Difficulty with dummy

[Doctor Christmas]

I'm trying to recertify my BLS/ACLS. However I am petite and was unable to successfully get my compressions "counted" by the automatic dummy device that my institution uses to pass us for BLS recertification. What are options to deal with this? I am the size and weight that I am. Even when I used the step stool and put my entire weight on the dummy, it still tells me to press harder. I was literally out of breath and my hands were red. The person who came in to help me "tested" the dummy and he was about 6'3 and close to 300lbs, and the compressions were successfully achieved when he pressed on the dummy.

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[PlutoBoy]

I'm trying to recertify my BLS/ACLS. However I am petite and was unable to successfully get my compressions "counted" by the automatic dummy device that my institution uses to pass us for BLS recertification. What are options to deal with this? I am the size and weight that I am. Even when I used the step stool and put my entire weight on the dummy, it still tells me to press harder. I was literally out of breath and my hands were red. The person who came in to help me "tested" the dummy and he was about 6'3 and close to 300lbs, and the compressions were successfully achieved when he pressed on the dummy.

Push harder. That's the point. Good luck!

 

[Doctor Christmas]

Push harder. That's the point. Good luck!

I physically cannot do so. I have never had this issue. The chest recoils significantly - these are new dummies that they have. I didn't grow or shrink in the last 2 years since my last recertification.

 

[HomeSkool]

You could try jumping on it.

Seriously, I'm not sure what you're looking for here. Put on a couple pounds (preferably muscle) and push harder. With patients getting more and more obese, you're going to have to do stronger and stronger compressions in real life, too. If you want the job, you have to be up to its physical requirements.

 

[gutonc]

I physically cannot do so. I have never had this issue. The chest recoils significantly - these are new dummies that they have. I didn't grow or shrink in the last 2 years since my last recertification.

But you know what did grow in the last 2 years? The average BMI of the real patients you may need to do this on.

Did you ask the instructor what to do? Or your PD? Or GME?

 

[VanDiemen]

There has got to be some sort of technique issue here. You might be pressing in the wrong location, or not keeping your elbows stiff. I have seen tiny 5'0 women do proper dummy compressions with no issues.

 

[hmockingbird]

There has got to be some sort of technique issue here. You might be pressing in the wrong location, or not keeping your elbows stiff. I have seen tiny 5'0 women do proper dummy compressions with no issues.

This. Though I’ve never used a dummy that counts compressions, I’m tiny and have no upper body strength and don’t have issues with dummy compressions. I did at one point and have had people give me tips for technique so maybe ask your instructor for pointers?

 

[Doctor Christmas]

But you know what did grow in the last 2 years? The average BMI of the real patients you may need to do this on.

Did you ask the instructor what to do? Or your PD? Or GME?

I did ask the education person who told me to talk to the BLS/ACLS person, who is this woman who did not care and said well you have to do it on the dummy. It's the VA- VA people don't have much of a mind in terms of thinking of ways of finding solutions to problems.

 

[Doctor Christmas]

This. Though I’ve never used a dummy that counts compressions, I’m tiny and have no upper body strength and don’t have issues with dummy compressions. I did at one point and have had people give me tips for technique so maybe ask your instructor for pointers?

It's an automated thing - it's entirely automated. There is no instructor. It's a program you do through the VA system, and you hit start essentially and start doing compressions on the dummy. There is a voice that says great! or "push harder." I have tried the tips - i used the stool, i put all my weight on the dummy, and nada.

 

[Doctor Christmas]

This. Though I’ve never used a dummy that counts compressions, I’m tiny and have no upper body strength and don’t have issues with dummy compressions. I did at one point and have had people give me tips for technique so maybe ask your instructor for pointers?

I'm 5'0 tall, have small arms and hands, have a h/o muscle disease so not much body strength, and literally put all my weight on this thing - to the point where I was short of breath at the end and still! The dummy's chest was recoiling. I've had small classmates who have also had the same issue. I even have a fellow resident who is much bigger than me and had to do it 10 times before getting a pass.

 

[hmockingbird]

I'm 5'0 tall, have small arms and hands, have a h/o muscle disease so not much body strength, and literally put all my weight on this thing - to the point where I was short of breath at the end and still! The dummy's chest was recoiling. I've had small classmates who have also had the same issue. I even have a fellow resident who is much bigger than me and had to do it 10 times before getting a pass.

Sorry, sounds like my nightmare I’m smaller than you. Can you get certified somewhere else? (Even if you have to pay out of pocket)

 

[deleted480308]

I'm 5'0 tall, have small arms and hands, have a h/o muscle disease so not much body strength, and literally put all my weight on this thing - to the point where I was short of breath at the end and still! The dummy's chest was recoiling. I've had small classmates who have also had the same issue. I even have a fellow resident who is much bigger than me and had to do it 10 times before getting a pass.

