Physical strain on advanced life support providers in different out of hospital environments.

Objectives: To examine to what extent the type of emergency medical transportation influences the physical response of advanced life support providers.

Background: Providing external chest compression during resuscitation is physically exhausting. If the decision is made to bring the patient to a hospital undergoing resuscitation procedures, there are usually two options for transportation: ambulance vehicles or helicopters. There should be discussion on deciding which means of transportation should be preferred, because there is evidence that the quality of rescuers performance influences patient's outcome.

Methods: The study was a randomised crossover trial comparing physical strain on 11 European Resuscitation Council (ERC) approved healthcare professionals during external chest compression in different environments: (a) moving ambulance vehicle vs. (b) flying helicopter, and both compared to (c) staying at the scene (control).

Main Outcome Measures: Difference in heart rate to systolic blood pressure ratio after 8 min of external chest compression. Secondary outcomes were BORG-rate of perceived exertion scale, blood pressure, serum lactate, and a Nine Hole Peg Test.

Results: Mean heart rate to systolic blood pressure ratio was 0.89+/-0.21 in the ambulance vehicle compared to 1.01+/-0.21 in the flying helicopter (p=0.04) There were no significant differences in the secondary outcome parameters. Perceived exertion increased by resuscitation time in all groups.

Conclusion: External chest compression CPR is possible in a flying helicopter as it is in a moving ambulance vehicle. There is no clinical relevant difference in physical strain during ALS between a flying helicopter and a moving ambulance car. As would be expected, the exertion increases with duration of CPR.