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4 Ways TeamReporter Can Help You Build High-Performance CPR Teams

EMTs using teamreporter and performing cpr

The American Heart Association emphasizes that the quality of CPR delivered during a resuscitation has a major impact on survival.1 When it comes to quality CPR training, many instructors focus on perfecting the technical skills of individual rescuers - but focusing on rescuers’ performance as a team can also affect the quality of the CPR delivered.2 High-performance CPR, or "letter perfect" CPR, centers on evidence-based, individual and team performance metrics.3

Many EMS agencies and training centers recognize the importance of team training in high-performance CPR but have reported not having the right tools to make training easier and more efficient. TeamReporter is a video-based mobile phone app designed to provide the essentials for helping build high-performance teams. Some of these essentials include real-time and summative feedback, tips for improvement, and intelligent video debriefing.

Below, we explore the difference that efficient teamwork can make in high-performance CPR, and how TeamReporter can serve as your “assistant coach” for high-performance team training.

First, a Quick Refresh: High-Performance CPR Is a Proven Game-Changer

If you’re already familiar with high-performance CPR, skip to the next section. But many systems are still trying to educate their staff on the topic – so here is a brief summary.

CPR is life-critical, but inherently inefficient – which is all the more reason to get it right. It provides just 10% to 30% of normal blood flow to the heart, and only 30% to 40% of normal blood flow to the brain.4 Considering this reality emphasizes the urgency behind the need to make CPR as efficient as possible to increase its effectiveness and buy more time. This is the intent behind high-performance CPR. The high-performance CPR experts at the Resuscitation Academy advocate, “It is as though the onset of high-performance CPR suspends death and gives a better opportunity for the defibrillatory shocks and medications to work their magic.”5

CPR quality contributes to the extensive variability of survival between and within systems of care.6 High-performance CPR can make drastic improvements to survival rates. King County, WA saw a 50% improvement in discharged survival in the first year following high-performance CPR training,7 and their survival rates are among the highest in the world.8 Compared to other communities, cardiac arrest victims are two to three times more likely to survive in Seattle and King County from out-of-hospital cardiac arrest.9

Now that you’re up to speed on the importance of high-performance CPR, read on to learn 4 ways that TeamReporter can help.


1. Measuring to Improve – As a Team

It may seem obvious that measurement is key to improvement – but this holds especially true for CPR, as it is near impossible to judge CPR quality by look or feel alone. TeamReporter provides measurement and real-time feedback on the elements of quality CPR,* allowing practitioners to adjust and improve their performance instantly. This type of precise measurement and feedback promotes continuous improvement of both individual and team CPR skills.

"Measuring performance allows you to see every nook and cranny of every flaw."

David Weed, Community Services Officer for Woodinville Fire and Rescue in King County, WA10

Key parameters of high-quality CPR include:

  • Compression rate of 100-120 per minute
  • Depth of 2-2.4 inches
  • Full recoil
  • Avoiding excessive ventilation (just enough to observe initial chest rise)
  • Minimal peri-shock pauses11
  • Correct hand position12

The specificity of these parameters makes using a precise measurement tool a must. With TeamReporter, it’s as easy as connecting the app with your Resusci manikin to begin getting detailed feedback in seconds.


2. Addressing the High Cost of a Pause in CPR

A well-coordinated team that performs at maximum efficiency has the potential to shave off critical seconds and maximize chest compression fraction during a resuscitation. When teams are practicing tactics that can increase efficiency, TeamReporter helps by monitoring how these efforts are affecting the team's CPR quality.

Evidence shows that increased chest compression fraction (CCF), or the total time spent doing compressions during a resuscitation attempt, improves outcomes.13 High-performing organizations aim for 80% time on the chest.14

It's a common misconception that a pause as short as 3 seconds is insignificant and that you can just pick up where you left off in terms of building blood pressure in the heart with compressions. But within 3 seconds of pause, this pressure falls to zero. When you resume compressions, you essentially start at the beginning – not where you were when you left off. It takes another 30 compressions, or about 16 seconds, to rebuild the same kind of blood flow you had before you paused. When you look at it this way, that 3-second pause costs your patient many more seconds of adequate blood flow.15

Data from the Resuscitation Outcomes Consortium shows that a 1% increase in fraction time equates to roughly a 1% increase in survival rates.16 This means that if you can increase your CCF by 20%, your patient has a 20% greater chance of surviving.

