Team work During a resuscitation effort, an interdisciplinary

team works together to provide coordinated patient

care.
Team work helps to ensure that he patient’s many
needs are met throughout the resuscitation effort.
 chest compressions,

Essential tasks ECG monitoring and defibrillation,

that must be
coordinated airwaymanagement,
during a
resuscitation Vascular access and medication administration,

effort include
and documentation of the events of the code.

The American College of Critical Care Medicine recommends that a

family support person be a recognized member of the code team
The size of a resuscitation team, also called a
code team, and the skills of each team member
vary.
 In the prehospital setting, emergency
medical technicians (EMTs) and
paramedics often work in teams of two
to four.

The number varies depending on the

environment in which the EMT or
paramedic works.
In the hospital setting, a predesignated
resuscitation team should be available 24 hours
a day, 7 days a week. It is estimated that 77% of
U.S. hospitals have a predesignated
resuscitation team, but nearly one-quarter do
not Kronick, et al., 2015
 It is important to know how to use apiece of equipment before
using it in an emergency

It is important to know, learn, and practice your facility’s code

procedure and to learn what is expected of you as a member of the
resuscitation team.

Frequent (eg, monthly) practice using methods such as simulation-

based mock codes is needed to minimize errors, maintain skills, and
optimize patient outcome (Morrison, et al., 2013).
 team leader
IF MORE THAN ONE PERSON ATTEMPTS TO THE PERSON INCHARGE OF THE
MAKE DECISIONS REGARDING THE PATIENT’S RESUSCITATION EFFORT IS TYPICALLY CALLED
CARE, CONFUSION WILL RESULT. THE CODE DIRECTOR OR TEAM LEADER.
In the prehospital setting, resuscitation
efforts are usually led by a paramedic or
nurse who operates understanding physician
orders, local protocols,or both

In the hospital setting,the team leader is

usually a physician who is experienced in
cardiac arrest management.
 Because research has shown that team leaders
who perform hands-on tasks in an emergency
are less likely to be efficient leaders, the team
team leaders leader should be in a position to “stand back” to
view and direct the resuscitation effort
(Hunziker, et al., 2011).
team leaders
AS THE TEAM LEADER, IT IS ESSENTIAL THAT YOUR
MANNER, ATTITUDE, WORDS, AND SKILLS BE
PROFESSIONAL THROUGHOUT THE RESUSCITATION
EFFORT.
IT IS BEST TO SPEAK IN A CALM AND CONFIDENT
TONE TO THE MEMBERS OF YOUR TEAM USING
TERMS THAT ARE KNOWN AND SHARED BY ALL
TEAM MEMBERS.
A GOOD TEAM LEADER VALUES HIS OR HER TEAM
MEMBERS, FOSTERS AN ENVIRONMENT IN WHICH
TEAM MEMBERS FEEL COMFORTABLE SPEAKING
UP, AND ENCOURAGES A RESPECTFUL EXCHANGE
OF IDEAS.
organizes group, monitors individual provides support, is prepared to
performance, preform the roles of
members,
Role of team
leader
models excellent trains and coaches, facilitates focuses on
team behavior, understanding, comprehensive
patient care
Receives a concise history of the eventand care given, when
applicable

Instructs the team to perform high-quality chest

compressions and evaluates the adequacy of chest
compressions including hand position, depth of cardiac
compressions, proper rate, and ratio of compressions to
team leader
ventilations.

Directs the team to administer appropriate oxygen therapy

to the patient throughout the resuscitation effort.
Instructs the team to perform
defibrillation, when indicated, and ensures
that it is performed safely and correctly.

Instructs the team to establish vascular

access (IV or IO). team leader

Orders the administration of the correct

medications, doses, and routes for the
dysrhythmia.
 Considers baseline
Considers placement of laboratory values and
an advanced airway; other relevant data if
necessary.

