Tourniquet application in time-critical aquatic emergencies on a moving rescue water craft (RWC): Can speed and precision coexist?

Lifeguards are the first responders to any type of aquatic incident, including rapid rescue situations such as boating and sporting accidents, animal bites/attacks, and cases involving massive bleeding. In their line of work, rescue boats such as Rescue Water Craft (RWC) are commonly utilized the aim of this study is to evaluate the time and technique of placing a tourniquet on the sled of an RWC navigating at full speed. METHODS: A randomized crossover study design was used with a sample of 44 lifeguards. The inclusion criteria required that participants be certified lifeguards with experience in RWC operations and possess knowledge of responding to massive bleeding. Two CAT tourniquet placement tests were performed. In the 1) Beach-Tourniquet (B-TQ) test: it was performed on land and in the 2) Rescue Water Craft-tourniquet (RWC-TQ) test, sailing at a cruising speed of 20 knots. The evaluation was recorded in a checklist on the steps and timing of the correct application TQ by direct observation by an expert instructor. RESULTS: The tourniquet placement on RWC was an average of 11 s slower than when placed on the beach (BT-TQ 35.7 ± 8.0 vs. 46.1 ± 10.9 s, p > 0.001). In the percentage analysis of the results on correct execution of the skills, higher values are obtained for the B-TQ test than in RWC-TQ in Distance to the wound (into 5-7 cm), band adjustment, checking the radial pulse and reporting the time of tourniquet placement (p > 0.005). CONCLUSION: The placement of a tourniquet on a RWC navigating at 20 knots is feasible, relatively quick, and technically well executed.

Assessment of knowledge and skills in using an Automated External Defibrillator (AED) by university students. A quasi-experimental study. / Evaluación del conocimiento y de las habilidades para el uso de un Desfibrilador Externo Automatizado (DEA) por estudiantes universitarios. Un diseño cuasiexperimental.

AIM: To evaluate layperson (university student) ability to use an automated external defibrillator (AED). DESIGN: A repeated measures quasi-experimental study with non-probabilistic sampling and a control group was carried out. SCOPE: Teacher training degree students at the University of Santiago de Compostela (Spain). PARTICIPANTS: The sample consisted of 129 subjects (69% women and 31% men), between 19-47 years of age (mean 23.2±4.7 years). As inclusion criterion, the subjects were required to have no previous knowledge of AED. INTERVENTIONS: Times to apply defibrillation with an AED to a mannequin were recorded untrained (T0), after a theoretical and practice explanation lasting less than one minute (T1), and 6 months after the training process (T2). MAIN VARIABLES OF INTEREST: The primary endpoint was the time taken to deliver a defibrillation discharge. The "improvement effect" variable was defined by the absolute time difference between T1 and T0, while the "degree of forgetfulness effect" variable was defined as the absolute difference between T1 and T2. RESULTS: The mean times were T0=67.7s; T1=44.2s; T2=45.9s. The time to apply defibrillation was reduced after explanation training (T1

Effect of High and Low Flexibility Levels on Physical Fitness and Neuromuscular Properties in Professional Soccer Players.

This study aimed to analyse the impact of high and low flexibility levels of hamstring and quadriceps muscles on physical fitness and neuromuscular properties in professional soccer players. 62 male professional soccer players participated in this study and performed 2 instrumented flexibility tests (passive straight leg raise [PSLR] and quadriceps flexibility [QF]). Anaerobic performance was assessed using countermovement jump (CMJ), Abalakov vertical jump, 20-m sprint, and Balsom agility test. A k-means cluster analysis was performed to identify a cut-off value of hamstring and quadriceps flexibility and classify players as high hamstring flexibility (HHF) and low hamstring flexibility (LHF) or high quadriceps flexibility (HQF) and low quadriceps flexibility (LQF), respectively, according to the PSLR and QF performances. The LQF players performed better than HQF on CMJ (p=0.042, ES: 0.64) and Balsom agility test (p=0.029, ES: 0.68). In addition, LQF showed higher muscular stiffness than HQF players (p=0.002, ES: 0.88). There were no significant differences between HHF and LHF groups. When pooling the HQF and LQF players' data, the Pearson's correlation showed significant moderate positive association between muscular stiffness and QF (r=0.516, p<0.001). These results support the rationale that baseline stiffness is likely to influence athletic performance rather than flexibility level in soccer players.

Resuscitation and emergency care in drowning: A scoping review.

BACKGROUND: The ILCOR Basic Life Support Task Force and the international drowning research community considered it timely to undertake a scoping review of the literature to identify evidence relating to the initial resuscitation, hospital-based interventions and criteria for safe discharge related to drowning. METHODS: Medline, PreMedline, Embase, Cochrane Reviews and Cochrane CENTRAL were searched from 2000 to June 2020 to identify relevant literature. Titles and abstracts and if necessary full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on the population (adults and children who are submerged in water), interventions (resuscitation in water/boats, airway management, oxygen administration, AED use, bystander CPR, ventilation strategies, ECMO, protocols for hospital discharge (I), comparator (standard care) and outcomes (O) survival, survival with a favourable neurological outcome, CPR quality, physiological end-points). RESULTS: The database search yielded 3242 references (Medline 1104, Pre-Medline 202, Embase 1722, Cochrane reviews 12, Cochrane CENTRAL 202). After removal of duplicates 2377 papers were left for screening titles and abstracts. In total 65 unique papers were included. The evidence identified was from predominantly high-income countries and lacked consistency in the populations, interventions and outcomes reported. Clinical studies were exclusively observational in nature. CONCLUSION: This scoping review found that there is very limited evidence from observational studies to inform evidence based clinical practice guidelines for drowning. The review highlights an urgent need for high quality research in drowning.