Add to all of this, studies have found that increasing pre-shock and post-shock pauses has an impact on defibrillation success and survival.17

These factors explain why high-performing teams use techniques that help them maximize their hands-on time. Observers of efficient high-performance CPR teams in action often notice that:

  • It’s quiet, because everyone knows their roles and what to do – eliminating the need for much talking.
  • The rotation between the responders seems like a choreographed ballet, because they’re moving in perfect harmony. For this reason, high-performance CPR is sometimes referred to as the “CPR ballet,” the “dance of resuscitation, “or the “pitstop approach” to CPR.
  • The manual defibrillator is pre-charged to avoid time off the chest for charging.
  • Intubation occurs without ceasing compressions.18

These are only some of the tactics that high-performance teams use to increase efficiency and minimize wasted time, resulting in maximum time on the chest. This routine, of course, doesn’t come naturally: teams need to train and re-train in order to reach and maintain these levels of precision.

"Just because we have a team of experts, doesn’t mean we perform expertly."

Mike Helbock, M.I.C.P, NR-P, Division Chief – EMS Training, Seattle/King County Medic One (ret.), Faculty – Seattle/King County Resuscitation Academy19

As teams work on achieving improved synchronization, TeamReporter helps ensure that they can closely monitor and perfect their CPR performance.


3. Debriefing to Make Learning "Stick"

TeamReporter helps keep debriefing objective. In addition to a full recording, the TeamReporter algorithm also creates a post-session video highlighting the most coachable moments. Positive reinforcement, tips on areas for improvement, and a session timeline view add to the debriefing experience. Together, these tools provide a much more effective debriefing while saving time and effort.

Experts agree that debriefing is a fundamental component of resuscitation education that drives performance improvement.20 Optimal feedback and debriefing practices have been shown to promote acquisition and retention of skills and even affect patient outcomes.21


4. Making a Commitment to Continuous Improvement

According to the Resuscitation Academy, high-performance CPR is about routine measurement of performance and understanding how to increase it. This demands a major commitment to monitoring, remediation and retraining.22 And, it also demands an easy way to manage performance data.

With TeamReporter, it’s easy to track performance from every session. Sessions are stored in the cloud for easy access, aiding quality improvement efforts.


Some Parting Advice From The Experts

When training your teams with TeamReporter to increase coordination and reduce pauses, some key areas to focus on could include:

  • Establishing pre-determined roles23
  • Choreographing movement24
  • Streamlining communication, including using and responding to commands such as "rotate," "switch,"  and "count compressions" 25
  • Practicing the skills of all roles, including assessor, compressor, ventilator, and timekeeper26
  • Hovering hands over the chest and finger over the “shock” button27


