Founder and CEO of CodePRep, Susan Davis

Susan Davis is a class act. She's also a doctorally-prepared nurse and CEO of Code PRep, an in-hospital cardiac arrest mock code training program that helps teams prepare, execute, and evaluate codes more effectively. Now, I opened with Susan is a class act, and let me explain. Susan and I recorded an entire 1-hour podcast episode, or at least I thought we recorded. There was just one small problem, I never hit the record button. It pained me to tell Susan that we had nothing. Our episode was flatline. Susan did not skip a beat and graciously agreed to give her precious time to do Susan and Michelle 2.0. Our second conversation was equally as memorable as our first. We discussed the challenges of running a code, teamwork, egos, and that darn defibrillator. Why are we all scared of the defibrillator? But Susan makes it as easy as one, two, three. Really, it's that easy! Our conversation is full of useful information to make saving lives more efficient with better outcomes. And as Susan says, outcomes equal people. In the five-minute snippet, I see a Game of Thrones remake. 
Susan's LinkedIn
RescueRN
The Rescue RN YouTube
Code Prep CPR Instagram
NTI 2024 AACN Conference
CASAhearts – Cardiac Arrest Survivor Alliance
Parent Heart Watch | Sudden Cardiac Arrest In Youth Prevention | SCA
Home | Sudden Cardiac Arrest Foundation (sca-aware.org)
Homepage - Citizen CPR
Susan's bio and contact info

Contact The Conversing Nurse podcast
Instagram: https://www.instagram.com/theconversingnursepodcast/
Website: https://theconversingnursepodcast.com
Your review is so important to this Indie podcaster! You can leave one here! https://theconversingnursepodcast.com/leave-me-a-review
Would you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-form
Check out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast
Email: theconversingnursepodcast@gmail.com
Thank you and I'll talk with you soon!

Transcript

[00:00] Michelle: Susan Davis is a class act. She's also a doctorally-prepared nurse and CEO of CodePRep, an in-hospital cardiac arrest mock code training program that helps teams prepare, execute, and evaluate codes more effectively. Now, I opened with Susan is a class act, and let me explain. Susan and I recorded an entire 1-hour podcast episode, or at least I thought we recorded. There was just one small problem. I never hit the record button. It pained me to tell Susan that we had nothing. Our episode was flatline. Susan did not skip a beat and graciously agreed to give her precious time to do Susan and Michelle 2.0. Our second conversation was equally as memorable as our first. We discussed the challenges of running a code, teamwork, egos, and that darn defibrillator. Why are we all scared of the defibrillator? But Susan makes it as easy as one, two, three. Really? It's that easy? Our conversation is full of useful information to make saving lives more efficient with better outcomes. And as Susan says, outcomes equal people. In the five-minute snippet, I see a Game of Thrones remake. 

[01:43] Susan: Michelle, long time, no see. Right?

[01:46] Michelle: I'm like, what else could happen?

[01:48] Susan: I'm not worried about it. Oh, look, don't worry about it. I think it's funny because, I mean, you know, ultimately, the proverbial dootie happens, and that's just how we got a roll.

[02:00] Michelle: Yep. It's all how you handle it. I was completely heartbroken yesterday. It happened one other time, and it was because the process changed. And, you know, we can talk about that because there's a lot of automation in what you do and in code teams. Right. And when you change one little thing, it kind of throws people off, like, all the new regulations that come out when they change CPR and all that stuff. And you're like, wait, do we still do this many compressions to that? You know, is it still one person? So, yeah. But anyway, thank you so much for coming back on. And I am recording. So I do see the red light flashing, saying, recording. I'm like, yay.

[02:49] Susan: Deal.

[02:51] Michelle: All right, ready to go 2.0. I love that.

[02:55] Susan: Yes, we are. Yes, we are. I'm ready to ride Clyde.

[03:00] Michelle: All right, I'll tell you what. I'm just going to start right now, and I might leave this whole intro in, so. Because, you know, like you said, dootie happens.

[03:12] Susan: It's just the way it works. And if we do not pick ourselves up and push ourselves forward, what's the alternative, Michelle?

[03:19] Michelle: Right? We won't get your message out. And we can't afford not to because you have a great message. So why don't you start by just telling us your story, what you've done, what you're doing now?

