Starting EMS Training in Halifax
FEATURES
In our western society, acute myocardial infarction continues to be the most frequent cause of sudden death and most of these deaths are caused by inappropriate rhythms of the heart as opposed to massive heart muscle damage.
A review of the records of the Halifax, Nova Scotia, Fire Department and the emergency department of Victoria General Hospital in Halifax, revealed that the number of heart/lung related responses of the fire department was on the increase. In the summer of 1976, the training division of the Halifax Fire Department asked the hospital to help train fire fighters in the recognition and management of heart/lung problems.
It was mutually agreed that this training should take two forms. First, the fire fighters would visit the emergency department. This would also allow the fire fighters and the ambulance driver/attendants to become familiar with each other’s operation. In addition to this, a spare, fully equipped ambulance from our station visited each fire station within the city for orientation purposes.
Secondly, the men would receive instruction in basic cardiac life support (BCLS) and emergency cardiac care (ECC) under the guidelines of the American and Canadian Heart Associations. Successful completion of this course would tresult in certification as a basic rescuer in BCLS and ECC. This writer was directly involved with the CPR portion of the program.
Time frame for course
The first consideration was the time frame for the course. Experience indicated that the course objectives could be accomplished in approximately 12 hours, so we split the 12 hours, presenting the introductory portion on Friday from 6:30 to 11 p.m. and the remainder on Saturday from 8:30 to 5 p.m.
A small class of no more than 15 individuals was chosen. We feel that a group this small allows for individual and detailed instruction in the particular cardiopulmonary resuscitation. With other groups, we have experimented with having about 70 individuals in the didactic portion of the program. Following this theory, groups of 15 were formed for practice and examination. We do not have objective evidence to support this technique. This writer supports the small group concept throughout the entire program.
Those on the teaching staff are certified in basic rescue under the Canadian and/or American Heart Association programs. For a class of 15 learners, we feel that in addition to the course director, there should be at least four instructor/examiners. We have found this to be a sufficient number to provide adequate instruction.
Visual aids used
At the present time, we are using several sources of audio-visual assistance. The movie, “The New Pulse of Life,” is the basis of our film presentation of basic CPR. In addition, 35mm transparencies on BCLS and ECC distributed by the American Heart Association are presented. The programmed instruction workbooks, distributed by the American Heart Association have been recently made available to us. In addition, we have produced some of our own 35mm transparencies and overhead projections. We stress that any of these educutional assists must be followed immediately with enlightened group discussion. Sound editorial comment and question and answer sessions should also be encouraged.
We have developed a closed question bank for written examinations. We do not circulate practice questions and answers, although this is done in some other programs. We have not found this necessary in our experience as the learners have been able to successfully meet the necessary passing grade without first “peeking” at the questions.
Our training and testing manikins meet the requirements suggested by the American Heart Association. At the present in our basic course, we are using only the Laerdal Recording ResusciAnne. For a group of 15 students, we would recommend a minimum of two Recording Resusci-Annes. ResusciAnnes are required for practice and examination on airway obstruction. We encourage learners to use each other to practice positioning and recognizing proper landmarks for compression and location of pulses.
Do not use human volunteers for actual chest compression.
Volunteers used
One can successfully demonstrate and test the management of airway obstruction on human volunteers if Resusci-Annes are in short supply. In actual fact, a human volunteer assumes reality much closer than the inflatable doll. With our group of 15 learners, we have been able to handle the teaching and testing of infant resuscitation by using one Resuci-Baby. Some type of cutaway thorax is necessary to teach the interrelated anatomy of the thorax as it applies to CPR. In addition to auditorium facilities, for didactic lectures and audio-visual presentations, cleared space of approximately 100 square feet per manikin is required. If at all possible, the testing and practicing should be carried out in separate areas.
Although the Canadian Heart Association course in basic cardiac life support does not include adjunctive equipment training, many fire departments have such equipment. In view of this, we deem it important to provide the opportunity for the learner to demonstrate for himself that he can use the equipment (resuscitators, manual and powered) safely and effectively.
To achieve this, we utilize the Ambu Trainer. We find this particularly effective since on this particular manikin, the stomach can be inflated if ventilations are too large or given at too high a flow, or the neck and jaw are not positioned properly. The Laerdal Recording Anne does not have a stomach that air can inadvertently enter.
Records kept
A file is started on each learner and upon completion of the course, it is forwarded to the Nova Scotia Heart Foundation. A course roster is also filed with the foundation, which issues certification cards. Candidate files are kept on record at the Heart Foundation offices as proof of successful completion in the course of instruction. In addition to acting as registrar, the Nova Scotia Heart Foundation has been valuable in providing course packets and information for learners of BCLS and ECC within the Province of Nova Scotia.
As of this date. 49 persons in the Halifax City Fire Department have received training and have become certified in BCLS and ECC under the guidelines of the Canadian Heart Foundation. The writer, at this time. must acknowledge the high spirits and enthusiasm of the fire fighters. This course of instruction and the experience in the emergency room has been done during time off and without pay.
The men have expressed on several occasions the opinion that they are perhaps more apt to use this skill while off duty then while on the job. In this regard, they have developed a high degree of social awareness as well as professional responsibility in regard to cardiopulmonary resuscitation.
Sometime after the basic rescuer experience, the training division of the Halifax City Fire Department recommended six individuals for further training as instructors in BCLS and ECC. This extra instruction has been given and certification as an instructor was successfully challenged by the six individuals. We have found that this time span of several months between training and certification as basic rescuer and instructor has enabled individuals to develop a true desire to become an instructor. A high degree of sensory overload has been noted when basic rescuer and instructor certification have been done at the same time or close together, particularly with non-medical groups. We recommend this more subtle approach of doing basic rescuer and instructor at separate times.
Six successes
At present, Halifax does not have the financial base for developing a fullfledged paramedic service. This has been the situation in many North American communities. However, it is this author’s opinion that all emergency service workers should be certified in the ability to control external hemorrhage and to provide manual methods of ventilation and circulation until the casualty can be treated at a medical facility. We are pleased to observe that the Halifax Fire Department, since the beginning of our program with it, has delivered six individuals to the emergency room who otherwise would have died at the scene.
With a high-risk target group such as fire fighters, policemen and beach guards, we recommend that the initial phase of CPR certification be done in a hospital by hospital instructors. This assures instructors who are clinically skilled in resuscitation. At the same time, the hospital instructors can work with the group’s candidates for basic instructor and bring them to certification level as an instructor in BCLS and ECC.
This is the course of action chosen for the Halifax Fire Department. The department now has purchased the necessary teaching equipment for its instructors, thus completing the teaching unit. Our hospital has now bowed out with the willingness to act as a resource service to the fire department on a consulting basis.
