CPR performed in battlefield emergency care


military medical personnel

How to Cite

Abelsson A, Lundberg L. CPR performed in battlefield emergency care. Australasian Journal of Paramedicine [Internet]. 2019Feb.4 [cited 2022Jul.3];160. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/610



During military missions medical care is provided to military personnel as well as civilians. Although cardiopulmonary resuscitation (CPR) may not be a common task in a military field hospital, all personnel need to be trained to deal with cardiac arrest.


This study was a comparative simulation study. Participants (n=36) from the Swedish armed forces performed CPR for 2 minutes at one of three different locations: at ground level, a military bed, or a transportable military stretcher. Compression depth and rate after 2 minutes of CPR and at the time of the participants’ own request to be relieved were measured. Descriptive and inferential analysis was conducted.


There is a direct correlation between compression depth and working level, concluding that the higher working level, the lower the compression depth. There is in total an overall low percentage of participants within limits for correctly conducted CPR regarding both compression depth and rate. Time to fatigue is related to working level, where increased level results in early fatigue.


The quality of CPR is affected by the level at which it is performed. The quality of CPR was satisfactory when working at ground level, but suboptimal when working at hospital bed level or military stretcher level. When working at raised levels, participants appeared to misjudge their own compression depth and rate. This may indicate that changes are needed when CPR is practised in the military hospital setting. Future studies regarding the use footstools are required due to the height of military beds and transportable stretchers.



Mozaffarian D, Benjamin EJ, Go AS, et al. Stroke statistics subcommittee. Heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation 2016;133:e38-360.

Merchant RM, Yang L, Becker LB, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med 2011;39:2401-6. doi: 10.1097/CCM.0b013e3182257459.

Soar J, Nolan JP, Böttiger BW, et al. European Resuscitation Council Guidelines for Resuscitation. Section 3. Adult advanced life support. Resuscitation 2015;95:100-47. doi: 10.1016/j.resuscitation.2015.07.016

Escott MEA. Traumatic cardiac arrest survivability is possible. JEMS 2016;July:82-3.

Monsieurs GK, Nolan JP, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation. Section 1. Executive summary. Resuscitation 2015;95:1-80. doi: 10.1016/j.resuscitation.2015.07.038.

Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:414-35. doi: 10.1161/CIR.0000000000000259.

Stiell IG, Brown SP, Christenson J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012;40:1192-8. doi: 10.1097/CCM.0b013e31823bc8bb.

Smart JR, Kranz K, Carmona F, et al. Does real-time objective feedback and competition improve performance and quality in manikin CPR training: a prospective observational study from several European EMS. Scand J Trauma Resusc Emerg Med 2015;15:23. doi: 10.1186/s13049-015-0160-9.

Wutzler A, Bannehr M, von Ulmenstein S, et al. Performance of chest compressions with the use of a new audio-visual feedback device: a randomized manikin study in health care professionals. Resuscitation 2015;87:81-5.

Field RA, Soar J, Davies RP, Akhtar N, Perkins GD. The impact of chest compression rates on quality of chest compressions: a manikin study. ibid. 2012;83:360-4.

World Medical Association. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013;310:2191-4. doi: 10.1001/jama.2013.281053.

Sonesson L, Boffard K, Lundberg L, Rydmark M, Karlgren K. The challenges of military medical education and training for physicians and nurses in the Nordic countries – an interview study. Scand J Trauma Resusc Emerg Med 2017;25:38.

Heldal I, Backlund P, Johannesson M, Lebram M, Lundberg L. Connecting the links: narratives, simulations and serious games in prehospital training. Stud Health Technol Inform 2017;235:343-7.

Vadeboncoeur T, Stolz U, Panchal A, et al. Chest compression depth and survival in out-of-hospital cardiac arrest. Resuscitation 2014;85:182-8. . doi: 10.1016/j.resuscitation.2013.10.002.

Yun SW, Lee BK, Jeung KW, et al. The effect of inclined step stool on the quality of chest compression during in-hospital cardiopulmonary resuscitation. Am J Emerg Med 2014;32:851-5. doi: http://dx.doi.org/10.1016/j.ajem.2014.04.008

Hong CK, Park SO, Jeong HH, et al. The most effective rescuer's position for cardiopulmonary resuscitation provided to patients on beds: a randomized, controlled, crossover mannequin study. J Emerg Med 2014;46:643-9. doi: 10.1016/j.jemermed.2013.08.085.

Kampmeier TG, Lukas RP, Steffler C, et al. Chest compression depth after change in CPR guidelines – improved but not sufficient. Resuscitation 2014;85:503-8. doi: 10.1016/j.resuscitation.2013.12.030.

Shin J, Hwang S-Y, Lee H-J, et al. Comparison of CPR quality and rescuer fatigue between standard 30:2 CPR and chest compression-only CPR: a randomized crossover manikin trial. Scand J Trauma Resusc Emerg Med 2014;22:59.

Jo CH, Cho GC, Hwan J, et al. Rescuer-limited cardiopulmonary resuscitation as an alternative to 2-min switched CPR in the setting of inhospital cardiac arrest: a randomised cross-over study. Emerg Med J 2015;32:539-43. doi: 10.1136/emermed-2013-203477.

Foo NP, Chang JH, Lin HJ, et al. Rescuer fatigue and cardiopulmonary resuscitation positions: a randomized controlled crossover trial. Resuscitation 2010;81:579-84. doi: 10.1016/j.resuscitation.2010.02.006.