[03:37] Susan: Okay, so let me see. I am a critical care nurse with experience and trauma, emergency, and some cardiac. I did get my medic license back in the day, so for to do some flight, actually. And I really, really love that. However, both my daughter and my mother were certain I was going to die every single time I went up. And the stress of that was killing me, killing them. My sons were like, high five, mom, you're the bomb. So I didn't do much of that, even though I very much enjoyed it, was a goal of mine. So I did that speed up to today. I am now the resuscitation education manager for a healthcare system in South Florida. I'm also their system code blue chair. I am also the code blue chair for our community Heart Safe initiative, which is something put on by the Citizen CPR Foundation. And that is a huge community effort, but I have a feeling we'll get into that. And from there, I am a member of the ROSC. It's a ROSC group here, which is. Anyway, all. No matter how you wrap it up, my big soapbox is the first. It literally comes down. You want to know, a niche, Michelle? My niche is the first two to six minutes of cardiac arrest. And I don't care whether it's in your living room, at the airport, or at your job, ICU or inpatient, outpatient rehab, long long-term care. I don't care. It's the same. So that's my deal.

[05:10] Michelle: I love it. I love your deal. And I share your family's anxiety about flying. You know, I shared yesterday that my sister flew for many, many years, and I always offered up a prayer every time I knew she was flying. Because for us, you know, the regular people, not the superstars like the flight nurses, you guys are, it scares the crap out of us.

[05:41] Susan: So it's not like they don't go down. I mean, they really do. They go down. I mean, there's just a lot of things in the way. So I don't know. It was a bucket list thing for me, and. And I did it. So. Check, check. I'm not, my feelings aren't hurt that I'm not doing it. I feel. You know what I hated about it, Michelle? I hated being on call because you would all day long, you know, 8 hours, 9 hours, and you'd be like 1 minute before the call was over and you'd want to crack a beer. And then they'd call, hey, can you be there? And you know, however many minutes you're, like, hurting so many times?

[06:19] Michelle: Yes. Oh, my gosh. Wow.

[06:23] Susan: I did love it.

[06:24] Michelle: Yeah, I know.

[06:26] Michelle: It's really amazing. And, you know, my sister loved it as well. And then she went on to become a pilot, and she loves that as well. And, you know, it's just one of those things I have so much respect for. Because when you're a big scaredy cat like me, you look up to those people.

[06:47] Susan: Well, they wouldn't let me fly anything. I'm blind as a bat. So I was happy to be in the backseat, but congrats. That's really cool. She got her pilot's license. I love that.

[06:57] Michelle: Yeah, she's a rock star. I have a lot of respect for her. She's my little sister, too. I'm eleven years older than her, so I'm like, damn, you're accomplishing a lot of stuff. So. All right, let's get into it. I want to talk about mock codes because you work with a lot of teams, and like you said, the first two to six minutes, like, that's your jam. So let's talk about that. What do you do with the teams that you work with? How do you advise them on how to get better? All of that stuff.

