Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei City, Taiwan.
Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
PLoS One. 2020 Jul 7;15(7):e0235315. doi: 10.1371/journal.pone.0235315. eCollection 2020.
The effect of paramedic crew size in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. We hypothesised that teams with a larger crew size have better resuscitation performance including chest compression fraction (CCF), advanced life support (ALS), and teamwork performance than those with a smaller crew size.
We conducted a randomized controlled study in a simulation setting. A total of 140 paramedics from New Taipei City were obtained by stratified sampling and were randomly allocated to 35 teams with crew sizes of 2, 3, 4, 5, and 6 (i.e. 7 teams in every paramedic crew size). A scenario involving an OHCA patient who experienced ventricular fibrillation and was attached to a cardiopulmonary resuscitation (CPR) machine was simulated. The primary outcome was the overall CCF; the secondary outcomes were the CCF in manual CPR periods, time from the first dose of epinephrine until the accomplishment of intubation, and teamwork performance. Tasks affecting the hands-off time during CPR were also analysed.
In all 35 teams with crew sizes of 2, 3, 4, 5, and 6, the overall CCFs were 65.1%, 64.4%, 70.7%, 72.8%, and 71.5%, respectively (P = 0.148). Teams with a crew size of 5 (58.4%, 61.8%, 68.9%, 72.4%, and 68.7%, P<0.05) had higher CCF in manual CPR periods and better team dynamics. Time to the first dose of epinephrine was significantly shorter in teams with 4 paramedics, while time to completion of intubation was shortest in teams with 6 paramedics. Troubleshooting of M-CPR machine decreased the hands-off time during resuscitation (39 s), with teams comprising 2 paramedics having the longest hands-off time (63s).
Larger paramedic crew size (≧4 paramedics) did not significantly increase the overall CCF in OHCA resuscitation but showed higher CCF in manual CPR period before the setup of the CPR machine. A crew size of ≧4 paramedics can also shorten the time of ALS interventions, while teams with 5 paramedics will have the best teamwork performance. Paramedic teams with a smaller crew size should focus more on the quality of manual CPR, teamwork, and training how to troubleshoot a M-CPR machine.
急救医疗技术员团队规模大小对院外心搏骤停（OHCA）患者复苏的影响尚无定论。我们假设团队规模较大者的复苏表现，包括胸外按压分数（CCF）、高级生命支持（ALS）和团队协作表现，优于团队规模较小者。
我们在模拟环境中进行了一项随机对照研究。通过分层抽样，从新北市获得了 140 名急救医疗技术员，并将他们随机分配到 35 个团队，团队规模为 2、3、4、5 和 6（即每个急救医疗技术员团队有 7 个团队）。模拟了一名经历心室颤动并连接心肺复苏（CPR）机的 OHCA 患者。主要结局为整体 CCF；次要结局为手动 CPR 期间的 CCF、从第一剂肾上腺素给药到完成插管的时间，以及团队协作表现。还分析了影响 CPR 过程中脱手时间的任务。
在团队规模为 2、3、4、5 和 6 的所有 35 个团队中，整体 CCF 分别为 65.1%、64.4%、70.7%、72.8%和 71.5%（P=0.148）。团队规模为 5 的团队（58.4%、61.8%、68.9%、72.4%和 68.7%，P<0.05）在手动 CPR 期间具有更高的 CCF，并且团队动态更好。有 4 名急救医疗技术员的团队给予第一剂肾上腺素的时间明显缩短，而有 6 名急救医疗技术员的团队完成插管的时间最短。M-CPR 机故障排除可减少复苏过程中的脱手时间（39 秒），有 2 名急救医疗技术员的团队脱手时间最长（63 秒）。
更大的急救医疗技术员团队规模（≧4 名急救医疗技术员）并未显著增加 OHCA 复苏中的整体 CCF，但在设置 CPR 机前的手动 CPR 期间显示出更高的 CCF。急救医疗技术员团队规模≧4 名急救医疗技术员还可以缩短 ALS 干预的时间，而有 5 名急救医疗技术员的团队将具有最佳的团队协作表现。团队规模较小的急救医疗技术员团队应更注重手动 CPR 的质量、团队协作以及如何排除 M-CPR 机故障的培训。
