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For the pediatric cohort, use of a semiautomatic IO access device in place of a manual device offered no statistically significant difference in first-attempt success (3.3%) or in success per attempt (13.0%). However, the rate at which IO access was used by emergency medical services providers more than tripled with use of the semiautomatic device.

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Abbreviations: (AI) adrenal insufficiency, (CGM) continuous glucose monitoring, (CI) confidence interval, (CLD) chronic liver disease, (CSII) continuous subcutaneous insulin delivery, (DM) diabetes mellitus, (EMS) emergency medical services, (ER) emergency room, (ERT) emergency room transportation, (ESRD) end-stage renal disease, (HR) hazard ratio, (IQR) interquartile range, (MDI) multiple daily insulin injection, (non-DM) with no diabetes mellitus, (OAA) oral antihyperglycemic agents, (SD) standard deviation, (SFUI) sulphonylureas alone or in combination with insulin, (TIDM) type 1 diabetes mellitus, (T2DM) type 1 diabetes mellitus

IntroductionAmerican Heart Association (AHA) guidelines recommend cardiopulmonary resuscitation (CPR) chest compressions 1.5 to 2 inches (3.75–5 cm) deep at 100 to 120 per minute. Recent studies demonstrated that manual CPR by emergency medical services (EMS) personnel is substandard. We hypothesized that transport CPR quality is significantly worse than on-scene CPR quality.MethodsWe analyzed adult patients receiving on-scene and transport chest compressions from nine EMS sites across Minnesota and Wisconsin from May 2008 to July 2010. Two periods were analyzed: before and after visual feedback. CPR data were collected and exported with the Zoll M series monitor and a sternally placed accelerometer measuring chest compression rate and depth. We compared compression data with 2010 AHA guidelines and Zoll RescueNet Code Review software. CPR depth and rate were “above (deep),” “in,” or “below (shallow)” the target range according to AHA guidelines. We paired on-scene and transport data for each patient; paired proportions were compared with the nonparametric Wilcoxon signed rank test.ResultsIn the pre-feedback period, we analyzed 105 of 140 paired cases (75.0%); in the post-feedback period, 35 of 140 paired cases (25.0%) were analyzed. The proportion of correct depths during on-scene compressions (median, 41.9%; interquartile range [IQR], 16.1–73.1) was higher compared to the paired transport proportion (median, 8.7%; IQR, 2.7–48.9). Proportions of on-scene median correct rates and transport median correct depths did not improve in the post-feedback period.ConclusionTransport chest compressions are significantly worse than on-scene compressions. Implementation of visual real-time feedback did not affect performance.

The institution of video event recorder technology along with formal review and feedback resulted in a change in driving behaviour. Given that call volumes increased and driving events decreased, these measures may serve as surrogates for improvements in safety and maintenance costs. Economic analysis is necessary for conclusions on fiscal impact.

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