Is the Over-the-Head Technique an Alternative for Infant CPR Performed by a Single Rescuer? A Randomized Simulation Study with Lifeguards.

(1) Objective: The objective was to evaluate the quality of cardiopulmonary resuscitation (CPR, chest compressions and ventilations) when performed by a lone first responder on an infant victim via the over-the-head technique (OTH) with bag-mask ventilation in comparison with the standard lateral technique (LAT) position. (2) Methods: A randomized simulation crossover study in a baby manikin was conducted. A total of 28 first responders performed each of the techniques in two separate CPR tests (15:2 chest compressions:ventilations ratio), each lasting 5 min with a 15 min resting period. Quality CPR parameters were assessed using an app connected to the manikin. Those variables were related to chest compressions (CC: depth, rate, and correct CC point) and ventilation (number of effective ventilations). Additional variables included perceptions of the ease of execution of CPR. (3) Results: The median global CPR quality (integrated CC + V) was 82% with OTH and 79% with LAT (p = 0.94), whilst the CC quality was 88% with OTH and 80% with LAT (p = 0.67), and ventilation quality was 85% with OTH and 85% with LAT (p = 0.98). Correct chest release was significantly better with OTH (OTH: 92% vs. LAT: 62%, p < 0.001). There were no statistically significant differences in the remaining variables. Ease of execution perceptions favored the use of LAT over OTH. (4) Conclusions: Chest compressions and ventilations can be performed with similar quality in an infant manikin by lifeguards both with the standard recommended position (LAT) and the alternative OTH. This option could give some advantages in terms of optimal chest release between compressions. Our results should encourage the assessment of OTH in some selected cases and situations as when a lone rescuer is present and/or there are physical conditions that could impede the lateral rescue position.

In-water resuscitation during a surf rescue: Time lost or breaths gained? A pilot study.

BACKGROUND: A technique called in-water resuscitation (IWR) was devised on a surfboard to ventilate persons who seemingly did not breathe upon a water rescue. Despite IWR still raises uncertainties regarding its applicability, this technique is recommended by the International Liaison Committee for Resuscitation (ILCOR). Thus, this study aimed to evaluate the feasibility of IWR with a rescue board before and during towing and, to compare rescue times and rescue-associated fatigue levels between rescues with rescue breath attempts and without (SR). METHODS: A randomized crossover pilot test was conducted: 1) IWR test with pocket mask and, 2) Conventional SR test. IWR tests were conducted using a Laerdal ResusciAnne manikin (Stavanger, Norway). Three groups of variables were recorded: a) rescue time (in s), b) effective ventilations during rescue, and c) rating of perceived effort (RPE). RESULTS: Focusing on the rescue time, the performance SR was significantly faster than IWR rescue which took 61 s longer to complete the rescue (Z = -2.805; p = 0.005). No significant differences were found between techniques for the RPE (T = -1.890; p = 0.095). In the IWR analysis, lifeguards performed an average of 27 ± 12 rescue breaths. CONCLUSION: The application of IWR on a rescue board is feasible both at the time of rescue and during towing. It shortens the reoxygenation time but delays the arrival time to shore. Both IWR and SR result in similar levels of perceived fatigue.

Aquatic Feasibility of Limbs Application of Tourniquets (AFLAT) during a Lifeguard Water Rescue: A Simulation Pilot Study.

INTRODUCTION: Control of massive hemorrhage (MH) is a life-saving intervention. The use of tourniquets has been studied in prehospital and battlefield settings but not in aquatic environments. OBJECTIVE: The aim of this research is to assess the control of MH in an aquatic environment by analyzing the usability of two tourniquet models with different adjustment mechanisms: windlass rod versus ratchet. METHODOLOGY: A pilot simulation study was conducted using a randomized crossover design to assess the control of MH resulting from an upper extremity arterial perforation in an aquatic setting. A sample of 24 trained lifeguards performed two randomized tests: one using a windlass-based Combat Application Tourniquet 7 Gen (T-CAT) and the other using a ratchet-based OMNA Marine Tourniquet (T-OMNA) specifically designed for aquatic use on a training arm for hemorrhage control. The tests were conducted after swimming an approximate distance of 100 meters and the tourniquets were applied while in the water. The following parameters were recorded: time of rescue (rescue phases and tourniquet application), perceived fatigue, and technical actions related to tourniquet skills. RESULTS: With the T-OMNA, 46% of the lifeguards successfully stopped the MH compared to 21% with the T-CAT (P = .015). The approach swim time was 135 seconds with the T-OMNA and 131 seconds with the T-CAT (P = .42). The total time (swim time plus tourniquet placement) was 174 seconds with the T-OMNA and 177 seconds with the T-CAT (P = .55). The adjustment time (from securing the Velcro to completing the manipulation of the windlass or ratchet) for the T-OMNA was faster than with the T-CAT (six seconds versus 19 seconds; P < .001; effect size [ES] = 0.83). The perceived fatigue was high, with a score of seven out of ten in both tests (P = .46). CONCLUSIONS: Lifeguards in this study demonstrated the ability to use both tourniquets during aquatic rescues under conditions of fatigue. The tourniquet with the ratcheting-fixation system controlled hemorrhage in less time than the windlass rod-based tourniquet, although achieving complete bleeding control had a low success rate.

