation to occur.
Kids Are People
Too
Promoting Pediatric Preferences - Since 2014

93. 49
56
38
24
17
2
17
13
0
0 10 20 30 40 50 60
2016/17
2014/15
2012/13
Polk County, FL Fire Rescue Pediatric Resus
Survival ROSC Cardiac Arrest
Epi at 16.5 min
Epi at 7.3 min
Epi at 5 min

96. WE EVENTUALLY COME BACK TO THE OLD STUFF
OLDER = BETTER!
From the beginning of this
century every red blooded
EMS provider knows that
everything they tell you not
to do today they’ll tell you
to do again later on. Just
you wait for it.
It is with this goal in mind
that the governor has
declared that there shall be
barrels and bellows
available on every street
corner across the state!