Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T22:51:01.161Z Has data issue: false hasContentIssue false
  • English
  • Français

The “delay effect” of donning a gown during cardiopulmonary resuscitation in a simulation model

Published online by Cambridge University Press:  21 May 2015

Leah Watson ,
William Sault ,
Randy Gwyn  and
P. Richard Verbeek
Leah Watson
Affiliation:
Emergency Medicine Residency Program, University of Toronto, Toronto, Ont.
William Sault
Affiliation:
Toronto Fire Service, Toronto, Ont.
Randy Gwyn
Affiliation:
Toronto Fire Service, Toronto, Ont.
P. Richard Verbeek*
Affiliation:
Division of Emergency Medicine, Sunnybrook Health Sciences Centre, Sunnybrook–Osler Centre for Prehospital Care, University of Toronto, Toronto, Ont.
*
Sunnybrook–Osler Centre for Prehospital Care, 10 Carlson Ct., Suite 640, Etobicoke ON M9W 7K6; rverbeek@socpc.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

We sought to determine whether the use of currently issued gowns delays initiation of chest compressions and ventilations during cardiopulmonary resuscitation and whether simple gown modifications can reduce this delay.

Methods:

Firefighter defibrillation instructors were allocated into pairs and videotaped while performing standardized cardiac arrest scenarios. Three scenarios were compared: “no gown,” “standard gown” and “modified gown.” Key time intervals were extracted from videotaped data.

Results:

Ninety-five scenarios were analyzed. Mean time interval to chest compression was 39 seconds (95% confidence interval [CI] 34–43) for “no gown” scenarios, 71 seconds (95% CI 66–77) for “standard gown” scenarios and 59 seconds (95% CI 54–63) for “modified gown” scenarios (p < 0.001). Time to first ventilation was 146 seconds (95% CI 134–158), 238 seconds (95% CI 224–253)and 210 seconds (95% CI 198–223) in the 3 groups, respectively (p < 0.001). Post hoc testing showed that the time differences between all groups were statistically significant.

Conclusion:

Standard gowns protect front-line care providers but cause significant delays to chest compressions and ventilations, potentially increasing patient morbidity and mortality. Minor gown modifications, including pre-tied neck straps and longer waist ties that tie in front, allow for easier use and shorter delays to time-critical interventions. Future research is required to reduce care delays while maintaining adequate protection of emergency medical service providers from infectious disease.

Keywords

cardiopulmonary resuscitationpersonal protective equipmentgownprehospitaldelay
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 4 , July 2008 , pp. 333 - 338
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Ontario Ministry of Health and Long Term Care. SARS Provincial Operations Centre. Directives to all Ontario prehospital care providers and ambulance communications services. 2003. Available: http://www.health.gov.on.ca/english/providers/program/pubhealth/sars/docs/new_normal/dir_prehospital_care.pdf (accessed 2008 May 27).Google Scholar
2.American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, adult basic life support [supplement]. Circulation 2005;112:IV–1–203.Google Scholar
3.Ontario Ministry of Health and Long-Term Care. Provincial Infectious Diseases Advisory Committee (PIDAC). Preventing febrile respiratory illnesses: protecting patients and staff. 2005. Available: http://www.health.gov.on.ca/english/providers/program/infectious/diseases/best_prac/bp_fri_080406.pdf (accessed 2008 May 27).Google Scholar
4.Verbeek, PR, McClelland, IW, Silverman, AC, et al. Loss of paramedic availability in an urban emergency medical services system during a severe acute respiratory syndrome outbreak. Acad Emerg Med 2004;11:973–8.CrossRefGoogle Scholar
5.Stiell, IG, Wells, G, Field, B, et al. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program. JAMA 1999;281:1175–81.CrossRefGoogle ScholarPubMed
6.Wik, L, Hansen, T, Fylling, F, et al. Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation. JAMA 2003;289:1389–95.CrossRefGoogle ScholarPubMed
7.Cobb, LA, Fahrenbruch, CE, Walsh, TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA 1999;281:1182–8.CrossRefGoogle ScholarPubMed
8.American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 7.2: adult basic life support [supplement]. Circulation 2005;112:IV–58–66.Google Scholar
9.American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 4: adult basic life support [supplement]. Circulation 2005;112:IV–18–34.Google Scholar
10.Cinti, S. Pandemic influenza: Are we ready? Disaster Manag Response 2005;3:61–7.Google Scholar
11.Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.CrossRefGoogle Scholar
12.Booth, TF, Kournikakis, B, Badien, N, et al. Detection of airborne severe acute respiratory syndrome (SARS) coronavirus and environmental contamination in SARS outbreak units. J Infect Dis 2005;191:1472–7.CrossRefGoogle ScholarPubMed
13.Center for Disease Control and Prevention. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007. Available: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf (accessed 2008 May 27).Google Scholar