Nueva herramienta de comunicación para el entrenamiento de soporte vital básico: smart glasses. Un diseño cuasiexperimental / New communication tool for basic life support training: smart glasses. A quasi-experimental study

Objetivo Analizar la efectividad de una metodología de enseñanza-aprendizaje de teleformación en soporte vital básico (SVB) basada en la comunicación a través de smart glasses. Diseño Estudio piloto cuasiexperimental de no inferioridad. Participantes Un total de 60 estudiantes universitarios. Intervenciones Aleatorización de los participantes en: grupo de teleformación a través de smart glasses (SG) y de formación tradicional (C). Ambas sesiones de entrenamiento fueron muy breves (<8 minutos) e incluyeron el mismo contenido en SVB. En SG, la capacitación fue comunicándose a través de una videollamada con smart glasses. Variables de interés principales Se evaluó el protocolo del SVB, el uso de desfibrilador externo automático (DEA), la calidad de la reanimación y los tiempos de actuación. Resultados En la mayoría de las variables del protocolo del SVB, la calidad de la reanimación y los tiempos de ejecución no hubo diferencias estadísticamente significativas entre grupos. Hubo mejor actuación de SG al valorar la respiración (SG: 100%, C: 81%; p=0,013), el avisar antes de la descarga del DEA (SG: 79%, C: 52%; p=0,025) y las compresiones con buena reexpansión (SG: 85%, C: 32%; p=0,008). Conclusiones El tele-entrenamiento en SVB-DEA para legos con smart glasses podría llegar a ser, al menos, tan efectivo como un método tradicional de enseñanza. Además, las smart glasses podrían ser más ventajosas para ciertos aspectos del protocolo del SVB y la calidad de las compresiones, probablemente debido a la capacidad de visualización de imágenes en tiempo real. La enseñanza basada en la realidad aumentada debe considerarse para la capacitación en SVB, aunque se requiere tanto cautela en la extrapolación de hallazgos como estudios futuros con mayor profundidad. (AU)

Aim To analyze the effectiveness of a teaching-learning methodology for teletraining in basic life support (BLS) based on communication through smart glasses. Design Pilot quasi-experimental non-inferiority study. Participants Sixty college students. Interventions Randomization of the participants in: tele-training through smart glasses (SG) and traditional training (C) groups. Both training sessions were very brief (less than 8 minutes) and included the same BLS content. In SG, the instructor trained through a video call with smart glasses. Main variables of interest The BLS protocol, the use of AED, the quality of resuscitation and the response times were evaluated. Results In most of the BLS protocol variables, the resuscitation quality and performance times, there were no statistically significant differences between groups. There were significant differences (in favor of the SG) in the assessment of breathing (SG: 100%, CG: 81%; p=0.013), the not-to-touch warning before applying the shock (SG: 79%, CG: 52%; p=0.025) and compressions with correct recoil (SG: 85%, CG: 32%; p=0.008). Conclusions Laypeople BLS-AED brief tele-training through smart glasses could potentially be, at least, as effective as traditional training methods. In addition, smart glasses could be more advantageous than traditional teaching for certain points of the BLS protocol and chest compressions quality, probably due to the capability of real-time visualization of images which supports the BLS sequence. Augmented reality supported teaching should be considered for BLS training, although caution is required in extrapolating findings, and further in-depth studies are needed to confirm its potential role depending on concrete target populations and environments. (AU)

New communication tool for basic life support training: smart glasses. A quasi-experimental study.

