Jeff Clawson, M.D.

Jeff Clawson, M.D.

Ask Doc

Jeff Clawson, M.D.


Is there a publication, either in the peer review literature or from IAED™, that shows when different telephone CPR scripts were implemented in MPDS® scripts? For example, when did the C-A-B (Chest compressions, Airway, Breathing) sequence get implemented? When did the Hands-only CPR instructions get implemented?


Michael R. Sayre, MD


Division of Emergency Medicine

University of Washington

Medical Director

Seattle Fire Department

Hey Michael,

Long time no see. Hope you’re thriving in the great NW. I can give you the time line for the beginnings and major changes in MPDS CPR protocols you have asked about below:

  1. CPR and choking instructions were included in the first MPDS v1.0 in 1979.
  2. We moved to a more logic-driven fully scripted and instruction linked form in 1983.
  3. In 1990 (v10.0), the Council of Standards (COS) of IAED implemented the panel-logic-script method of the 3x3 (9-panel format) that greatly simplified EMD use (you guys had that in Cincy).
  4. In 1995 (v10.3), CPR was mirrored with an AED Support protocol that integrated all AED steps logically with the various CPR steps.
  5. In 1998 (v10.4), the pulse check was removed based on AHA recommendations at that time.
  6. In 2004, CAB was implemented, which gave compressions first, followed by 2 vents at the 400 (4 minute) compression mark. This coincided with 30:2 for kids at this time. These recommendations came from an Academy Resuscitation Council that published this rationale in Resuscitation (see attached).
  7. In 2008, CAB was modified to start with continuous compressions for 600 (6 minutes). This modification was made based on recommendations from the Academy's Resuscitation Council and the latest evidence regarding positive pressure ventilations.
  8. In 2015 (v13.0), the choice was given to local Medical Directors (via use of an Administration Utility setting feature) to select either Compressions 1st(600) or Compressions Only (until responder arrival) based on their clinical and geographical needs. Some extended response regions and rural/wilderness areas have 30- to 60-minute response times, so “refilling the oxygen tank” via some breathes at 6 minutes out has been desired by some. AHA has never taken a stand on this concept—e., no evidence one way or another they say…
  9. In 2015 (v13.0), the COS completely revamped all aspects of arrest detection, eliminating unneeded elements, to get Hands-on-Chest (HOC) faster and improve the quality of CPR, as well as provide the metrics to implement an EMD CPR Quality Improvement process. This has been, on initial studies that are undergoing now, at great success.
I have attached a couple of short articles from the Academy’s Journal that better detail some of these changes as well as an abbreviated list of changes of interest to local medical directors. Please note that these were published prior to the official release of v.13 and are now past tense. Additionally, Brett Patterson, Chair of the Academy’s Medical COS, and several other Academy CPR and resuscitation experts, have put together a “High Performance EMD” course designed to heighten the EMD’s appreciation of their critical role in resuscitation and improve their performance using the new v.13 protocol. It also includes a Q&A module specific to telephone CPR. I have attached the related course brochure.

I have also attached an article published by our joint buddies in Dallas outlining a more general history of EMD in the US.

(Editor’s Note: The Journal web site at includes these articles and the brochure among other archived documents and publications.)

Again, hope things are going swimmingly for you and your work. Please don’t hesitate to contact me if any further information or clarifications are needed.

Best regards always… Jeff C.