Evaluation of the thoracic compression technique using APPs. Do they help or hinder cardiopulmonary resuscitation? / Evaluación sobre la técnica de compresiones torácicas usando APP. ¿Ayudan o entorpecen la reanimación cardiopulmonar?

OBJECTIVE: To evaluate the quality of cardiopulmonary resuscitation (CPR) by lay people when guided by a mobile phone application with real-time feedback, with the comparison of three different mobile phone applications (APPs). DESIGN: A cross-sectional quasi-experimental study was carried out. PARTICIPANTS: A sample of 113 nursing students participated in the study. INTERVENTIONS: Three hands-only CPR tests with continuous compressions were performed: (i)without external help; (ii)with the mobile phone turned off; and (iii)guided by APP. Three different APPs were randomly assigned (Pocket CPR®, CPR Pro®> and Massage cardiaque et DSA®). The mannequin Laerdal Resusci Anne QCPR (Stavanger, Norway) 2.0.0.14 software was used. VARIABLES OF PRIMARY INTEREST: APPs used. Demographic variables characterizing the study sample. INDEPENDENT VARIABLES: mean depth, mean rate, percentage of correct hand positioning, percentage of compressions with correct re-expansion, percentage of compressions with correct depth, percentage of compressions at the correct rate, and overall quality of CPR. RESULTS: Overall CPR quality was 33.3% ± 32.7 using Pocket CPR, 10.9% ± 22.72% using CPR Pro and 7.8% ± 9.2 using Massage cardiaque et DSA. None of the APPs produced a statistically significant improvement. The percentage of time that the resuscitator managed to maintain a correct compression rate improved when using all three APPs. CONCLUSIONS: Cardiopulmonary resuscitation guided by phone APPs did not improve the overall quality of compressions during resuscitation, though it improved the percentage of compressions performed at the correct rate.

A new chest compression technique in infants. / Nueva técnica de masaje cardíaco en lactantes.

OBJECTIVE: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin. DESIGN: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. SETTING: A University Hospital with a Pediatric ICU in the north of Spain. PARTICIPANTS: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. INTERVENTIONS: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad® with SkillReporter™ system was used. MAIN VARIABLES OF INTEREST: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. RESULTS: Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods. CONCLUSIONS: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method.

Effect of 3basic life support training programs in future primary school teachers. A quasi-experimental design. / Efecto de 3métodos de enseñanza en soporte vital básico en futuros maestros de Educación Primaria. Un diseño cuasiexperimental.

AIM: To evaluate the learning of basic life support (BLS) measures on the part of laypersons after 3different teaching programs. DESIGN: A quasi-experimental before-after study involving a non-probabilistic sample without a control group was carried out. SCOPE: Primary school teacher students from the University of Santiago (Spain). PARTICIPANTS: A total of 124 students (68.8% women and 31.2% men) aged 20-39 years (M=22.23; SD=3.79), with no previous knowledge of BLS, were studied. INTERVENTIONS: Three teaching programs were used: a traditional course, an audio-visual approach and feedback devices. MAIN VARIABLES OF INTEREST: Chest compressions as sole cardiopulmonary resuscitation skill evaluation: average compression depth, compression rate, chest recoil percentage and percentage of correct compressions. Automated external defibrillator: time needed to apply a shock before and after the course. RESULTS: There were significant differences in the results obtained after 2minutes of chest compressions, depending on the training program received, with feedback devices having a clear advantage referred to average compression depth (p<0.001), compression rate (p<0.001), chest recoil percentage (p<0.001) and percentage of correct compressions (p<0.001). Regarding automated external defibrillator, statistically significant differences were found in Tafter (p=0.025). CONCLUSIONS: The teaching course using feedback devices obtained the best results in terms of the quality of chest compressions, followed by the traditional course and audio-visual approach. These favorable results were present in both men and women. All 3teaching methods reached the goal of reducing defibrillation time.

Utility of a simple lighting device to improve chest compressions learning. / Utilidad de un dispositivo luminoso simple para mejorar el aprendizaje del masaje cardiaco.

INTRODUCTION: The recommendations on cardiopulmonary resuscitation (CPR) emphasize the quality of the manoeuvres, especially chest compressions (CC). Audiovisual feedback devices could improve the quality of the CC during CPR. The aim of this study was to evaluate the usefulness of a simple lighting device as a visual aid during CPR on a mannequin. MATERIAL AND METHODS: Twenty-two paediatricians who attended an accredited paediatric CPR course performed, in random order, 2min of CPR on a mannequin without and with the help of a simple lighting device, which flashes at a frequency of 100 cycles per minute. The following CC variables were analyzed using a validated compression quality meter (CPRmeter®): depth, decompression, rate, CPR time and percentage of compressions. RESULTS: With the lighting device, participants increased average quality (60.23±54.50 vs. 79.24±9.80%; P=.005), percentage in target depth (48.86±42.67 vs. 72.95±20.25%; P=.036) and rate (35.82±37.54 vs. 67.09±31.95%; P=.024). CONCLUSIONS: A simple light device that flashes at the recommended frequency improves the quality of CC performed by paediatric residents on a mannequin. The usefulness of this CPR aid system should be assessed in real patients.