AIM: To analyze the effectiveness of a teaching-learning methodology for teletraining in basic life support (BLS) based on communication through smart glasses. DESIGN: Pilot quasi-experimental non-inferiority study. PARTICIPANTS: Sixty college students. INTERVENTIONS: Randomization of the participants in: tele-training through smart glasses (SG) and traditional training (C) groups. Both training sessions were very brief (less than 8 min) and included the same BLS content. In SG, the instructor trained through a video call with smart glasses. MAIN VARIABLES OF INTEREST: The BLS protocol, the use of AED, the quality of resuscitation and the response times were evaluated. RESULTS: In most of the BLS protocol variables, the resuscitation quality and performance times, there were no statistically significant differences between groups. There were significant differences (in favor of the SG) in the assessment of breathing (SG: 100%, C: 81%; p = 0.013), the not-to-touch warning before applying the shock (SG: 79%, C: 52%; p = 0.025) and compressions with correct recoil (SG: 85%, C: 32%; p = 0.008). CONCLUSIONS: Laypeople BLS-AED brief tele-training through smart glasses could potentially be, at least, as effective as traditional training methods. In addition, smart glasses could be more advantageous than traditional teaching for certain points of the BLS protocol and chest compressions quality, probably due to the capability of real-time visualization of images which supports the BLS sequence. Augmented reality supported teaching should be considered for BLS training, although caution is required in extrapolating findings, and further in-depth studies are needed to confirm its potential role depending on concrete target populations and environments.

Dispatcher-assisted BLS for lay bystanders: A pilot study comparing video streaming via smart glasses and telephone instructions.

OBJECTIVE: To determine whether dispatcher assistance via smart glasses improves bystander basic life support (BLS) performance compared with standard telephone assistance in a simulated out-of-hospital cardiac arrest (OHCA) scenario. METHODS: Pilot study in which 28 lay people randomly assigned to a smart glasses-video assistance (SG-VA) intervention group or a smartphone-audio assistance (SP-AA) control group received dispatcher guidance from a dispatcher to provide BLS in an OHCA simulation. SG-VA rescuers received assistance via a video call with smart glasses (Vuzix, Blade) connected to a wireless network, while SP-AA rescuers received instructions over a smartphone with the speaker function activated. BLS protocol steps, quality of chest compressions, and performance times were compared. RESULTS: Nine of the 14 SG-VA rescuers correctly completed the BLS protocol compared with none of the SP-AA rescuers (p = 0.01). A significantly higher number of SG-VA rescuers successfully opened the airway (13 vs. 5, p = 0.002), checked breathing (13 vs. 8, p = 0.03), correctly positioned the automatic external defibrillator pads (14 vs.6, p = 0.001), and warned bystanders to stay clear before delivering the shock (12 vs. 0, p < 0.001). No significant differences were observed for performance times or chest compression quality. The mean compression rate was 104 compressions per minute in the SG-VA group and 98 compressions per minute in the SP-AA group (p = 0.46); mean depth of compression was 4.5 cm and 4.4 cm (p = 0.49), respectively. CONCLUSIONS: Smart glasses could significantly improve dispatcher-assisted bystander performance in an OHCA event. Their potential in real-life situations should be evaluated.

Augmented reality training in basic life support with the help of smart glasses. A pilot study.

Introduction: Laypeople should be trained in basic life support and traditional and innovative methodologies may help to obtain this goal. However, there is a knowledge gap about the ideal basic life support training methods. Smart glasses could have a role facilitating laypeople learning of basic life support. Aim: To analyze the potential impact on basic life support learning of a very brief training supported by smart glasses video communication. Methods: Twelve laypeople were basic life support tele-trained by means of smart glasses by an instructor in this pilot study. During training (assisted trough smart glasses) and after the training (unassisted) participants' performance and quality of basic life support and automated external defibrillation procedure were assessed on a standardized simulated scenario. Results: After the training all participants were able to deliver good quality basic life support, with results comparable to those obtained when real time remotely guided by the instructor through the smart glasses. Mean chest compression rate was significantly higher when not guided (113 /min vs. 103 /min, p = 0.001). When not assisted, the participants spent less time delivering the sequential basic life support steps than when assisted while training. Conclusions: A very brief remote training supported by instructor and smart glasses seems to be an effective educational method that could facilitate basic life support learning by laypeople. This technology could be considered in cases where instructors are not locally available or in general in remote areas, providing basic internet connection is available. Smart glasses could also be useful for laypeople rolling-refreshers.

Are smart glasses feasible for dispatch prehospital assistance during on-boat cardiac arrest? A pilot simulation study with fishermen.

