The ”resuscitation” competences are those involved in the initial management of patients suffering from a suspected critical condition, i.e. patients triaged as priority 1 either in the pre-hospital arena or upon presentation to the emergency department. Patients with suspected critical conditions are initially managed by multidisciplinary teams. The benefits of teamwork over working alone are increased rate of action (”many hands”) and increased knowledge/competence (”many heads”). Effective teamwork is contingent upon organizational and communicative skills. Team-members need to communicate with each other in order to distribute the tasks that need to be carried out, share information obtained from diagnostic investigations, and present suggestions regarding further management.
Resuscitation involves both carrying out diagnostic investigations and administering therapeutic measures. The EMCC teaches a generic ABCDE algorithm, augmented by
bedside blood tests
The purpose of the ABCDE is to decrease morbidity through initial interventions. The onus is on identifying and initiating the management of time-sensitive conditions:
“problems” such as hypoxia, hypoventilation, hypoglycemia
“patterns” (syndromes) such as anaphylaxis, hyperkalemia associated with wide QRS-complexes, severe sepsis
The Sign-In and Sign-Out algorithms are tools designed to facilitate teamwork and encourage all team-members to contribute, not only with their hands but also with their heads.
Teams often have a couple of minutes between receiving preliminary information about a potentially critical patient and patient contact. These minutes can be used to carry out a Sign-In. The purpose of the Sign-In algorithm is to spread key information among team-members, stimulate mental readiness for patient management, and create a environment that encourages participation of all team-members in patient management.
The EMCC teaches a Sign-In inspired from WHO Surgical Safety Checklist Time-Out part and structured according to the SBAR communication format. It includes many of the items recommended by CRM (Crisis Resource Management).
The Sign-Out is another team-based algorithm designed to smooth the transition from initial resuscitation to further management.
Course participants alternate acting as team-leader during these 10-minute scenarios. The team-leader’s tasks are to
lead a Sign-In
ensure that the generic ABCDE is carried out
recognize and initially treat ”problems” and “patterns”
lead a Sign-Out
One course participant fills out a checklist specific to the scenario which is then used to give immediate, objective, constructive feedback. The remaining course participants play the roles of other health care personnel.