Comparative Analysis of the Effectiveness of Performing Advanced Resuscitation Procedures Undertaken by Two- and Three- Person Basic Medical Rescue Teams in Adults under Simulated Conditions

Abstract

(1) Objective: Paramedics as a profession are a pillar of the State Medical Rescue system. The basic difference between a specialist and a basic team is the composition of members. The aim of the study was to benchmark the effectiveness of performing advanced resuscitation procedures undertaken by two- and three-person basic emergency medical teams in adults under simulated conditions. (2) Design: The research was observational. 200 two- and three-people basic emergency medical teams were analyzed during advanced resuscitation procedures, ALS (Advanced Life Support) in adults under simulated conditions. (3) Method: The study was carried out among professionally active and certified paramedics. It lasted over two years. The study took place under simulated conditions using prepared scenarios. (4) Results: In total, 463 people took part in the study. The analysis of the survey results indicates that the efficiency of three-person teams is superior to the activities performed by two-person teams. Three-person teams were quicker to perform rescue actions than two-person teams. The two-person teams were much quicker to assess the condition of victims than the three-person teams. The three-person teams were more likely to check an open airway. The three-person teams were more efficient in assessing the heart rhythm and current condition of victims. It was demonstrated that three-person teams were more effective during electrotherapy. The analysis demonstrated that three-person teams were significantly faster and more efficient in chest compressions. Three-person teams were less likely to use emergency airway techniques than two-person teams. The results indicate that three-person teams administered the first dose of adrenaline significantly faster than two-person teams. For the “call for help”, the three-person teams were found to be more effective. (5) Conclusion: Paramedics in three-person teams work more effectively, make a proper assessment of heart rhythm and monitor when taking advanced actions. The quality of ventilation and BLS in both groups studied is insufficient. Numerous errors have been observed in two-person teams during pharmacotherapy.

Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review

“… 14 Several simulation studies demonstrated superior CPR quality (chest compression quality and fraction) in teams larger than two, along with a more efficient achievement of critical CPR endpoints such as rhythm recognition, adrenaline administration, and tracheal intubation. 20 , 21 , 22 No significant difference in the no-flow fraction was observed between teams of two, three, and four paramedic students in one simulated ALS/CPR study. 23 One study comparing team compositions found that teams of two paramedics were more prone to errors and generally slower in most interventions (except for tracheal intubation), compared to paramedic-emergency medical technician (EMT) teams.…”

“… Klosiewicsz (2020A) 7 Paramedics ( n = 104) Mechanical CC during ALS/CPR CC quality Use of mechanical CC device increased CC quality measures Klosiewicsz (2020B) 8 Paramedics ( n = 104) Mechanical CC during ALS/CPR Intervals between rhythm checks, duration of rhythm check, time to medication Use of mechanical CC device: improved adherence to ALS protocol and earlier achievement of resuscitation endpoints. Krzyzanowski (2021) 21 Paramedics ( n = 463) Team size comparison Time to critical interventions, CC quality measures, medication errors Three-member teams: faster times to critical interventions, higher CC quality, less medication errors. Martin-Gill (2010) 23 Paramedic students ( n = 40) Team size comparison No-flow fraction No significant difference in no-flow fraction between 2-, 3- and 3-member teams.…”

“…One and five studies investigated the effect of ALS team configuration on clinical outcome and quality of CPR respectively. 14 , 20 , 21 , 22 , 23 , 24 Five of these examined the effects of team size. 14 , 20 , 21 , 22 , 23 One retrospective clinical study involving 10 057 OHCA patients found that having more than two paramedics at the scene did not improve survival to hospital discharge (2 paramedics − 8.7%, 3 paramedics − 8.7%, ≥4 paramedics − 8.4%, p = 0.88).…”

“… 14 , 20 , 21 , 22 , 23 , 24 Five of these examined the effects of team size. 14 , 20 , 21 , 22 , 23 One retrospective clinical study involving 10 057 OHCA patients found that having more than two paramedics at the scene did not improve survival to hospital discharge (2 paramedics − 8.7%, 3 paramedics − 8.7%, ≥4 paramedics − 8.4%, p = 0.88). 14 Several simulation studies demonstrated superior CPR quality (chest compression quality and fraction) in teams larger than two, along with a more efficient achievement of critical CPR endpoints such as rhythm recognition, adrenaline administration, and tracheal intubation.…”

“…Larger crew sizes appear to be less error-prone and more efficient in airway management and overall performance, including CPR quality. 20 , 21 , 22 , 23 However, clinical outcomes for OHCA patients treated by two-member crews have only been evaluated in a single retrospective study, which did not detail specific protocols or contributions of first professional responders beyond crew size. 14 …”