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Who should have the authority to "push the button" in a hospital setting?
Dear Healthcare Professionals and Industry Stakeholders,
In this edition of the Rescue RN Newsletter, we investigate a critical aspect of in-hospital cardiac arrest response: the use of defibrillators and who should be empowered to use them. With nearly 300,000 in-hospital cardiac arrests annually in the U.S. and increased awareness surrounding failure-to-rescue rates, it's time to reassess our approach and culture surrounding defibrillation.
The Current Defibrillation Paradigm
Traditionally, only physicians or Advanced Life Support (ALS) providers are authorized to defibrillate in many healthcare settings, a practice that varies significantly across systems. However, we must ask ourselves:
Is using a defibrillator beyond the scope of Basic Life Support (BLS) trained healthcare professionals?
Technology and Training - Simplifying the Process
Modern defibrillators have analytic functions and can operate in AED mode. They are designed specifically to assist in recognizing cardiac rhythms so that healthcare providers don’t have to. This technology suggests simplifying defibrillation, aligning it more closely with BLS than advanced procedures.
The No-Ego Team Sport of Cardiac Arrest
Cardiac arrest response is a collaborative effort. The standard protocol of recognizing the problem, calling for help, starting compressions, and then waiting for an ALS provider to arrive for defibrillation might be costing valuable time.
If a 10-year-old can use an AED in a mall,
Why shouldn't all BLS-trained healthcare professionals be empowered to do the same in a controlled medical environment?
BLS before ALS
Advanced Life Support (ALS) techniques require in-depth training, critical thinking skills, and the ability to analyze complex clinical situations quickly. ALS is crucial for managing cardiac arrests effectively, especially as situations evolve.
However, the significance of those first few minutes during a cardiac arrest cannot be overstated. Before ALS teams arrive, the immediate actions taken can dramatically influence outcomes. BLS procedures like effective chest compressions and early defibrillation are pivotal. These actions serve as the frontline defense against cardiac arrest, preserving brain function and improving survival until further interventions can be applied.
Empowering BLS Teams - Recognize, Call, Act
The potential impact of a well-trained, rapid-response BLS team is enormous. If BLS teams are empowered to recognize cardiac emergencies quickly, call for help, and immediately begin defibrillation, they can stabilize the patient's condition, potentially reducing the need for more invasive ALS measures. This approach not only enhances the efficiency of cardiac care but also
elevates the role of BLS personnel in emergencies.
By strengthening the capabilities and trust in our BLS teams, we ensure a robust, responsive system that maximizes patient outcomes from the moment of emergency onset.
Cultural Barriers and Healthcare Hierarchy
Is the hesitation to empower all healthcare workers to use defibrillators rooted in culture or the ingrained hierarchies within our healthcare systems? When initiating training programs, I often ask if BLS-trained staff can defibrillate, sparking essential discussions about responsibilities and capabilities.
Legal and Ethical Considerations
Consultations with risk management teams confirm that if defibrillation is within the standard of care and staff are trained - there is a duty to respond. More importantly, empowering staff to use their training fully enhances self-efficacy and confidence profoundly.
Time for a Cultural Shift?
As we continue to empower laypeople to use AEDs effectively in public settings, it’s worth considering why we hesitate to extend that trust to our trained healthcare professionals in a resource-rich environment like a hospital.
Who should have the authority to "push the button" in a hospital setting?
Your thoughts and feedback are invaluable as we navigate these pressing questions and work towards a more efficient and empowered response to cardiac emergencies.
Warm regards,
Challenge the norms, push the boundaries of traditional practice, and embrace a culture of empowerment and rapid response in cardiac care.
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