The aim of the study was to explore feasibility of basic life support (BLS) guided through smart glasses (SGs) when assisting fishermen bystanders. Twelve participants assisted a simulated out-of-hospital cardiac arrest on a fishing boat assisted by the dispatcher through the SGs. The SGs were connected to make video calls. Feasibility was assessed whether or not they needed help from the dispatcher. BLS-AED steps, time to first shock/compression, and CPR's quality (hands-only) during 2 consecutive minutes (1st minute without dispatcher feedback, 2nd with dispatcher feedback) were analyzed. Reliability was analyzed by comparing the assessment of variables performed by the dispatcher through SGs with those registered by an on-scene instructor. Assistance through SGs was needed in 72% of the BLS steps, which enabled all participants to perform the ABC approach and use AED correctly. Feasibility was proven that dispatcher's feedback through SGs helped to improve bystanders' performance, as after dispatcher gave feedback via SGs, only 3% of skills were incorrect. Comparison of on-scene instructor vs. SGs assessment by dispatcher differ in 8% of the analyzed skills: greatest difference in the "incorrect hand position during CPR" (on-scene: 33% vs. dispatcher: 0%). When comparing the 1st minute with 2nd minute, there were only significant differences in the percentage of compressions with correct depth (1st:48 ± 42%, 2nd:70 ± 31, p = 0.02). Using SGs in aquatic settings is feasible and improves BLS. CPR quality markers were similar with and without SG. These devices have great potential for communication between dispatchers and laypersons but need more development to be used in real emergencies.

Efficiency of virtual reality for cardiopulmonary resuscitation training of adult laypersons: A systematic review.

BACKGROUND: Virtual reality (VR) is an interesting and promising way to teach cardiopulmonary resuscitation (CPR) to adult laypersons as its high immersive characteristics could improve the level of skills and acquired knowledge in learning basic life support (BLS). METHODS: This systematic review assesses current literature about BLS training with VR and its possible effect on CPR-quality parameters, self-efficacy, perceived learning, and learners' satisfaction and short and long-term patients' outcome. We screened the Cochrane Library, PubMed, CINAHL, MEDLINE Ovid, Web of Science, and Scopus databases and included only clinical trials and quasi-experimental studies published from inception to October 1, 2021, which analyzed adult laypersons' BLS training with the use of VR. Primary outcomes were CPR parameters (chest compression rate and depth, Automated External Defibrillator use). Secondary outcomes were self-efficacy, perceived learning and learners satisfaction, and patients' outcomes (survival and good neurologic status). The risk of bias of included study was assessed using the Cochrane Handbook for Systematic Reviews of Interventions tool to evaluate randomized control trials and the transparent reporting of evaluations with nonrandomized designs checklist for nonrandomized studies. RESULTS: After full article screening, 6 studies were included in the systematic review (731 participants) published between 2017 and 2021. Because of the heterogeneity of the studies, we focused on describing the studies rather than meta-analysis. The assessment of the quality of evidence revealed overall a very low quality. Training with VR significantly improved the rate and depth of chest compressions in 4 out of 6 articles. VR was described as an efficient teaching method, exerting a positive effect on self-efficacy, perception of confidence, and competence in 2 articles. CONCLUSION: VR in BLS training improves manual skills and self-efficacy of adult laypersons and may be a good teaching method in a blended learning CPR training strategy. VR may add another way to divide complex parts of resuscitation training into easier individual skills. However, the conclusion of this review suggests that VR may improve the quality of the chest compressions as compared to instructor-led face-to-face BLS training.

Quality of Ventilations during Infant Resuscitation: A Simulation Study Comparing Endotracheal Tube with Face Mask.

Background: There are few studies that analyze ventilation volume and pressure during CPR carried out on infants. The aim of this study was to evaluate the quality of the ventilations administered using a self-inflating bag with an endotracheal tube and a face mask in manikins. Methods: a quasi-experimental simulation study with a randomized case crossover design [endotracheal tube (ET) vs. face mask (FM)] was performed. Sixty participants who were previously trained nursing students participated in the study. The estimated air volumes breathed, and the pressure generated during each ventilation were assessed and the quality of the chest compressions was recorded. Results: the ET test presented a higher percentage of ventilations that reached the lungs (100% vs. 86%; p < 0.001), with adequate volume (60% vs. 28%; p < 0.001) in comparison to FM. Both tests presented peak pressures generated in the airway greater than 30 cm H2O (ET: 22% vs. FM: 31%; p = 0.03). Conclusions: performing quality CPR ventilations on an infant model is not an easy skill for trained nursing students. Both tests presented a significant incidence of excessive peak pressure during ventilations. Specific training, focused on quality of ventilations guided by a manometer attached to the self-inflating bag, must be considered in life support training for pediatric providers.