I was googling around.....these folks say the force needed might be enough that you could even try compressing with the heel haha. But yeah, you gotta get more force or direct it better....

CPR Details

 

[Doctor Christmas]

Sorry, sounds like my nightmare I’m smaller than you. Can you get certified somewhere else? (Even if you have to pay out of pocket)

I'm trying to see if I can or if I can do the in person class. I think though that the issue is the dummy - I have taken the original class and have recertified - with no significant issue. I think the dummies they have now are different and stiffer. I mean if the chest recoils it should be enough!! I shouldn't have to be Batman to get credit for chest compressions.

 

[Raryn]

I'm 5'0 tall, have small arms and hands, have a h/o muscle disease so not much body strength, and literally put all my weight on this thing - to the point where I was short of breath at the end and still! The dummy's chest was recoiling. I've had small classmates who have also had the same issue. I even have a fellow resident who is much bigger than me and had to do it 10 times before getting a pass.

Honestly, I've done this same recertification before. At a VA. Using the same software. I'm a large male and it took me >1 hour for it to appropriately register my chest compressions/breaths. The dummies had an absurdly bad seal with the mask, and the sensors for compressions were ****. Between the two assessments (BLS and ACLS), I think I did it 15 times. And I'm a man probably twice your size.

My best advice? Off the record? The system is completely automated. There are no cameras. Grab your nearest larger friend you would trust, log into the computer, and have him do the compressions while you get the credit.

On the record? If you want to do it right, sign up for an in person class somewhere. Might have to pay for it though.

 

[Doctor Christmas]

Honestly, I've done this same recertification before. At a VA. Using the same software. I'm a large male and it took me >1 hour for it to appropriately register my chest compressions/breaths. The dummies had an absurdly bad seal with the mask, and the sensors for compressions were ****. Between the two assessments (BLS and ACLS), I think I did it 15 times. And I'm a man probably twice your size.

My best advice? Off the record? The system is completely automated. There are no cameras. Grab your nearest larger friend you would trust, log into the computer, and have him do the compressions while you get the credit.

On the record? If you want to do it right, sign up for an in person class somewhere. Might have to pay for it though.

See! If you are a big dude, and it took you >1 hour to get it, how do you think I would be able to do it? And again I don't think it's my technique. I tried it every possible way and the chest freaking recoils like it should! I'm also not pressing lightly. It counted "0 percent" on compressions! If I was compressing this hard into a real person I would be breaking all their ribs without question, and probably giving them a PTX. Unfortunately there are cameras at my center - in the testing room!! It's a nightmare. I even said fine let me waste my time and do the in person class even though I already did all the online training - and I was told well the VA already paid for you to train so not sure you can do it. It's ridiculous. I don't want to make a huge deal but it's almost discriminatory - again I should not be Batman in order to get through this.

 

[Iso4ane]

Sort of a silly solution, but makes friends with the EMS team and ask to borrow their Lucas Device.

 

[Raryn]

See! If you are a big dude, and it took you >1 hour to get it, how do you think I would be able to do it? And again I don't think it's my technique. I tried it every possible way and the chest freaking recoils like it should! I'm also not pressing lightly. It counted "0 percent" on compressions! If I was compressing this hard into a real person I would be breaking all their ribs without question, and probably giving them a PTX. Unfortunately there are cameras at my center - in the testing room!! It's a nightmare. I even said fine let me waste my time and do the in person class even though I already did all the online training - and I was told well the VA already paid for you to train so not sure you can do it. It's ridiculous. I don't want to make a huge deal but it's almost discriminatory - again I should not be Batman in order to get through this.

Do they review the cameras?

Probably not worth risking regardless.

Sign up for a class out in the community. Lots of AHA certified options around. You may even be able to find one where you bring the online certificate and just do the megacode in person, though I'm not sure how that would work if you did the online portion through the VA.

ACLS and BLS are dumb merit badges anyway. Just figure out a way to get the cards before yours expire. Better to be out some cash and just get to residency graduation.

 

[Doctor Christmas]

Do they review the cameras?

Probably not worth risking regardless.

Sign up for a class out in the community. Lots of AHA certified options around. You may even be able to find one where you bring the online certificate and just do the megacode in person, though I'm not sure how that would work if you did the online portion through the VA.

ACLS and BLS are dumb merit badges anyway. Just figure out a way to get the cards before yours expire. Better to be out some cash and just get to residency graduation.

