Lucas 3

Palm Beach County Fire Rescue Medical Services Division has been able to secure some funding through a grant to also obtain Lucas III devices for every ALS unit, whether it's an engine or a rescue. So the good news is, is that there will now be a Lucas 3 on every engine on every rescue here in Palm Beach County Fire Rescue. This is going to be a big help for a lot of those units that are already on scene. You're waiting for a rescue to show up and you can get this Lucas device put on to give us consistent chest compression. That's a big deal. However, we cannot put the Lucas device on until we at least get hands on the chest manual compressions first and get that first shock delivered if it's indicated. Obviously, if the patient's in asystole, we're not going to shock that rhythm. So we're going to go ahead, dump the monitor and, and then we'll apply the Lucas. So I'd like to take a minute now that these Lucases are going to be showing up on your engines here in the next few weeks. We've already received them in the shop. We're getting ready to send them out. So now that they're going to be showing up on the engines, I like to just kind of go over this as a reminder on how this is supposed to work. So you can just press the alarm button and it'll give you a quick digital readout on the battery status. The other thing you can do is you can turn this on while it's in there. Allows it to go through its self check and open it up when we're trying to shave seconds. Because every second matters, every second truly matters. So let's go over the Lucas 3 device and how this works. First off, let's start with a back plate. The back plate right here. As you can see, it's got a diagram to shows you where this needs to be placed. This will fit with the combi board in the back. As you can see the curve, that's what it's intended for. Quick diagram to show you how this is supposed to be centered. Remember, these are the clips. This goes underneath the patient's armpits. And this is the back plate. Let's go over, let's go over the controls on the Lucas 3. So the Lucas 3, this is your power button. You see the green button. I'll go ahead and turn it off. It's already on right now. That's the power down sound that it's going to make. It's a little chime when and Just as a reminder, if you press the alarm button, it'll give you a battery readout. Now, I turn it on and you're going to hear a chime, and you're going to see the Lucas reset itself. That's important. That's a little self check that it's going to go through as we move across here. This is just to silence alarms. There's really no need to silence our alarms. There is a wireless Bluetooth module that we are not utilizing this feature in Palm Beach County Fire Rescue, but there is a wireless feature that there's some technology that can be applied to this. Let's talk about steps 1, 2, and 3. If there's any confusion. 1, 2, 3. This is how you should be applying this. So the first and most important thing is whenever you place this on the patient, I have the back plate.

Underneath the patient. And I go to clip this in. I need to press this yellow button. As you can see, the light is the indicator light is already lit up. And what this does is this allows me to adjust the plunger. By putting the plunger on the chest, The Lucas device now knows how far it needs to compress. When you don't put this down on the chest prior to pressing play, it doesn't do effective chest compressions. So you have to manually set the depth by doing this. Now, when I go to number two, you can see obviously in the sequence go from one to two. When I press two, you can actually flip. Feel this Lucas device lock in place. That locks this so that it knows this is how far we need to compress. So we don't go from 1 to 3, we go from 1 to 2 to 3. That locks into place. We are not utilizing 30 to 2. This feature. Down here, we're going to go to straight, continuous chest compressions. And by pressing play, you go ahead and hear this starting to work.

If I need to pause it, I press the pause button. Press play again. If for some reason I need to readjust because the plunger is not in the right position, in order for me to move this up and down. Remember, I locked it by pressing number two. In order for me to move this up and down, I need to press the number one. That's going to disengage the hydraulic piston. Now, I can put this where it needs to go. If I push this too far down, you hear this sound. That means that this patient's too small for the Lucas. The plunger is extended all the way. It cannot compress anymore. So I'll need to lift this back up. As soon as I get this into an acceptable range, you'll hear that alarm go away. So that's one of the indicators. Remember, there's no contraindications for the Lucas device other than the patient doesn't fit in the Lucas. So if the patient is too obese, you're not going to even be able to put the patient in this. But if the patient is too small, meaning it's a child, and maybe they're not quite. They haven't hit puberty yet, and so the base on their body habitus, they just don't fit for this. You'll know whenever you go to push this down. Hey, this is not going to fit this patient. All right, assuming the patient fits, we're good. We're going to readjust this, lock it in, and we'll press play. Now, the feature of the Lucas 3 that makes this thing so good is that at a minute and 55 seconds, it's going to chime. That chime is intended to be a reminder that a minute 55 has gone by. We need to pause. We need to assess for a rhythm and a shockable rhythm. This is key. So let's talk about this peri shock pause and the sequence. We got to get this right. So if I have a patient, we're running a code, and that chime goes off, the person at the monitor position needs to charge the monitor to the setting that's indicated for that patient. Charge the monitor, and they need to be prepared to deliver that shock. So when the monitor is charged, we know our two minutes have gone by. We press pause. Let's go ahead and simulate this. It's compressing. Monitors charged. Go ahead and press pause. What is that rhythm? If it's a shockable rhythm.