A Comparison between Three Different Techniques Considering Quality Skills, Fatigue and Hand Pain during a Prolonged Infant Resuscitation: A Cross-Over Study with Lifeguards.

The aim of the study was to compare the quality of CPR (Q-CPR), as well as the perceived fatigue and hand pain in a prolonged infant cardiopulmonary resuscitation (CPR) performed by lifeguards using three different techniques. A randomized crossover simulation study was used to compare three infant CPR techniques: the two-finger technique (TF); the two-thumb encircling technique (TTE) and the two-thumb-fist technique (TTF). 58 professional lifeguards performed three tests in pairs during a 20-min period of CPR. The rescuers performed compressions and ventilations in 15:2 cycles and changed their roles every 2 min. The variables of analysis were CPR quality components, rate of perceived exertion (RPE) and hand pain with numeric rating scale (NRS). All three techniques showed high Q-CPR results (TF: 86 ± 9%/TTE: 88 ± 9%/TTF: 86 ± 16%), and the TTE showed higher values than the TF (p = 0.03). In the RPE analysis, fatigue was not excessive with any of the three techniques (values 20 min between 3.2 for TF, 2.4 in TTE and 2.5 in TTF on a 10-point scale). TF reached a higher value in RPE than TTF in all the intervals analyzed (p < 0.05). In relation to NRS, TF showed significantly higher values than TTE and TTF (NRS minute 20 = TF 4.7 vs. TTE 2.5 & TTF 2.2; p < 0.001). In conclusion, all techniques have been shown to be effective in high-quality infant CPR in a prolonged resuscitation carried out by lifeguards. However, the two-finger technique is less efficient in relation to fatigue and hand pain compared with two-thumb technique (TF vs. TTF, p = 0.01).

[Descriptive analysis of triggers, outcomes and the response of the health systems of child drowning in Galicia (Spain). A 17-year retrospective study.] / Análisis descriptivo de las causas, consecuencias y respuesta de los sistemas de Salud Pública en los ahogamientos pediátricos en Galicia. Un estudio retrospectivo de 17 años.

OBJECTIVE: Drowning is one of major public health problem in childhood. The aim of this paper was to describe the characteristics, locations, interventions and outcomes of child drowning in Galicia over 17 years. METHODS: Retrospective study of 100% of data of drowning amongst children aged 0-14 in the 2004-2020 period who were attended by the 061 emergency services in Galicia (Spain) was made. The characteristics of the incident, the victim's profile, location, type of medical care given and whether the victim survived or died were analysed using the Chi Square test to compare relative frequencies, and Odds Ratio to estimate the risk. RESULTS: During the period under study, 100 child drownings were recorded. In 55%, the main cause was lack of supervision. Young children (aged 0-4) primarily drowned in pools, and pre-teens and teenagers (aged 10-14) in the sea. In 42% of the incidents, bystanders performed CPR (37% included ventilation). Emergency services took 12 minutes on average to arrive at the scene. 6% died in situ and of the rest, were taken to hospital and admitted in 47% PICU, 26% ward, 8% discharged from Accident and Emergency (43% with pulmonary oedema, 41% with supplemental oxygen, 13% with IMV/NIMV [invasive mechanical ventilation/non-invasive]). Pneumonia was the most common complication and survival to discharge was 77%. CONCLUSIONS: Small children usually drown in pools and water facilities because of lack of supervision, whereas adolescents usually drown in the sea. CPR started by bystanders and the fast response of emergency services contributed to a high rate of survival. A large amount of data was lost during the process: accurate, standardized coding of drowning is necessary.