[07:32] Susan: So, okay, it was about 18 questions, Michelle, but that's cool. Like you said, my codes are my jam. And honestly, my preference is for code drills. And then this is weird how people get hung up on that mock code terminology. So I'm actually working with the American Heart Association right now. We have a group together, and we are currently getting ready to publish a step-by-step how-to-start a mock code program for in-hospital cardiac arrest. So that's super cool. I'm beyond honored and proud to be participating and consulting with this group. The point being is one of my first questions was, well, what is a mock code? Because I often. I'm a big fan of, like I said, rescue drills. I like code drills. I like brief, hands-on, repetitive practice. For me, that's how we drive home those basic skills. And if they can get through the basic skills, sweet. When we can move on to advanced stuff, we can go to the top drawer. But the big push for myself when it comes to mock codes is, first of all, I'd like to talk about why are we having a code in the first place? Like, what have we missed? So I like to go upstream a little bit and talk a little bit about early warning systems. And I'm not talking about the kind that are on your computer that are built in as software. I'm talking about, hello, you are not just a nurse or in healthcare. You're a mom, you're a sister, you're a brother, and you know what sick or not sick looks like. So let's not try making too much of this, okay? Like, people who are about to tank look like crap. They just do. And it usually can come on pretty quickly. We know the signs and symptoms can be 24 hours ahead, 8 hours ahead, but darn sure 3 hours ahead, they're going to show some kind of sign or symptom. So I always do a little red, green, yellow. What are we looking for? And then I get into the emergency equipment. That's a big deal. So I do a, I do a 911. Everything you need to save life is on the outside of the crash cart, Michelle. I think we spend so much time freaking out, worried about those, a, the rhythms, and b, holy Christmas, I don't remember my drugs. They scare me to death. I'm not sure if this drug matches this rhythm. Oh, my gosh, my gosh. I'm just not gonna do it. I'm out of here. They freak out about the rhythms. So the beauty is you don't have to know the rhythms because the machine does. So we teach, I teach step one, step two, step three on how to use your defibrillator. Then I go into the key roles of one, two, and three. Again, let's talk meat and potatoes. You know, you know who's up in the middle of a code? You are. If you're there and you find the person, you're up. You're rescuer one. So I just, I really work hard against pushing against the, the grain of. It takes a critical care team, it takes a rapid response team, it takes the ICU or the ER team to save a life because I'm kind of gonna call baloney on that because honestly, everything you need to save a life and all the research in the world, Michelle, all of it says that it's compressions and electricity that win or lose the game. So for me, mock codes, I prefer drills. I really don't care for, the secret squirrel bomb. You know, let's bomb them, let's surprise them. Let's let's throw everything we've got at them because guess what? You know, no one learns very well, in my opinion, in that type of environment. They'll feel embarrassed, they feel nervous, they don't like performing in front of their peers. They're away from their patients, they're not doing the charting. There's a million reasons that they're going to come up with why they don't like. And plus, let's just say you're not on that unit that day, then you don't get the benefit of it. So in the long and the short of it, I love mock code drills better than anything. And then honestly, I will hand you the keys at a minute, in a minute and a half or two minutes. I mean, I only asked for two to six, but if they're all that and a bag of chips, Michelle, then they're ready to go on to advanced measures at a minute and a half. And I say, good, here's the keys. See you later. Get you some epi. Go for it.

[11:26] Michelle: Nice. Yeah. And I really love how you touched on what's happened before the patient got to this, this point because that's like the in-hospital stuff that we see. Right. And people out in the community, and we'll talk about your citizen CPR. People in the community don't get to see that. They may just come upon somebody that's down or they see something, they witness something. And so we, as you know, medical professionals, we have that jump on. This patient's here, they're already sick, but they're getting sicker and kind of. How can we kind of stave off the bad stuff?

[12:08] Susan: Right. Yeah.

[12:10] Michelle: Before we get to that point.

[12:11] Susan: Absolutely. But then again, you know, it's almost easier, Michelle, to teach the signs and symptoms of deterioration to a family member, to a community member, because they're eager and they want to hear like, what is sick enough look like. But in the hospital, you know, for every extra patient a nurse has in the hospital, the chance of failure to rescue you goes up by 7%. So I hate when people talk about numbers, the entire, you know, an entire podcast, but 7%, let's say we have six patients, that 42% chance of not making it from something that we should have been able to save. So it's not as clear-cut. But I think often also there's barriers in the, this looks bad to me. I think it's bad. It sounds, I think it's bad, but I'm not sure. I'm just going to wait a little bit longer because I want validation because I'm a little bit nervous to call, but, you know, because. Right. More barriers. If we do call and they show up and we are wrong, are we? Do we? Do we look stupid? Do we, you know, oh, my gosh, I'm just med surge. Drives me crazy.

[13:17] Michelle: Yeah.

[13:18] Susan: Critical. They don't know. They don't know. Making them feel bad about it is not a help.

[13:26] Michelle: Yeah, no. And, you know, we have all these teams in the hospital, like, we have the rapid response team, and they're meant to be called kind of before the patient crashes.

[13:36] Susan: Right.

