Why Aren't There CPR Instructions In FPDS Or PPDS?
April 12, 2023
Why aren’t CPR instructions available in the Fire Protocols? If a caller is reporting something like a Vehicle vs. Pedestrian and reports the person is not conscious and not breathing, you can’t access the CPR instructions until you fully process the MVC. Then you have to switch to the Medical Protocols, select the most appropriate related call type, and then select the CPR instructions. This seems like a very long and unnecessary delay in hands-on-chest. If I am missing something here, please let me know. I have Emergency Dispatchers asking about this, and at the moment I don’t have a good answer for them.
Benton County Office of Emergency Communications
Bentonville, Arkansas (USA)
We have discussed and debated this topic during our cross-discipline team meetings that include our police, fire, and medical subject matter experts and our logic team. Each discipline has limitations with regard to interrogation and instruction simply because each discipline has different priorities. I will defer to Mike Thompson, the Chair of our Fire Council of Standards, for further explanation, but my basic understanding is that the generally futile nature of CPR following traumatic arrest is outweighed by other scene priorities facilitated by the FPDS®. So, while extrication or airway opening may be accomplished quickly and in unison with other priorities, CPR essentially removes or limits what may be the only rescuer from providing essential information or carrying out important safety instructions.
Brett A. Patterson
Academics & Standards Associate
Chair, Medical Council of Standards
International Academies of Emergency Dispatch®
Brett has captured essentially what the issue is here. Based on extensive review and studies by the IAED™ after other similar requests, the Fire Council of Standards has determined that—at this time at least—chest compression instructions will not be added to the FPDS.
The reasons for that are threefold. First, if chest compressions were to be added to the FPDS, all age categories would have to be accounted for as well as patients with stomas, trach tubes, etc. The scope of that, to include the training, is at least for now beyond what is considered practical for the FPDS.
Second, a very high percentage (but not all) of the patients encountered in a fire rescue setting that are in cardiac arrest are in that state secondary to blunt trauma, and by most clinically accepted standards, a person that arrests secondary to blunt trauma does not survive. Many EMS systems will not even start a resuscitation on a patient that presents like that. When you’re talking about motor vehicle crashes, they tend to have some of the highest percentages of fatal blunt trauma injuries compared even to other incident types. You do occasionally see a patient in an MVA that has arrested secondary to a medical problem, but those are virtually impossible to sort out in the dispatch process in terms of who might be able to be resuscitated versus who shouldn’t be.
Third, in many of the incident types handled by the FPDS, there can be and is a real-time scene safety threat to the caller and/or bystanders that could make it impractical and unsafe for a caller to engage in what could be extended treatment like that. In an MVA, I would say that once again ensuring scene safety is very much a potential issue as compared with other incident types.
One thing we have done with the upcoming release of FPDS v8.0 [coming later this year] is there will be a stand-alone Medical PAI incorporated into the Protocol. That Medical PAI will include instructions for bleeding control and burn care as it presently does but will also have basic trauma instructions and airway positioning instructions (with no chest compression instructions) adapted directly from the EMD Protocol. It will also contain scene safety assessment tools to make sure any patient treatment can be performed safely.
As Brett mentioned, these are interventions that, for the most part, can be accomplished quickly and will not require an extended period at the patient’s side in the event the scene is unsafe.
Fire Protocol, Academics and Standards Expert
IAED Academics, Research, and Standards Division
Chair, Fire Curriculum Council
Brett and Mike have brought up good points. I will say that the Police Standards Council has discussed having CPR instruction in PPDS® as recently as in our v7 discussions. There was some vocal opposition to this by a minority of members. At what point do we remain focused on police interests (e.g., caller and responder safety and the quick identification needs of individuals involved) versus the belief that a medical PAI will have a lifesaving outcome in a law enforcement event? Of course, this includes assaults, stabbings, and shootings primarily (the blunt trauma issues Mike wrote about previously).
We recognized that implementing CPR would require EPDs to become certified before system use. This was another concern the Council discussed. Yes, we could (given software enhancements) make these instructions optional. This is to say if an agency used MPDS® and/or staff were EMD certified, the PAI could be enabled in PPDS. There are a lot of moving parts and a good part of the reason we elected to pass on this endeavor for now.
Police Protocol, Academics and Standards Associate
IAED Academics, Research, and Standards Division