*measurement of peri-shock pauses requires ShockLink and AED-LINK manikin

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  1. Meaney, P., Bobrow, B., Mancini, E., Christenson, J., de Caen, A., Bhanji, F., Abella, B., Kleinman, M., Edelson, D., Berg, R., Aufderheide, T., Menon, V., & Leary, M. (2013). Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement From the American Heart Association. Circulation, 128, 417-435. DOI: https://doi.org/10.1161/CIR.0b013e31829d8654
  2. Hunziker, S., Johansson, A., Tschan, F., Semmer, N., Rock, L., Howell, M., & Marsch, S. (2011). Teamwork and Leadership in Cardiopulmonary Resuscitation. Journal of the American College of Cardiology, 57(24), 2381-2388. DOI: https://doi.org/10.1016/j.jacc.2011.03.017
  3. Resuscitation Academy. (n.d.) The Art and Science of Resuscitation: A Guide to Improve Community Cardiac Arrest Survival. Retrieved from https://static1.squarespace.com/static/5f74bfd9d36c8e051d674096/t/6026f8c637d78a138ba9a987/1613166797492/art_science.pdf
  4. Meaney, P., Bobrow, B., Mancini, E., Christenson, J., de Caen, A., Bhanji, F., Abella, B., Kleinman, M., Edelson, D., Berg, R., Aufderheide, T., Menon, V., & Leary, M. (2013). See reference #1.
  5. Resuscitation Academy. (2020). 10 Steps for Improving Survival from Cardiac Arrest. Retrieved from http://globalresuscitationalliance.org/downloads/ebook/10_steps_2019.pdf
  6. Meaney, P., Bobrow, B., Mancini, E., Christenson, J., de Caen, A., Bhanji, F., Abella, B., Kleinman, M., Edelson, D., Berg, R., Aufderheide, T., Menon, V., & Leary, M. (2013). See reference #1.
  7. Resuscitation Academy. (n.d.) Improve EMS CPR in King County, Washington with High-Performance CPR. Retrieved from https://www.globalresuscitationalliance.org/wp-content/uploads/2019/12/King_County_HPCPR.pdf
  8. Sudden Cardiac Arrest Foundation. (2014). King County, WA, Has World’s Highest Survival Rate for Cardiac Arrest. Retrieved from https://www.sca-aware.org/sca-news/king-county-wa-has-worlds-highest-survival-rate-for-cardiac-arrest
  9. Public Health – Seattle & King County. (2021). Division of Emergency Medical Services 2021 Annual Report. Retrieved from https://kingcounty.gov/depts/health/emergency-medical-services/~/media/depts/health/emergency-medical-services/documents/reports/2021-Annual-Report.ashx
  10. Resuscitation Academy. (n.d.) Making feedback part of your EMS DNA. Retrieved from https://www.resuscitationacademy.org/blog/2017/10/06/making-feedback-part-ems-dna
  11. Resuscitation Academy. (n.d.) See reference #3.
  12. Resuscitation Academy. (2020). See reference #5.
  13. Panchal, A., Bartos, J., Cabanas, J., Donnino, M., Drennan, I., Hirsch, K., Kudenchuk, P., Kurz, M., Lavonas, E., Morley, P., O’Neil, B., Peberdy, M., Rittenberger, J., Rodriguez, A., Sawyer, K., & Berg, K. (2020). Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 142(16), S366-S468. DOI: https://doi.org/10.1161/CIR.0000000000000916
  14. Ibid.
  15. Resuscitation Academy. (2016). Science of CPR with Peter Kudenchuk, MD. Retrieved from https://www.youtube.com/watch?v=irHXrNqRbcY
  16. Resuscitation Academy. (n.d.) The Evolution of Quality CPR: What Exactly IS High-Performance, Anyway? Retrieved from https://www.resuscitationacademy.org/blog/2017/04/19/evolution-quality-cpr-exactly-high-performance-anyway
  17. Leary, M. & Abella, B. (2014). Defibrillation does not occur in isolation: The importance of peri-shock CPR. Resuscitation, 85(3), 313-314. DOI: https://doi.org/10.1016/j.resuscitation.2014.01.009
  18. Resuscitation Academy. (n.d.) See reference #3.
  19. Laerdal Medical (2021). If We Knew Then What We Know Now – Technology-Driven Tactics for Teaching CPR. Retrieved from https://laerdal.com/us/learn/sun/2021-Resuscitation-SUN/
  20. Cheng, A., Nadkarni, V., Mancini, M., Hunt, E., Sinz, E., Merchant, R., Donoghue, A., Duff, J., Eppich, W., Auerbach, M., Bigham, B., Blewer, A., Chan, P., & Bhanji, F. (2018). Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation, 138(6), e82-e122. DOI: https://doi.org/10.1161/CIR.0000000000000583
  21. Ibid.
  22. Resuscitation Academy. (n.d.) See reference #16.
  23. Resuscitation Academy. (2021). High Performance CPR Instructor Guide. Retrieved from https://www.dropbox.com/sh/sdas6j814htqmfu/AACRMvlai7NpgEIKRE0byhw2a?dl=0&preview=DRAFT+Instructor+Guide+for+HP-CPR+3.0.1+_10_21.pdf
  24. Ibid.
  25. Resuscitation Academy. (2021). High Performance CPR (HP-CPR) Course Objectives. Retrieved from https://static1.squarespace.com/static/5f74bfd9d36c8e051d674096/t/6182d8f2976de1356aa39abb/1635965170379/HP-CPR+3.0_Objectives_9_21+copy.pdf
  26. Ibid.
  27. Resuscitation Academy. (2021). See reference #23.