Directs reassessment of Monitors the

the patient’s response to
interventions
performance of team
members.
team leader

Ensures family
notification of
resuscitation events.
Problem-solves Directs post–cardiac arrest care
when there is a ROSC. Decides
Provides an opportunity for team
members to be involved in a team
team leader
when to terminate resuscitation debriefing or reflection on the
efforts (in consultation with team resuscitation effort after the
members), when there is no event.
response to resuscitation efforts
after a reasonable period.
awareness of roles of team members
will help
Team Member
Responsibilities
awareness of the actions that will be
performed next, how to communicate
and work as a member of the team
 be clear about role assignments,

prepared to fulfill role responsibilities,

Role of team
member well practiced in resuscitation skills,

knowledgeable about the algorithms,

committed to success
Role of team In the prehospital setting, paramedics must be familiar with
the location of all medications in their drug box and the
member resuscitation-related equipment in their emergency bags and
vehicles, if applicable.
The team member responsible for CPR
must be able to properly perform CPR and provide chest compressions of adequate rate, force,
and depth in the correct location.
The team member responsible for ECG
monitoring and defibrillation
• Operate an AED and a manual defibrillator.
• Properly place handheld defibrillator paddles and combination adhesive pads.
• Consider the necessary safety precautions when performing electrical therapy.
• Solve problems with regard to equipment failure.
The team member responsible for airway
management
• Perform the head tilt–chin lift maneuver and the jaw thrust without neck extension maneuver.
• Correctly size and insert an oral airway and a nasal airway.
• Correctly apply and understand the indications, contraindications, advantages, disadvantages,
complications, liter flow ranges, and concentrations of delivered oxygen for oxygen delivery
devices, including the nasal cannula, the simple face mask, the pocket mask, the nonrebreathing
mask, and the bag-mask device (BMD).
The team member responsible for airway
management
• Suction the upper airway by selecting an appropriate suction device and catheter and by using
correct technique.
• Know the indications, contraindications, advantages, disadvantages, complications,
equipment, and techniques for the insertion of an advanced airway, if this is within his or her
scope of practice.
• Know how to confirm the placement of an advanced airway.
• Know how to use waveform capnography, an exhaled carbon dioxide detector, and an
esophageal detector device.
• Know how to properly secure an advanced airway.
The team member responsible for vascular
access and medication administration
must be familiar with the location of the emergency medications, IV fluids, and related supplies
that may be used during a resuscitation effort.
This team member prepares and labels the medications and IV fluids used during the code as
directed by the team leader.
The team member responsible for ECG
monitoring and defibrillation
the site of first choice for vascular access
• The procedure for performing IO access in an adult.
• The importance of following each medication given during a cardiac arrest with a 20 mL IV
fluid bolus and brief elevation of the extremity.
• The routes of administration and appropriate dosages for IV, IO, and tracheal resuscitation
medications.
Team Dynamics
Clear Roles and Responsibilities
■ Team leader
■ Chest compressor
■ Airway manager
■ Monitor-defi brillator operator
■ IV/IO access and medication administrator
■ Observer/recorder
■ If there are fewer than six team members, all the roles must still be performed, requiring some
team members to perform more than one. The team leader should clearly assign the roles to team
members within their scope of practice and level of competence or expertise.
■ Team members must clearly inform the team leader if they are unable to perform their assigned
roles.
Clear Messages
■ The team leader and team members should speak calmly, and loudly enough to be heard
without shouting .
■ One person should speak at a time to avoid confusion, miscommunication, and error, and
should look directly at the person for whom the communication is intended.
■ Team members should validate orders by repeating them, and should question any ambiguity
or doubt about an order.
Closed-Loop Communication
■ The team leader should order one task at a time (e.g., “Give epinephrine 1 mg IV”) and seek
confirmation that the order was received and implemented.
■ The team member should confirm that the task was performed (e.g., “epinephrine 1 mg IV
given”).
Knowledge Sharing
Team members possess knowledge, skills, and expertise and should provide helpful suggestions
during a code.
■ If resuscitative efforts remain ineffective, the entire team should go back to the basics, review
what has been done so far, and determine whether anything has been missed.
■ The team leader should ask for suggestions and ideas, collaborate with team members to
evaluate suggestions, and decide whether to act on them or not.
Mutual Respect
An effective team works collaboratively in a friendly, and supportive manner.
Team members must:
■ Demonstrate mutual respect when interacting.
■ Speak in controlled voices, avoiding yelling and aggressive or demeaning behavior.
The team leader should express gratitude for good performance.