[13:37] Michelle: We see the patient deteriorating before code blue. Of course, they do come to the code blues, too. At least they did in my institution. But. Yeah, exactly what you said. Nobody wants to feel like they have, you know, egg on their face and that they're crying wolf. So those things are important considerations. I want to talk about the defibrillator because that just freaks everybody out. And you have a course called Learn to Love Your Defibrillator or AED, which I think is brilliant. But how do we become more confident in using the defibrillator?

[14:19] Susan: In my opinion, there's only one way. You got to touch it. You got to push the buttons. You got to turn the dials. You got to handle it. Now, when I was running the American Heart Association program, instructor-led, where we had a couple hundred practitioners of all varieties coming through every single week. I made sure that the equipment we had in that classroom was the same equipment that they have in their units. Because often it's a simulated something or other. You know, it's. People do it on iPads and, you know, push your. That to me. Okay, I. Great. It's great. It's all great. But to me, not so much. Because when the duty once again hits the fan and you're in your environment, if you don't know how to work your piece of equipment, well, you are already in trouble because your heart's skipping ten beats. You're not sure if you even should. And then if you haven't touched or handled it, you're freaked out and you're going to get out of the way, which equals time lost towards this resuscitation. So for me, it's, again, brief, hands-on, repetitive practice, mash the buttons, twist the dials, and figure out what you need to do. But frankly, in a cardiac arrest, it's. It's step one, step two, and step three. You literally turn it on, push the button, and then push the button if it glows and tells you to shoot, there's only three things you have to do to be ready. And when you put it in meat and potatoes like that, you should see the weight that comes off of nurse's shoulders when they're like, are you even kidding me? I'm like, no, silly pants, just push the button. You don't have to know the rhythms. The machine knows. You don't even have to pick the joules The machine knows. Just push the button. So it's really, really relieving to people when they take that. It's a short listen. That's a ten-minute module on loving your defibrillator. Ten minutes.

[16:03] Michelle: No, that's brilliant. And I love just the fact that you're talking about you got to have hands-on and touch it and feel it and turn the dials. And I think that does, for a lot of people, take away a lot of the anxiety. And these machines have gotten so technologically great that's exactly what you're saying. Like, they tell us what we need to do and we just need to pay attention. So that's. That's a great point. And I think that's why we do mock codes or mock drills. And I shared the other day that I worked in a NICU where we had an amazing clinical nurse specialist that had us doing mock drills every month. And obviously, we were doing them in the neonatal population, and we used the defibrillator in actual codes, thankfully, maybe once a year, but we practiced it all the time. And it was just for the fact that we used it so infrequently like we needed to practice it a lot. So it's one of those things that kind of practice makes perfect, right?

[17:21] Susan: Oh, yeah. So I was training. This is a while ago now, but I was training in the. Yeah. And forgive me, Michelle, I do work with NICU nurses, but personally, again, I want zero part of that deal. I mean, I can't even, like, honestly, I didn't just hear. I started getting sweaty hearing you talk about the NICU, but, you know, when the PICU, which is not much better for me, but I spent more time in there. So we were training one day, we were doing our drills. Three nurses were particularly concerned about getting it right. So they came in, we ran it. I'm like, oh, my gosh, you guys. Oh, stop, stop, stop. You were making way too much of this. I take a breath. Let's try it again. So we tried it again. We did it. They. They were so happy to keep going because again, when you do it right. It's. You're done in a minute and a half. So you don't even need the full six minutes, but about six minutes. So anyway, we. Let's just say we went 3,4,5, 6 times, and they were like, you know, we got this sweet. So they went to work. They were on the night shift that night. I woke up the next morning to an early phone call from the director of that unit, who said, Susan, you're not gonna believe what happened. And I said, okay, do tell. So that very night, there was a pediatric code in the PICU, and who ended up being rescued? One, two, and three. But those same three nurses. And they resuscitated that baby. They were there for twelve minutes. Michelle. There was an issue in the overhead call system. There was a delay. The provider, the family was in the room, and they resuscitated this baby. Baby Savannah. So I think, like, wow, I guess what? You know, this is absolutely silly, silly, silly, silly. I'm not doing anything but reinforcing what our foundational classes are supposed to give us. But. But you have to not be in the classroom with a bunch of people you don't know. You have to not be in the classroom with equipment that you don't use. You have to be in your environment with your team. Brief, hands-on, repetitive practice, and then, boom, watch this, baby Savannah's alive. How cool is that?

