Primary Care Workers- Cardiopulmonary Resuscitation

The following extracts have been taken from the Resuscitation Council UK Website, and do not constitue the full guidelines.  

Guidance for Clinical Practice and Training in Primary Care

"Throughout this publication the use of the term Primary Care Organisations (PCO) is intended to embrace the terms Primary Care Trust (PCT), Primary Care Group (PCG), Local Health Care Co-operative (LHCC) and Local Health Care Group (LHCG).  The term ‘practice’ refers to Primary Health Care Centres, General Practitioners’ surgeries and other places where the Primary Health Care Team may be based.

Sudden cardiac arrest, particularly from coronary heart disease remaind one of othe commonest causes of death in the United Kingdon and many such deaths occur outside hosptial.  All health care professionals who work in the community may be required to resuscitate a vitime of cardiopulmonary arrest.

Throughout this document, our priority is to provide advice that will do the most good for those most likely to survive a cardiopulmonary arrest.  Hence our main concern is the treatment of patients with ventricular fibrillation with early external defibrillation.  This is the single intervention that most radically improves the prognosis of cardiopulmonary arrest.

Data held by the British Heart Foundation confirm the efficacy of resuscitation by general practictioners in this situation.  When cardiac arrest complicates the early stages of acute myocardial infarction for example, a rhythm likely to respond to attempted defibrillation is present in 90% of patients.  Approximately 60% of those who arrest at home (and 75% of those who arrest on surgery presmises) subsequently survive to leave hospital after early defibrillation by their doctor.

The current National Service Framework for Coronary Heart Disease in England explicitly recognises the importance of early defibrillation, specifying that patients with symptoms of a possible heart attach should be attended to by someone trained and equipped to defibrillate within 8 minutes of calling for help to maximise the chance of successful resuscitation should it be necessary.  When Ventricular Fibrillation occurs, the earlier defibrillation is attempted the more favourable the outcome.

Advanced in defibrillator technology have produced a generation of machines that are relatively inexpensive, easy to use and which require minimal maintenance.

In this document, the first of its kind, we seek to provide guidance about resuscitation standards and trainingfor those working in the community as part of the Primary Health Care Team,  Although the persons most likely to attempt resuscitation are general practitioners and nursing staff, any proffessional health care worker may contribute either directly or indirectly. Receptionist staff for example may make a very important contribution, as they often receive urgent calls and summon the emergency services."

Summary

• All member of the Primary Health Care Team who have contact with patients should be trained and equipped to a level appropriate for their expected role, to resuscitate patients who suffer cardiopulmonary arrest in the community.  The minimum standard should be profficiency in BLS.  The majority of the team should be capable (with appropriate training) of using an Automated External Defibrillator (AED).

• National and international guidelines for the management of cardiopulmonary arrest should be followed.  For the Primary Health Care Team this refers to the guidelines on basic life support and use of an AED.

• Every healthcare practice should be equipped with an automated external defibrillator (AED) and appropriate arrangements should exist to ensure that it is readily available in the surgery whenever it may be required.  Equally, there should always be someone capable of using AED whenever patients may be in the building.  An AED should also be available to those providing medical cover outside normal practice hours, whether working as individuals, in Primary Care Centres or community hospitals, as part of a deputising service, co-operative or any other similar out-of-hours service.  Other basic resuscitation equipment for managing the airway and administering drugs should also be accessible.

• Primary Care Organisations (PCOs) should ensure that appropriate training takes place within the trust i.e. within the individual practices or a centre for training.  Resuscitation Officers, either employed by the trust or under a service level agreement with an acute trust, will usually be required to ensure this occurs.  Funding should be provided to maintain the highest standards of training and practice in resuscitation throught the PCO.

• Resuscitation attempts should be audited to maintain and improve standards of practice.  Cardiopulmonary arrest in the community is an appropriate subject for critical incident debriefing within any practice.

A significant number of patients collapse at home in the presence of the doctor, while a further proportion actually suffer a cardiopulminary arrest at the doctors surgery.  All health care care workers in the community who encounter a cardiopulmonary arrest must be trained and equipped to attempt defibrillation and perform other resuscitation techniques as appropriate.  Outcome will be optimal when the first person to attend the patient with ventricular fibrillation is trained and equipped to attempt immediate defibrillation.

When attempted defibrillation is delayed, the chances of siccessful resuscitation are greatly enhanced if a bystander performs BLS.  All medical, nursing and paramedical staff should be trained to perform BLS and should practice the techniques regularly on a training manikin.  It  is highly desirable that other staff e.g. reception staff, who come into contact with patients can also perform BLS.

The Nominated Person

PCOs should have a named person responsible for co-ordinating resuscitation services within the trust. They should liaise closely with a nominated person in each practice and with any organisations responsible for undertaking training in the practices of the trust. Resuscitation Officers, specifically employed by the PCO, would be ideally suited to this role.

A nominated person with an interest and knowledgeable background in resuscitation should ideally implement the tasks of administering the resuscitation services within a practice. Their role should include the purchase, maintenance and replacement of equipment, the arrangement of suitable training for all the Primary Health Care Team and the audit of performance.

Training in Resuscitation Techniques

Training and practice are necessary to acquire skill in resuscitation techniques. Theoretical training alone without actual practice in a simulated environment, for example on training manikins, is likely to be of limited value. The use of manikins should therefore be mandatory. Resuscitation skills decline rapidly and regular updates and retraining using manikins are necessary to maintain adequate skill levels. Formal studies have shown that repeated tuition and practice is the most successful method of learning and retaining skills in resuscitation.

The level of resuscitation skill (or skill attainment) required by different members of the Primary Health Care Team will necessarily differ according to the individual's role and in some cases, their enthusiasm. The aim of an individual healthcare practice however, should be to provide a competent response at all times with the resources available.

All those in direct contact with patients should be trained in BLS and related resuscitation skills such as the recovery position; as a minimum they should be able to provide effective BLS with an airway adjunct such as a pocket mask. Doctors, nurses and other paramedical workers like physiotherapists should also be able to use an AED effectively. Other personnel, for example receptionists, may also be trained to use an AED; they are nearly always present when a practice is open and may have to respond before more highly trained help is available.

It is unacceptable for patients who sustain a cardiopulmonary arrest to await the arrival of the ambulance service before basic resuscitation is performed and a defibrillator is available.

Training should be provided to teach to the level required by the trainees. In many cases, particularly for higher levels of skill attainment, the services of a Resuscitation Officer will be required. PCOs should engage their services according to their requirements. Ambulance service training schools can also provide training to a similar level of competency. The voluntary aid societies and comparable organisations also train their members in resuscitation skills, including the use of an AED and may be engaged to provide training for some members of the Primary Health Care Team. Knowledgeable members of the practice team could undertake training for the other members of their own practice.

No evidence base exists on which to provide definite recommendations about the frequency of refresher training for those specifically working in Primary Health Care Teams. A consensus view, based on studies of comparable providers and the practice of the organisations responsible for their actions, suggests that doctors and nurses should have refresher training in basic life support every six to twelve months. Retraining in the use of the AED for this group of workers should be carried out at least as frequently.

The importance of acquiring and maintaining competency in resuscitation skills may be an appropriate subject to include in an employee's job description. It is also a suitable subject for inclusion in individual personal development plans and may in due course form part of revalidation procedures."

To view the full version of 'Guidance for Clinical Practice and Training in Primary Care' please visit the Resuscitation Council Uk website on www.resus.org.uk.

To speak to one of the Back to Life team directly concerning your training requirements, please do not hesitate to Contact Us.