Yeah, that's what I"m thinking of doing. Today I was thinking - even if it sucks I'd rather just dish out some money, pay for this thing and just present it and call it a day. It sucks that my cards experience 2months before ed of residency but I'd rather do that than not graduate i guess.

 

[rokshana]

It's an automated thing - it's entirely automated. There is no instructor. It's a program you do through the VA system, and you hit start essentially and start doing compressions on the dummy. There is a voice that says great! or "push harder." I have tried the tips - i used the stool, i put all my weight on the dummy, and nada.

so go somewhere else and have it done with an actual person. that way they can judge you and not a dummy.

 

[Raryn]

Yeah, that's what I"m thinking of doing. Today I was thinking - even if it sucks I'd rather just dish out some money, pay for this thing and just present it and call it a day. It sucks that my cards experience 2months before ed of residency but I'd rather do that than not graduate i guess.

It's actually funny whether or not they even notice. I had a cofellow whose merit badges expired in April who still graduated in June just fine because the program never looked. The plan was to just feign ignorance if it ever came up.

Still don't advise that though. The recertification is just a one day class. PITA but better than the 2 day class if yours expires .

 

[Doctor Christmas]

It's actually funny whether or not they even notice. I had a cofellow whose merit badges expired in April who still graduated in June just fine because the program never looked. The plan was to just feign ignorance if it ever came up.

Still don't advise that though. The recertification is just a one day class. PITA but better than the 2 day class if yours expires .

No I have already been notified that I must do this before it expires - I'm on the "list". So they have noticed unfortunately. And if they noticed I'm sure they would make a big deal out of it - I'm sure it would go do as "unprofessional" or some crap like that. Despite the fact that the VA people were incredibly unhelpful and apathetic. Now that's truly unprofessional. I found a groupon deal so that'll be that. Can't wait until end of residency!

 

[Psai]

In real life you will be running the code and other people will be doing the compressions. Outcomes will likely be poor anyway as most patients who code have chronic diseases that they won't recover from.

 

[Doctor Christmas]

In real life you will be running the code and other people will be doing the compressions. Outcomes will likely be poor anyway as most patients who code have chronic diseases that they won't recover from.

No I would actually not be running a code at all. I'm not in a primary/surgical type specialty so in the rare event that one of my patients coded, I would call a rapid response and/or code team.

 

[AdmiralChz]

No I would actually not be running a code at all. I'm not in a primary/surgical type specialty so in the rare event that one of my patients coded, I would call a rapid response and/or code team.

You say that, but you never know where you will be when someone has a spontaneous cardiac arrest particularly outside of the hospital. Push hard and fast, it saves lives. You're a doctor, you should be expected to know how to run a very basic code.

 

[WingedOx]

Honestly, I've done this same recertification before. At a VA. Using the same software. I'm a large male and it took me >1 hour for it to appropriately register my chest compressions/breaths. The dummies had an absurdly bad seal with the mask, and the sensors for compressions were ****. Between the two assessments (BLS and ACLS), I think I did it 15 times. And I'm a man probably twice your size.

My best advice? Off the record? The system is completely automated. There are no cameras. Grab your nearest larger friend you would trust, log into the computer, and have him do the compressions while you get the credit.

On the record? If you want to do it right, sign up for an in person class somewhere. Might have to pay for it though.

Does your facility accept outside certifications? I work at a VA and always just find a class closer to where I actually live, and it's only 2 hours and 50 bucks, but whatever.

 

[Raryn]

Does your facility accept outside certifications? I work at a VA and always just find a class closer to where I actually live, and it's only 2 hours and 50 bucks, but whatever.

AHA certified ACLS is the same everywhere.

The big question mark would be if you took a cheaper red cross course or something. Most hospitals won't accept those. Gotta pay your dues to the AHA.

 

[WingedOx]

AHA certified ACLS is the same everywhere.

The big question mark would be if you took a cheaper red cross course or something. Most hospitals won't accept those. Gotta pay your dues to the AHA.

Yeah, brainfart on my part, I (probably wrongly) assumed the dummy stuff was BLS.

 

[Bobblehead]

That BLS/ACLS dummy is extremely unforgiving with regards to ventilation and chest compressions. It wants both exactly as it wants it and there's nothing you can do about it besides do as it says. Lower the stretcher as low as possible, get a taller step stool from somewhere and make sure your shoulders are directly over the compression point. If a taller step stool isn't going to happen you can climb on top of the stretcher with the dummy, just make sure your upper body and shoulders are directly over the dummy.

That being said, that dummy is the best thing to use for BLS/ACLS requalification because you can literally do it any time of the day and there is no scheduled session you need to attend, just the online training and then the practical part on the dummy.