[19:32] Michelle: That is so cool. And it kind of gave me the chills, and I thought, man, divine intervention right there where everyone was in place. Everybody knew, first of all, you were there the day before and going through all of these steps and helping people feel more comfortable. And then, you know, they had the confidence to run that code and have a great, successful outcome, which we talked about the other day, too. Outcomes are people, right?

[20:02] Susan: Yeah, yeah, yeah. I mean, how goosebumpy is that story? And think, think. Conversely, now, let's think about how they went home. I mean, they went home. They went home to their family. Like, you won't believe what happened. And this is what we did. And look at the other side of that story. Let's just say we didn't do those drills the day before because I can tell you, when they came in, in the first round, it was. It was ghastly. And that hurts my feelings. It hurts my feelings for them, and it hurts my feelings for every nurse in the world because, my gosh, we're nurses. To feel like you. You're not sure of how to do it or what to do. I mean, we're there to serve and to feel confident and comfortable that we can, but having that internal fear, and then let's just say it happened to them that night and they weren't prepared and it didn't go that way. Holy cow. Going home from that is a whole different ripple effect than the previous story.

[20:57] Michelle: Yeah, absolutely. Two different outcomes right there. Okay, I wanted to get your thoughts on the Lucas machine, and for our listeners, the Lucas is sort of a new invention, and it's, I guess you would say, provides automatic CPR. So talk about that. Talk about where would we use it and just your thoughts on it.

[21:26] Susan: So again, I. You know, I. I've never used one myself, and there is a lot of chatter. I try to pay, I try to keep up on all things resuscitation, even if it's out of my wheelhouse. I know EMS loves them. I think in-hospital, not so much in general. I think the big concern is that depth, once it's set and going, is it, would it damage the actual myocardium and so forth vessels more than it is to save a life. However, on the other side of that coin, I know EMS loves them, and especially with long transport, I mean, anyone who's done a 1 minute of let me sing on the treadmill at a sprint, you know, that that's really hard to do. So two minutes of compressions for a human is not easy if you're going to do the right dip and the right rate and so forth. So I love the idea of it being consistent and giving perfect compressions for, gosh knows, however long and allowing the medics to do what else they need to do to care for that patient. I know they use them in-hospital in some cases where they will respond from the ER and bring it into the inpatient environment and take over for the human. So I love the concept of them. They have different, different styles anymore. There's two or three different styles, and I think even more coming out as we speak. So I think they have a place, a for sure, awesome place. I share the concern of some of my intensivist friends who think they're a bit, you know, kind of too dramatic on the internal, you know, goods on the inside that we're working on, but I think it's innovation, and I think that they're fantastic. I also have concerns that when you have a responding agency that has one, but a receiving hospital that does not, because my brain is always thinking about the drills, you know, especially handoff drills. What does that handoff look like, Michelle, when you're taking a patient off of a compression device and then the humans taking over and is that even cool? Like, what does that even look like? Hey, Sally, hang on. Ready? Okay, go. Like, I don't know. I don't have enough experience in it, but I think there's pros and cons.

[23:35] Michelle: Yeah, well, thank you for that. They recently came to our community and, you know, I thought it was fantastic from a pre-hospital standpoint and exactly like you said, once you get in-hospital, then what's the procedure for that? How smoothly does it go? But no, thank you so much for your insight into that. Okay, let's talk about the code team, because you alluded to it earlier that there's number one, number two, number three, but who's on the code team specifically?

