Background: The aim of this study was to examine whether it is possible to perform resuscitation according to the present European Resuscitation Council (ERC) guidelines with a modified algorithm in the case of special, e.g. military, circumstances. On international missions of the German Armed Forces a rescue team only consists of an emergency physician and a paramedic. As the German Armed Forces require the same means of medical aid for all soldiers on every type of mission worldwide the algorithm must meet the ERC requirements.
Material and methods: In the study 20 medical teams specialized in resuscitation were examined. Of these teams 10 were from the German Armed Forces (the physician is a certified emergency physician) and 10 were civilian (the emergency physicians had up to 28 years experience). Each team was monitored as they performed resuscitation on a simulator for a period of 10 min. The patient's airway was secured by a laryngeal tube (LT) and over-the-head chest compressions were performed by the emergency physician. During resuscitation both team members held their position. In addition to comparing all results to the ERC guidelines both groups were analyzed separately and compared to each other.
Results: The median time needed for securing the airway was 17 s without any differences between the 2 groups. In 75% of the cases the time needed for successfully securing the airway on the first attempt was less than the allowed 30 s. In 5 cases (25%) the teams did not manage to successfully install the LT during the first attempt (4 failed attempts were performed by civilian teams and 1 by the military emergency teams); however, all 5 teams were successful at the second attempt. In the cases where the placement of the LT was not successful at the first attempt the time required for the final and successful placement was nevertheless less than 40 s. During the 10 min resuscitation procedure the hands-off fraction was on average 22.4%. No differences between the two groups were noted concerning the hands-off time (133.5 s for the civilian teams and 134.5 s for the teams of the German Armed Forces). The frequency of chest compressions was above the required 100/min (for the civilian teams 110/min and for the teams of the German Armed Forces 116.5/min).
Conclusion: During military missions of the German Armed Forces there are no other options to perform resuscitation than by performing this procedure with only two rescuers. Using the algorithm in a modified way securing of the airway with an LT, the performance of over-the-head chest compressions and an effective resuscitation with advanced cardiac life support according to the ERC guidelines of 2005 are feasible even with 2 rescuers. Using the LT instead of endotracheal intubation to secure the airway particularly contributed to shortening the hands-off time.