OBJETIVO: El ahogamiento es un importante problema de Salud Pública en la etapa infantil. El objetivo de este trabajo fue describir las características, localizaciones, intervenciones y resultados del ahogamiento pediátrico en Galicia durante 17 años. METODOS: Se realizó un estudio retrospectivo del 100% de los datos de ahogamiento de personas entre 0 y 14 años de edad del año 2004 a 2020, que fueran atendidos por los servicios de emergencias de Galicia 061. Se analizaron las características del incidente, perfil de la víctima, localización, tipo de asistencia sanitaria recibida y supervivencia respecto a muerte mediante el test Chi Cuadrado para comparar frecuencias relativas, y Odds Ratio para estimar el riesgo. RESULTADOS: Se registraron 100 ahogamientos pediátricos. En el 55% la principal causa fue la falta de supervisión. Los niños y niñas de 0-4 años se ahogaban mayoritariamente en piscinas, mientras que los/las adolescentes (10-14 años) en playas. En el 42% de los incidentes el testigo hizo reanimación cardiopulmonar (un 37% incluyó ventilaciones). Los servicios de emergencia tardaron 12 minutos de media en llegar. Un 6% falleció in situ y el resto fueron trasladados al hospital e ingresaron el 47% en UCI, 26% en planta, y 8% cursaron alta en Urgencias (43% con edema pulmonar, 41% con oxígeno suplementario, 13% con VMI/VMNI [ventilación mecánica invasiva/no invasiva]). La neumonía fue una complicación habitual y la supervivencia al alta fue del 77%. CONCLUSIONES: Los niños/as más pequeños se ahogan habitualmente en instalaciones acuáticas por falta de supervisión mientras que los/las adolescentes se suelen ahogar en playas marítimas. El inicio de la reanimación por parte de testigos y la rápida respuesta de los servicios de emergencias se asocia a una alta tasa de supervivencia. Numerosos datos fueron perdidos durante el proceso por lo que es necesaria una correcta y unificada codificación del ahogamiento.

Análisis descriptivo de las causas, consecuencias y respuesta de los sistemas de Salud Pública en los ahogamientos pediátricos en Galicia. Un estudio retrospectivo de 17 años / Descriptive analysis of triggers, outcomes and the response of the health systems of child drowning in Galicia (Spain). A 17-year retrospective study

FUNDAMENTOS: El ahogamiento es un importante problema de Salud Pública en la etapa infantil. El objetivo de este trabajofue describir las características, localizaciones, intervenciones y resultados del ahogamiento pediátrico en Galicia durante 17 años.MÉTODOS: Se realizó un estudio retrospectivo del 100% de los datos de ahogamiento de personas entre 0 y 14 años de edad delaño 2004 a 2020, que fueran atendidos por los servicios de emergencias de Galicia 061. Se analizaron las características del incidente,perfil de la víctima, localización, tipo de asistencia sanitaria recibida y supervivencia respecto a muerte mediante el test Chi Cuadradopara comparar frecuencias relativas, yOdds Ratio para estimar el riesgo.RESULTADOS: Se registraron 100 ahogamientos pediátricos. En el 55% la principal causa fue la falta de supervisión. Los niños yniñas de 0-4 años se ahogaban mayoritariamente en piscinas, mientras que los/las adolescentes (10-14 años) en playas. En el 42% delos incidentes el testigo hizo reanimación cardiopulmonar (un 37% incluyó ventilaciones). Los servicios de emergencia tardaron 12minutos de media en llegar. Un 6% fallecióin situ y el resto fueron trasladados al hospital e ingresaron el 47% en UCI, 26% en planta, y 8% cursaron alta en Urgencias (43% con edema pulmonar, 41% con oxígeno suplementario, 13% con VMI/VMNI [ventilación mecánicainvasiva/no invasiva]). La neumonía fue una complicación habitual y la supervivencia al alta fue del 77%.CONCLUSIONES: Los niños/as más pequeños se ahogan habitualmente en instalaciones acuáticas por falta de supervisión mien-tras que los/las adolescentes se suelen ahogar en playas marítimas. El inicio de la reanimación por parte de testigos y la rápidarespuesta de los servicios de emergencias se asocia a una alta tasa de supervivencia. Numerosos datos fueron perdidos durante elproceso por lo que es necesaria una correcta y unificada codificación del ahogamiento.(AU)

BACKGROUND: Drowning is one of major public health problem in childhood. The aim of this paper was to describe the characte-ristics, locations, interventions and outcomes of child drowning in Galicia over 17 years. METHODS: Retrospective study of 100% of data of drowning amongst children aged 0-14 in the 2004–2020 period who were attended by the 061 emergency services in Galicia (Spain) was made. The characteristics of the incident, the victim’s profile, location, type ofmedical care given and whether the victim survived or died were analysed using the Chi Square test to compare relative frequencies,and Odds Ratio to estimate the risk.RESULTS: During the period under study, 100 child drownings were recorded. In 55%, the main cause was lack of supervision.Young children (aged 0-4) primarily drowned in pools, and pre-teens and teenagers (aged 10-14) in the sea. In 42% of the incidents, bystanders performed CPR (37% included ventilation). Emergency services took 12 minutes on average to arrive at the scene. 6% diedin situ and of the rest, were taken to hospital and admitted in 47% PICU, 26% ward, 8% discharged from A&E (43% with pulmonaryoedema, 41% with supplemental oxygen, 13% with IMV/NIMV [invasive mechanical ventilation/non-invasive]). Pneumonia was the most common complication and survival to discharge was 77%.CONCLUSIONS: Small children usually drown in pools and water facilities because of lack of supervision, whereas adolescentsusually drown in the sea. CPR started by bystanders and the fast response of emergency services contributed to a high rate of survi-val. A large amount of data was lost during the process: accurate, standardized coding of drowning is necessary.(AU)

"Dispatcher, Can You Help Me? A Woman Is Giving Birth". A Pilot Study of Remote Video Assistance with Smart Glasses.

