Thursday, March 17, 2016

Leg-Heel CPR for nurses with disabilities...Why not?

Some nurses and nursing students with disabilities are unable to perform CPR with two hands (nurses with one hand or arm, cerebral palsy, or paralysis). 

Responses to requests for disability-related accommodation for CPR classes can vary from one instructor/provider to another.

Should we consider the leg-heel method as a reasonable accommodation?

Positive results of a pilot study of the “leg-heel method” were reported in JAMA 38 years ago (Billfield & Regula (1978).

In 2012, Fernando Perez, MD, and Robert H. Trenkamp, Jr., EMT-P, presented their research findings at the American Heart Association Resuscitation Science Symposium. Perez & Trenkamp studied the duration an adult could maintain two-inch deep chest compressions at a rate of at least 100 per minute using “Hands-Only” and then Pedal Compressions (“Heel CPR”) in two sequential tests (SCAF, 2012). 

"The test subjects were all 35 years old or older, and half of the cohort was between 50-80 years old. Fewer than 20 percent of the cohort was able to perform two-inch manual chest compressions for four minutes at the required one hundred per minute or higher rate.

In contrast, more than 60 percent of study participants were able to perform two-inch pedal compressions for 10 minutes at that rate—and those subjects felt that they could easily perform adequate depth and rate pedal compressions for another extended period, if necessary." 

In an article published in the American Journal of Emergency Medicine, Trenkamp & Perez (2015) "reported that heel compressions are useful in situations where a lone rescuer cannot get down on the floor, cannot compress the chest to guideline depth because of an infirmity or lack of weight, or becomes too tired to continue manual compressions. Heel compressions significantly increase the bystander population's ability to provide effective, uninterrupted compressions until EMS arrival."

Do these findings merit a closer look?

Could this approach to CPR be considered as a reasonable accommodation for CPR certification for some nurses with disabilities? For example, nurses working in home health or community settings? 

Would a write-in campaign to the American Heart Association and American Red Cross help?

Appreciate reading your comments about this important topic.


Billfield, L., Regula, G. (1978). A new technique for external heart compression.  Journal of the American Medical Association, 239(23): 2468-2469. doi:10.1001/jama.1978.03280500064023.

Durham, J. (2013). CPR Pedal-Heel Compressions. Frontline First Aid and Emergency Training.

Trenkamp, R., Perez, F. (2015, October).  Heel compressions quadruple the number of bystanders who can perform CPR for 10 minutes. The American Journal of Emergency Medicine, 33(10):1449-1453. Retrieved at

Sudden Cardiac Arrest Foundation (SCAF) (2012) Can heel CPR help?

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