The "pit crew" concept in cardiac arrest

While the drivers and owners may get most of the credit a good "pit crew" is essential for team success in NASCAR.

 

 

So what makes a good pit crew?

Leadership

A good pit manager will ensure that the pit crew is ready and that all the necessary resources are in place. That includes ensuring that the appropriate number of people have been assigned to critical tasks, and that equipment is organized in a logical manner.

Skills and Competencies

Individual team members should possess all of the skills and competencies to perform their functions quickly, efficiently, and accurately. For example, the tire replacement crew should know when the tires need to be replaced, where the tires are kept, and whether wet or dry tires are required. Similar skills are required of the team members responsible for refueling and repairing mechanical breakdowns.

Teamwork and Communication

Fluency in communication can make the difference between winning and losing. This is where precious seconds can be lost or gained. Good communication is what leads to coordination and problem solving. Lack of communication leads to errors and loss of situational awareness.

Best Practices

Doing something because "that's the way it's always been done" or because "that's how a real pit crew operates" is short-sighted if the end result is losing the race. A good pit crew learns from its mistakes (and the mistakes of others) and will not hesitate to amend its procedures when another pit crew demonstrates a way to do it better. The outcome drives the process. Not tradition. Not ego.

Rehearsal

A good pit crew doesn't "make it up the day of the race" and neither does any other high-performance team (Navy SEALs, surgical team at Johns Hopkins, NFL football team). It takes practice. Lots of practice. It also takes a commitment to excellence which is the motivation. It has to start with the desire to win and be the best.

Applying these lessons

Firefighters with Hilton Head Island Fire & Rescue discuss
the "lessons learned" from a recent cardaic arrest.

Are you familiar with the latest evidence based guidelines for the care of cardiac arrest patients?

Have you bothered to find out how the top EMS systems in the country are doing it?

When's the last time you practiced working a cardiac arrest with a fully clothed 175 pound mannequin found face-down between a toilet and a bathtub?

When's the last time you practiced using your own real equipment (as opposed to the equipment laid out on the table at your last ACLS class)?

When's the last time you sat down with your crew and choreographed exactly who would do what during a cardiac arrest?

Are you like a "pit crew" when you arrive on scene? Or do you "do the best you can" and hope for the best?

Who would you want showing up to save a member of your family?

Photo credit: Wake County EMS blog

See also:

Why you need to strengthen your community's chain-of-survival

Tom Bouthillet and Jamie Davis discuss cardiac arrest and the chain-of-survival

Cardiac arrest – Anatomy of a System Failure

Cardiac arrest – Are you ready to save one of our own?

65 year old male CC: Cardiac arrest on the tennis court

57 year old male CC: Cardiac arrest

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Dominic
Conclusion to 59 Year Old Male: Unwell
Great discussion on a difficult 12lead! I follow these very closely and based on pt presentation and 12lead tracing, this was a difficult or to treat with impending heart failure, hypotension, and trouble breathing. Thanks for the follow up and look forward to next week!
2015-07-06 20:53:35
Billy
Conclusion to 59 Year Old Male: Unwell
Hmmmm, I was fairly close. Sounds like most of the treatment occurred IN Hospital. Love case studies, and that one was good.
2015-07-06 20:28:25
Kori
59 Year Old Male: Unwell
There's the point! There is are no P waves, and the rhythm is irregulary-irregular-atrial fibrillation. If you look, it is rsR phenomen-RBBB, BUT there are huge ST elevations on all leads from V1-V5 (that's why the QRS complexes look so broad). I and aVL is clearly ST elevation suggesting STEMI. In limb leads you can…
2015-07-06 10:12:16
Vince DiGiulio
Conclusion to 59 Year Old Male: Unwell
I'll expand on this in the next post but unfortunately I actually wasn't present for this case so I can't give my direct account of how things happened. That said, from the notes I read and word-of-mouth from those involved (which I suspect painted things in a better light than I would have viewed them),…
2015-07-06 04:09:22
Matt King
Conclusion to 59 Year Old Male: Unwell
Hey Vince thanks for the through follow up with this case. I am curious how his rate was controlled since he was hypotensive and maybe an unknown onset of when his A-Fib stated(thinking anticoagulation first)? As you know the wrong approach could be devastating in this PT with risks of further infarction, stroke, or death…
2015-07-05 14:10:57

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