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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

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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

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