[24:15] Susan: So that's a big can of worms, Michelle. I mean, I think code teams around the country, we like to think that they're uniform in the same, but I think everybody has a little bit of their own idea on what makes up a good code team. My focus is always on rescuer one, two and three because I feel like by the time we wait for the code team, which, by the way, could be, you know, could be 30 seconds, it could be 1 minute. It could be. We just heard an example where it was twelve minutes, you know, I mean, it just, it happens. What about if it's the second code? So who's going to arrive and what are they going to do? So I'm being pusher on one, two and three. One being the person who finds the patient, calls for help, begins compressions. Rescuer two is the closest person to that call and they immediately become on first entry into the space, you know, CPR coach, meaning how are you going to tell rescue number one? Okay, take a breath. We got this. Slow your roll. Speed it up a little deeper. A little faster. Let me lower the bed. Let me get all the junk out of the way. So they're, they're code CPR coach. Pardon me. Then room prep and rescuer three brings the crash cart. And then they're going to immediately do with our priority being compressions, electricity. Right? So they got to get the pads, the backboard and be able to push the button. Now, when my teams do this drill, they do it about a minute and a half, again and again and again. So the next question I hear is, well, what about when the code team arrives? Well, okay, what are the next things we need? Respiratory. Boom. Get to the head of the bed? Whose team lead? Well, whoever gets there first from your code team, quote, unquote, whatever their role is, because we do need a team lead. And then who's recording? So those are my top six. But as you know, the roles go on and on and on.  The composition, where are they coming from? Are they coming from the ER? Are they coming from the ICU? Is it a combination thereof? Is this a dedicated code team? Are they our dedicated rapid response team? Depends on how many resources you have, Michelle. And what does your healthcare system look like? Some with all the resources, you know, in the world have giant, dedicated teams, and that's all they do, and many of them do not. So that is why I push on one, two, and three. People ask me this often, but my respiratory one, two, and three code roles come before your existing code rolls. It suggests that the people who are there know what to do until help arrives. And then again, I like handing them the keys at a minute and a half or six minutes and say, you know, it's all yours, kid. If there's a role here that you see that is not being done, then assume it. And, you know, I also, at that point, speaking of transition of care, you know, we talked about it coming in the ED. Whether they're using the Lucas or not, right? We still have to do a transition to care from what's happening. If it's a rest coming in from outside to the inside, there's a transition to care, and there they have to get their equipment off and are on. Same here. Let's say we're inpatient. One, two, and three are rocking it. In the ideal world, the red carpet's been rolled out because they have everything in place. The room's going, they have CPR, they're, like, ready to order pizza, like. Like shock three times before rapid response arrives. By the way, if you do the math, it happens two and three times, even. Whether it's shock was or was not advised. Are they pushing the analyze button, showing they are ready? Boom. Red carpets rolled out. They give a little sbar or whatever you want to give, and then take over, kids, and see ya. Let's go eat our pizza.

[27:38] Michelle: I'm just giggling over here because you're just too funny. I would love to learn from you. Well, I am learning from you, but, man, I'm like, where were you? Like, you know, five years ago when I was in the thick of it, right?

[27:54] Susan: You know, if you think about that example that I just gave, I love always trying to listen. Our pre-hospital people. They are rock stars of the rock stars of cardiac arrest. In-hospital people think they are, but I'm here to break it to them. They're not pre-hospital. Got it all day long, and they do it on the back of an ambulance with one provider. One, one, maybe two. Now, we just. We just taught it. We're freaking out over the six roles, the seven rolls, 8,9,10, 11,12, 20 people show up, and we still have a chaotic bomb of a resuscitation. So it's like, just take a breath. It's okay. We know how to do this. This is really basic. We often make a lot more of it than it is. I mean, like someone's dying. I get it.

[28:43] Michelle: Yeah. But we do tend to complicate it. And the other thing that we have in-hospital is we have a lot of egos, right? We all show up to a code. We all have our respective roles and so forth. But what happens to the team when there's too many alphas or there's too many cooks in the kitchen and too many leaders? It's like, how do we differentiate that? And is a physician always the one that should be the leader? Speak to that.

