CPR skills: Use it or lose it

EMS providers perform a wide variety of technical tasks during the course of their duties. Skills like measuring vital signs, performing a physical assessment or auscultating lung sounds are common tasks. Gaining vascular access, administering a fluid bolus or injecting a medication is less common. Creating airway access through a surgical cricothyrotomy may be a once in a career intervention.

The upshot is that EMS providers must maintain competency and proficiency in their complete scope of practice. Whether it's a high-frequency low-criticality procedure of measuring a pulse rate, to a low-frequency high-criticality skill of pediatric intubation, it is assumed that we are proficient in the entire range of skills.

It's also known that in the low-frequency interventional skills, that if you don't use it, you lose it. Previous studies have shown that many paramedics intubate only once a year. Advanced life support providers on engine companies rarely start IVs due to time constraints. Some systems only see a handful of working cardiac arrests annually.

It's abundantly clear that ongoing training is necessary to maintain proficiency. It's no different than a law enforcement officer having to regularly qualify on firearm use. To maintain "muscle memory" of a technical procedure, you have to perform it regularly.

The key point is "regularity." Many of us have experienced the trauma of taking a mandatory in-service class once a year, where much of the time is spent talking about procedures and very little time spent is spent practicing them. And since we are "on the same team" so to speak, there is unspoken pressure to "pass" everyone on skill proficiency and pencil whip the competency forms, which are then put away in employee files to show the world that we "do" training.

As this study on high-quality CPR proficiency shows, it doesn't have to be this way. Quarterly training sessions in CPR using feedback mechanisms can be effective in maintaining high-quality technique. In another words, training can be brief, targeted and effective in skill maintenance. Using short, but intense scenarios to simulate real-world conditions promotes motor skill retention and by permeating those scenarios with high-level stress the quality of the training is elevated many fold. Providers are better prepared to function under formidable conditions.

No matter how well designed training can be, none of it will be helpful if you're not into it. The machismo and bravado side of our profession can often blind us from the need to stay current and proficient. That's simply not fair to our patients.

Next time, instead of sulking in the back of the classroom, take the time — and the energy — to make sure you are prepared to perform the procedures and techniques that are demanded of you at the most critical time.

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