Smart glasses (SG) could be a breakthrough in emergency situations, so the aim of this work was to assess the potential benefits of teleassistance with smart glasses (SG) from a midwife to a lifeguard in a simulated, unplanned, out-of-hospital birth (OHB). Thirty-eight lifeguards were randomized into SG and control (CG) groups. All participants were required to act in a simulated imminent childbirth with a maternal−fetal simulator (PROMPT Flex, Laerdal, Norway). The CG acted autonomously, while the SG group was video-assisted by a midwife through SG (Vuzix Blade, New York, NY, USA). The video assistance was based on the OHB protocol, speaking and receiving images on the SG. The performance time, compliance with the protocol steps, and perceived performance with the SG were evaluated. The midwife's video assistance with SG allowed 35% of the SG participants to perform the complete OHB protocol. No CG participant was able to perform it (p = 0.005). All OHB protocol variables were significantly better in the SG group than in the CG (p < 0.05). Telemedicine through video assistance with SG is feasible so that a lifeguard with no knowledge of childbirth care can act according to the recommendations in a simulated, unplanned, uncomplicated OHB. Communication with the midwife by speaking and sending images to the SG is perceived as an important benefit to the performance.

Airborne infection risk during open-air cardiopulmonary resuscitation.

AIM: Cardiopulmonary resuscitation (CPR) is an emergency procedure where interpersonal distance cannot be maintained. There are and will always be outbreaks of infection from airborne diseases. Our objective was to assess the potential risk of airborne virus transmission during CPR in open-air conditions. METHODS: We performed advanced high-fidelity three-dimensional modelling and simulations to predict airborne transmission during out-of-hospital hands-only CPR. The computational model considers complex fluid dynamics and heat transfer phenomena such as aerosol evaporation, breakup, coalescence, turbulence, and local interactions between the aerosol and the surrounding fluid. Furthermore, we incorporated the effects of the wind speed/direction, the air temperature and relative humidity on the transport of contaminated saliva particles emitted from a victim during a resuscitation process based on an Airborne Infection Risk (AIR) Index. RESULTS: The results reveal low-risk conditions that include wind direction and high relative humidity and temperature. High-risk situations include wind directed to the rescuer, low humidity and temperature. Combinations of other conditions have an intermediate AIR Index and risk for the rescue team. CONCLUSIONS: The fluid dynamics, simulation-based AIR Index provides a classification of the risk of contagion by victim's aerosol in the case of hands-only CPR considering environmental factors such as wind speed and direction, relative humidity and temperature. Therefore, we recommend that rescuers perform a quick assessment of their airborne infectious risk before starting CPR in the open air and positioning themselves to avoid wind directed to their faces.

Out-of-hospital cardiac arrest attended by the sports professional: Recommendations for intervention and training in coexistence with COVID-19

The aim is to promote a safer intervention in a cardiac arrest assisted by a sports professional during the current pandemic conditions due to COVID-19. The European Resuscitation Council protocol for lay people is adequate for this group, but it must be complemented with the use of personal protective equipment (PPE) adapted to sports professionals. The adaptations of action with respect to the 2015 practical guidelines are: assessment of breathing visually without opening the victim's airways, placement of a mask (preferably>FFP2) on the victim before starting resuscitation, resuscitation only with chest compressions except for of children and drowned-cohabitant, and the use of PPE for the sports field of easy learning and greater safety against possible transmission of COVID-19 by drops/aerosols (FFP3, glasses, gloves). These considerations should be included in the training/re-training of sports professionals in resuscitation and sports entities should favour the availability of aforementioned PPE. (AU)

[Occupational health recommendations for lifeguards in aquatic emergencies in the Covid-19 era: prevention, rescue and resuscitation.] / Recomendaciones de salud laboral para socorristas ante emergencias acuáticas en la era Covid-19: prevención, rescate y reanimación.