Just hit play. We can shock right through the Lucas. We do not need to pause the Lucas to deliver a shock. If it's asystole, just hit play. We do not need to deliver a shock if they're in asystole. So the peri. Shock pause needs to look just like this. We're trying to make sure that. That we eliminate hands off the chest time. We want to make sure that we keep this to less than five seconds. And by doing it in this sequence, you can actually reduce the amount of time that we have. Hands off the chest. That's an important teaching point. So again, once this patient, we've determined that they're in a shockable rhythm. Press play. Go ahead and deliver that shock right through the Lucas. So now I'm going to Grab a mannequin, and we're just going to talk about how to put this in, how to lock it in place, and then we'll talk about a couple more teaching points and wrap this up. When I go to put the back plate on, we like to get the back plate underneath the patient's head so that whenever we raise the patient, we can slide it underneath. Now, obviously, this is a mannequin, and real patients are much heavier. I understand all of that.

And most patients, we don't need to put their arms up like this, but the mannequins, we do because they don't have actual bending elbows. Okay, so back plates in position. Hands are on the chest. This is going on. We haven't stopped compressions yet. First shock has already been delivered or either dumped. But the fact is that it's time to put the Lucas on now. So now that we got the Lucas ready to go, let's talk about the best way to employ this when you go to put this on. If I pull on these yellow triggers here.

It makes it a little bit easier for this to lock in place. If I'm actually the one that's going to be controlling the Lucas, I like to have the control module facing me, but for the sake of the video, I'll turn it towards you so that you can see what we're doing here.

So when I go to clip this in, I want to clip this side first. Okay. And you'll hear it lock in just. Just like we did. Now imagine there's hands on the chest. We've been doing this like this for years, so nothing is really going to change. We're going to go right through the compressor's arms. We're not going to miss. We're not going to miss any chest compressions. Now I want to center this right away. Take an extra moment to adjust the Lucas early on. Remember, if this is compressing over the stomach, it's not compressing the heart, so it needs to be at the center of the sternum in between the nipples. That really is your goal. The back plate shows you that example, just in case you forget. So let's go through our sequence. Number one, I'm going to push the plunger down till it touches the patient's chest. Number two, I'm going to lock it into position so that it doesn't move and that I can maximize the chest compressions of this device. Number three is I'm going to press continuous chest compressions. That's it. Now it's a good idea to go Ahead and put the patient's arms.

In these wrist straps. That's important. By putting the patient's arms in these wrist straps, then it keeps this device from moving forward and migrating towards the head.

The next and most important thing is to go ahead and throw the neck strap on the patient. So we're going to place this neck strap right behind the patient's head. And as you see, it's got some quick connects right here.

And we're going to make this connection.

Same thing on the other side. We're going to make this connection. The idea here is that this is going to keep the Lucas from migrating south. By putting it inside the axilla, it keeps it from going north and helps maintain it in the right position. Now, one of the things that we're hearing right now is this chime. Every so many seconds, you're hearing a chime. What that's doing is it's telling you when it's time to ventilate. So this is going to be chiming every one breath every 10 seconds. So the person that's delivering the breaths at the airway is not doing it too much, they're not doing it too slow. They're doing it at just the right amount of time. So when you hear the chime, go ahead and squeeze the bag. When you hear the chime, go ahead and squeeze the bag.

The next chime that you're going to hear is you're going to hear at 1 minute, 55 seconds, you're going to hear the chime go off. To tell you that we are nearing the two minute mark. It's time to check for a shockable rhythm. Okay, so we're not just pausing, we're checking for a shockable rhythm. Okay, there it is.

You're hearing that now. We are at 1 minute and 55 seconds. It's time to pause. I'd have the monitor ready to go. Charge the monitor to the desired setting based on the protocol. When the monitor's charged, pads are applied, pause. What is the rhythm? If that's a shockable rhythm, press play. Go ahead and deliver the shock after you press play. If the monitor is charged, go ahead and pause the Lucas. That's a Sicily. We're not shocking that. Go ahead and press play. Okay, so that's the system. That's the sequence that we want to utilize for the Lucas 3. So last but not least, when we're placing this Lucas, if you happen to notice that this is migrating to the south or towards the head, you got to stop and fix it right away. Chest compressions that are done on the wrong side don't help anything. Chest compressions that are not done directly over the sternum can actually have adverse effects. Hand positioning is crucial. Lucas positioning is crucial towards maximizing cardiac output and cardiac arrest. So you can look forward to seeing the Lucas three coming to the trucks very soon. If you do have any questions reach out to your EMS captains. They've been trained on this. They understand and these have been on the rescues for quite some period of time. So you can obviously start familiarizing yourself with it now and once they get out there, put it on the engine. I think we're going to save a lot of lives by changing how we do things just a little bit. Every time we do something like this we aim to get a little bit better, shave off a few more seconds and maximize everything that we do obviously for the good of the patient. Thank you so much for your time. Stay safe.