“Debriefing of cardiac arrest events, either in isolation or as part of an organized response system, improves subsequent CPR performance in-hospital and results in higher rate of return of spontaneous circulation (ROSC). Debriefing of actual resuscitation events can be a useful strategy to improve future performance (Class IIa, LOE C). Additional research on how best to teach and implement post event debriefing is warranted.”

1. DEBRIEFING
AND
CARDIAC ARREST
QUALITY IMPROVEMENT
David Hiltz, NREMT-P
Mike Smith, MPH, EMT-B
American Heart Association
Emergency Cardiovascular Care Programs

2. OBJECTIVES

4. AN
OBVIOUS INFLUENCE

5. HOUSTON, WE DO HAVE A
PROBLEM!

6. PROBLEMS AT A GLANCE PART 1

7. PROBLEMS AT A GLANCE PART 2

8. The DISPARITY

9. SURVIVAL TO DISCHARGE
“IS ALL OVER THE MAP”

10. BUT NOT AN
UNSOLVABLE
PROBLEM!

11. DEVELOPING A CULTURE OF
EXCELLENCE

12. BASTARD I HATE
LIFESAVER WAITIN DAMN
S G! EMTS

13. A NECESSARY COMBINATION!

14. A QUICK WORD…
CAN’T WE SOLVE OUR
PROBLEMS WITH TECHNOLOGY?
A COMMON MISCONCEPTION!

15. DEBRIEFING IS CHEAP!

16. Debriefing of cardiac arrest events, either
in isolation or as part of an organized
response system, improves subsequent
CPR performance in-hospital and results in
higher rate of return of spontaneous
circulation (ROSC).
Debriefing of actual resuscitation events
can be a useful strategy to improve
future performance (Class IIa, LOE C).

17. Innovative concepts to reduce the decay of
skills and knowledge may include continuous
maintenance of competency programs that
employ frequent short-duration interactions
with content and skills after an initial
course, or they may include guided
debriefings after real-life events that focus
on response
improvement.

18. Debriefing is a learner-
focused, nonthreatening technique to assist
individual rescuers or teams to reflect
on, and improve,
performance. In manikin-based
studies, debriefing as part of the learning
strategy resulted in improved performance in
post-debriefing simulated scenarios, and it
improved adherence to resuscitation
guidelines in clinical settings.
Debriefing as a technique to facilitate
learning should be included in all advanced
life support courses (Class
I, LOE B).

19. Structured and Supported Debriefing
Our Definition!
A provider‐centric process
designed to standardize the
debriefing process to assist
clinicians in thinking about what
they did, how they did it, and how
they can improve.

20. A provider-centered approach
emphasizes self-discovery and
self-critique.
A provider-centered
approach also draws upon
professional experience and
motivation to perform well to
enhance performance and
outcomes.

21. Thoughtful discussion after an attempted
resuscitation is important to facilitate the
sorting out of events as well as gaining
insight on what happened and why
We often learn better through self‐discovery
and self‐analysis than by other methods!

22. PROVIDERS NEED TO
EXPRESS
THEMSELVES AND
THEIR FEELINGS…
AND THIS IS A GREAT
FORUM FOR THAT!

23. IMPLEMENTATION
•Have long term view
•Patients and patience
•INSTANT GRATIFICATION!

24. Structured and Supported Debriefing
Supported elements include both interpersonal
support as well as use of protocols, algorithms, and
best evidence to inform debriefing
statements/questions.

26. Team leader
trained in
Structured
and
Supported
Debriefings

28. ROLE OF FACILITATOR
•PROVIDE SAFE ENVIRONMENT FOR
SHARING EXPERIENCES
•DRAW OUT INFORMATION AND
EXPERIENCES
•CONTENT DIRECTED BY THE CREW
•NEVER JUDGE!

29. Gather, Analyze, Summarize

30. Structured and Supported Debriefing
Structured elements include three specific debriefing
phases with related goals, actions, and time
estimates.

33. USE UNTAPPED
DATA!

34. INSTRUMENTED
MANIKINS

35. ANECDOTAL EVIDENCE NUMERICAL DATA

36. NOT PUNATIVE!

37. PIZZA DIPLOMACY!

38. BOY, I AM
REALLY
LOOKING
FORWARD TO
THE
DEBRIEFING ON
THIS CASE!

39. PRACTICE MAKES PERFECT!

40. THROUGH TEAMWORK,
TRAINING AND EDUCATION,
STRETCH FOR EXCELLENCE!

41. Be the change you want to
see in the world.
-Ghandi