Severe acute respiratory syndrome (SARS-CoV-2), which causes coronavirus disease 2019 (Covid-19), is highly contagious. Lifeguards are the first line of response in aquatic emergencies and they will suffer a strong exposure to risk this first summer of the Covid-19 era, so their occupational health must be rethought in their professional practice during the new normal. The main public health measure to prevent drowning is prevention, but when this fails and assistance or rescue is required, in most interventions, distancing will not be possible. The limitation of personal protective equipment (PPE) for rescue is a reality that must be known and that can affect the health of the lifeguard. A review of the current literature aimed at avoiding or minimizing the risk of contagion in the interventions carried out by rescuers in the Covid-19 era was performed. This article provides structured information on the prevention of contagion in lifeguards, the potential risks, the available PPE, and the recommendations for its proper use during rescue or prehospital care in aquatic settings.

El síndrome respiratorio agudo severo (SARS-CoV-2), que causa la enfermedad por coronavirus 2019 (Covid-19), es altamente contagioso. Los socorristas son la primera línea de respuesta en las emergencias acuáticas y van a sufrir una fuerte exposición al riesgo este primer verano de la era Covid-19, por lo que su salud laboral debe ser replanteada en su práctica profesional durante la nueva normalidad. La principal medida de salud pública para evitar ahogamientos es la prevención, pero cuando esta falla y se requiere la asistencia o el rescate, en la mayor parte de las intervenciones el distanciamiento no será posible. La limitación de los equipos de protección personal (EPI) para el rescate es una realidad que debe conocerse y que puede afectar a la salud del socorrista. Se realizó una revisión de la literatura actual orientada a evitar o minimizar el riesgo de contagio en las intervenciones realizadas por rescatadores en la era Covid-19. Este artículo ofrece una información estructurada sobre la prevención del contagio en los socorristas, los riesgos potenciales, los EPI disponibles y las recomendaciones para su adecuado uso durante los rescates o la atención prehospitalaria en los entornos acuáticos.

Eficacia del Quick Rescue (dispositivo flotante autoinflable para el rescate de ahogados en el mar) en comparación con el tubo y la boya de rescate / Quick Rescue self-inflating flotation device for rescuing sea swimmers in distress versus conventional tube or buoy rescues

Objetivos: El Quick Rescue es un nuevo dispositivo flotante de rescate (DFR) autoinflable. Se compara su eficacia frente al tubo y la boya de rescate ante una víctima con distrés en el mar, y la fatiga del socorrista tras los rescates con los distintos DFR. Método: Estudio cuasiexperimental con aleatorización de condiciones (sin DFR, con tubo de rescate, con boya de rescate y con Quick Rescue). Cada participante realizó cuatro rescates de víctima con distrés a 100 m en el mar, con estandarización de las condiciones ambientales, tipo de víctima y playa. Se registró el tiempo de rescate (total, aproximación, control de víctima y remolque) y la percepción del esfuerzo (total y segmentaria) de los socorristas. Resultados: En general, no hubo diferencias entre las cuatro condiciones en los tiempos de rescate. A excepción del tiempo de control de la víctima, que sin material fue en torno a 3 segundos inferior que en las tres condiciones con DFR (p < 0,05). No hubo diferencias en la percepción del esfuerzo total ni segmentaria entre condiciones. Conclusiones: El DFR autoinflable Quick Rescue presenta una validez similar a los DFR habituales en relación a los tiempos de rescate y la fatiga. Por lo tanto, recomendamos su uso para víctimas distrés en el mar

Objectives: To compare the efficacy of the new self-inflatable Quick Rescue (QR) flotation device to conventional tube and buoy devices. To compare lifeguard fatigue after rescues with different flotation devices. Methods: Forty lifeguards participated in this quasi-experimental field study. Each performed simulated rescues of sea swimmers in distress under 4 conditions (no device, the QR device, a tube, and a buoy) assigned in random order. The swimmer in distress was located at a distance of 100 m. Ambient conditions, victim type, and beach were standardized. Participants underwent training to use the inflatable QR float and all other devices. Expertise was defined as a score of at least 3 on a Likert scale of 1 to 5. We recorded rescue times (total, and approaching, securing and towing back the distressed swimmer) as well as the lifeguards’ perceptions of effort (overall and for each stage). Results: Most rescue times did not differ between conditions, with the exception of time needed to secure the victim, which was shorter by 3 seconds when no device was used (P<.05). The rescuers did not perceive differences between devices in overall effort or effort during any of the phases. Conclusions: The new self-inflating QR device is as useful as other flotation devices in terms of rescue