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Burla et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

will impact the quality of bystander CPR performance (2) whether the use of a LUCAS (mechanical compression) device will lead to a difference in CPR performance as compared to traditional compressions (3) whether the presence of ACP gear will have a detrimental effect on depth, rate, and hand positioning of both bystander and LUCAS CPR.Methods: This study was an observational, prospective study of a convenience sample of 26 residents of all levels of training, from a single emergency medicine residency. Residents performed CPR on a high fidelity Laerdal mannequin that provided real-time computer feedback and measured compression depth, rate, and proper hand placement. Multiple trials of CPR were performed: baseline CPR for both 1 minute and 2 minute cycles, and CPR on a mannequin wearing the ACP. The ACP used was a common, commercially available HEART-GARD. We also measured the time required to remove the ACP prior to initiating CPR. LUCAS CPR performance was measured both at baseline and over the ACP.Results: For bystander CPR, there was a statistically significant difference in both percentage of correct hand placement and compression rate for baseline versus ACP compressions (85% versus 57%, p<0.05; 138 versus 142, p<0.05, respectively). Difference in compression depth were not significant (51.08 versus 50.08mm, p¼0.39). With LUCAS CPR, there was no significant difference noted in aspects of CPR performance with or without an ACP in place. When comparing bystander versus LUCAS CPR quality, a significant difference was noted in compression rate (138 versus 101, p<0.01), but not in overall depth or hand placement when compressions were performed either at baseline or with ACP in place. Lastly, average time to remove the ACP prior to CPR initiation was noted to be 5.4 seconds.Conclusions: Previous research has shown that many variables have a critical impact on overall CPR quality, including compression depth, rate and hand placement. In our study, the use of an ACP had a significant impact on hand placement during bystander CPR. This may have a detrimental effect on bystander CPR quality. Considering ACP removal required only 5.4 seconds, it may be beneficial to remove the ACP prior to starting of bystander CPR. However, ACP equipment was shown to have no significant impact when a LUCAS device is utilized for mechanical CPR. In addition, there was a significant difference between resident and LUCAS CPR in rate of compressions, which plays a critical role in CPR quality.

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county resident, calculated by the total number of pills dispensed, divided by the total population); rate of opioid prescriptions by type (rates of brand or generic types of opioids or painkillers); and morphine equivalency: (how many units of morphine are prescribed per person in the form of all opioids). Descriptive statistics were presented. Results: There is an annual rate increase in all three types of controlled substances prescribed. In 2012, 37.8 opioid pills, 13.8 benzodiazepine pills, and 4.7 stimulant pills were prescribed for every person in the county. This has been a steady increase annually from 2008 when the pills/person were 30.0, 11.3 and 3.8. The rate of opioid prescriptions are further detailed by the generic types, including the number of pills per population prescribed for hydrocodone, oxycodone, codeine, fentanyl, hydromorphone, methadone, and morphine. Hydrocodone is the most prescribed medication with 21.1 pills written for each person in the county in 2012, up 19.4% from 17.6 in 2008. Oxycodone has an increase of pills/person up 172.1%. The rate of morphine equivalency is how many units of morphine are prescribed per person with the total morphine equivalents having increased 30.1% from 2008 to 2012 across all opioids. Oxymorphone increased 209.4% over the study period. Conclusion: Since 2008 there has been a steady increase in rates of opioid prescribing in our county, with the most alarming increase being from oxymorphone.