 

[hmockingbird]

So I just recertified BLS and they had that dummy, but an instructor too. I wasn’t able to get it to count without the instructor helping me. I feel like it literally wants you to get all the way to the ground. I also feel like there’s a certain amount of body weight it needs that just doesn’t happen for some people as the instructor told me lots of people have issues with the dummy. I had good chest recoil and the instructor told me my technique was good/compressions looked adequate so passed me on that. I literally am not sure if I could get it to count if I stomped on it!!! Lol. So I’d definitely try to do the class with an instructor if possible! Also they had a baby one and I got that to work lol.

ETA: I also read an article a few months ago which was about disability accommodations in med school and one of them was adjusting the technical standards. One of the things mentioned was that there are lots of 5’ women who may not be doing as good compressions as someone larger but nobody prevents them from being doctors even though... do they actually meet the standards? So one of the things some schools were doing it was to have it say “perform or direct BLS” instead of just “perform BLS”.

 

[Doctor Christmas]

So I just recertified BLS and they had that dummy, but an instructor too. I wasn’t able to get it to count without the instructor helping me. I feel like it literally wants you to get all the way to the ground. I also feel like there’s a certain amount of body weight it needs that just doesn’t happen for some people as the instructor told me lots of people have issues with the dummy. I had good chest recoil and the instructor told me my technique was good/compressions looked adequate so passed me on that. I literally am not sure if I could get it to count if I stomped on it!!! Lol. So I’d definitely try to do the class with an instructor if possible! Also they had a baby one and I got that to work lol.

ETA: I also read an article a few months ago which was about disability accommodations in med school and one of them was adjusting the technical standards. One of the things mentioned was that there are lots of 5’ women who may not be doing as good compressions as someone larger but nobody prevents them from being doctors even though... do they actually meet the standards? So one of the things some schools were doing it was to have it say “perform or direct BLS” instead of just “perform BLS”.

My compressions and chest recoil were perfectly adequate. The dummy's chest was moving in a perfectly adequate fashion so it should count. Clearly lots of people have difficulty with this so it's telling us something.

 

[sliceofbread136]

No I would actually not be running a code at all. I'm not in a primary/surgical type specialty so in the rare event that one of my patients coded, I would call a rapid response and/or code team.

So you would call the code and just stand there?

 

[NotAProgDirector]

My compressions and chest recoil were perfectly adequate. The dummy's chest was moving in a perfectly adequate fashion so it should count. Clearly lots of people have difficulty with this so it's telling us something.

To be fair, you thought the chest was moving adequately. Most studies of CPR demonstrate that we don't compress deeply enough. So maybe the dummy was actually "correct"? There's no way to know without calibrating the dummy.

If you have a medical muscle weakness issue, you probably could request ADA accommodations around this, although this should be your LAST option. If your program were to consider BLS as an "essential function", you end up in a bit of trouble.

 

[killerleaf]

To be fair, I do not know the setup where you are doing this test, but could you put the dummy on the floor, for more leverage? I mean, in the "wild" aren't most people you would be doing ACLS on be on the ground?

 

[swoopyswoop]

No I would actually not be running a code at all. I'm not in a primary/surgical type specialty so in the rare event that one of my patients coded, I would call a rapid response and/or code team.

What field are you in that you wouldn't run a code? Sure, the ICU team can take over when they get there but you will at some point be in a situation where you are the only person around and need to do compressions, or you're the only doctor around and need to intellectually run the code while others do compressions.

 

[Raryn]

What field are you in that you wouldn't run a code? Sure, the ICU team can take over when they get there but you will at some point be in a situation where you are the only person around and need to do compressions, or you're the only doctor around and need to intellectually run the code while others do compressions.

My father is a psychiatrist. He works at a stand alone inpatient psych facility. I asked him at one point what he would do if he walked in on a pulseless patient. His answer was he would tell the nurses to call an ambulance. Then he went back and said that he also presumed the nurses might do chest compressions.

Pretty sure the last time he was ACLS certified was a few decades ago in residency.

A huge proportion of physicians do not work in a hospital setting. Many of them aren't ACLS certified.

 

[mvenus929]

My father is a psychiatrist. He works at a stand alone inpatient psych facility. I asked him at one point what he would do if he walked in on a pulseless patient. His answer was he would tell the nurses to call an ambulance. Then he went back and said that he also presumed the nurses might do chest compressions.

Pretty sure the last time he was ACLS certified was a few decades ago in residency.

A huge proportion of physicians do not work in a hospital setting. Many of them aren't ACLS certified.

A huge portion work in hospitals and are not advanced life support trained. Our faculty is not required to be PALS certified, which scares me a little.