[29:15] Susan: Goodness, another can of worms. Michelle's coming in hot. So we all know these. This hierarchy deal that. And I honestly feel like it's getting better. I think it's getting. But, you know, who am I to say so? Yeah. Recognize the call. Recognize the problem. Call for help, begin compressions, and wait for the doctor. What? Doesn't say that anywhere, last time I checked. So big can of worms, Michelle. So, inevitably, often, and most often, yes, it is the physician that is in charge. But let's talk about what's really happening. 99% of the time, there really are nurses there that are running the code before the physician arrives doing just fine. Most of them, of course, have their basic advanced and or pediatric life support provider cards, which says they can run that code. They can. They can order that, they can order the drugs that are needed, and they can use the electricity. So could the pharmacist that's in the room, by the by. So, technically, if you weren't in the walls of a hospital and you have that card, you can run the whole nine yards. So, yeah, we have a hierarchy of who's going to be pushing the button, who's going to be interpreting the rhythms. Yes. Sometimes you'll have two or three physicians that'll respond. Right. You might have an anesthesiologist in the room. Okay, so that's their code. If they called it overhead, then now you've got the Ed doctor there. Well, is it his code or her code or? Whose code is it? Let me say the hospitalist has shown up because it was an inpatient environment. Now, whose code is it? And then you've got their PA's and their residents and yikes, what's going on? So, I mean, I've worked with some teams where they get those first key six people, and they shut the door. And I kind of like that. I kind of like that because often when I should go to codes now, Michelle, you remember when I first changed it where you couldn't be smoking in restaurants anymore? And then you'd walk out the front door of the restaurant and there's like ten smokers out in front of the restaurant, and you had to walk through that big cloud of smoke just to come in or out. I mean, that's what I feel like a code is like. You know, not only is there a pile of people in the room, but in the hallway, it's like we're waiting for a bus out there. I mean, it's. It's so loud and there's so many people. I just love the concept of the one person in the back of the ambulance doing it like a rock star. So I don't even know if I answered your question, but I know that codes in-hospital can be smoother, they can be cleaner. Code rolls definitely help. They definitely help keep down on traffic. But then there's the whole, let's say I have the code roll. Pardon me? And at lunch, or I'm just off the floor, so someone else has to assume that role. It's kind of a sticky wicket. But I know less is more. I can tell you less is more. And pushing the button using the analyze function kind of can save everybody. Just push the darn button, and then. And then we can get into that top drawer. But, yeah, I don't know. The alpha question is always tough. And, no, it doesn't have to be a doctor.

[32:06] Michelle: It is, and you handled that really well. So sorry for opening that can of worms, but you made a great analogy. You know, the smoking thing, and I definitely remember that. Okay, let's talk about our partners on the code team, and those are our respiratory therapists. And, you know, being a NICU nurse for a long time, those, to me, are true rock stars. You also have a course called Airway Allies, the Synergy Between RN's and Respiratory Therapists in Code Blue. So talk about the role of the RT and just a little bit about what we can expect from our RT friends.

[32:53] Susan: So, first of all, you know, I wouldn't be a nurse without having my RT's next to me. I just wouldn't. And frankly, I've not been to bedside in a hot, hot, hot, long minute. But when I was working in trauma and emergency and responding to the inpatient environment, I can promise you I wouldn't want to do it without my RT. So I'm a huge RT fan, and I feel like every baby nurse should be born with a baby respiratory therapist, and they should grow up together so that they have their wingman, wing wingwoman with them, and an extra set of eyes and intelligence. You know, respiratory therapists respond to every code, every code, everywhere in the hospital. So they are so diverse in their skill set, where if you think about many nurses, you know, they'll work on, you know, two or three, maybe different types of units in their career, and they don't really lead that unit. So if you don't see a bunch of codes in that unit, you might not see one at all. But respiratory, boy, they work everywhere. ED, ICU, they respond. I often hear, Susan, how many respiratory therapists does it take to respond?  Four or five of them will show up. And I said, well, every last one of them because I get to the room often, Michelle, they'll be on the chest and the airway. They're like, in it to win it. Respiratory is. They just are. So what they do is they all respond just to make sure that they're covered, and then once they know they've got one or two in there, then they split and they go back. So respiratory and nursing, to me also, we spoke a little bit earlier, Michelle, about those early warning symptoms. When I train, I train green, yellow, red. I teach, you know, sick or not sick, green, yellow, red. With some really basic parameters, you know, rpms, respiration, perfusion, and mental status. Thumbs up, thumbs down, crossroom assessment. Let's not get all worked up. I don't need numbers. Just do they look good or do they look bad? And often when we get to that yellow zone, we should have an action step. And the action step is, should I or shouldn't I get help? And what does that help look like? So I often say, 1-800-call your respiratory therapist. You want a second opinion? You don't want to ask your charge or supervisor or nurses who are being, you know, cranky and rude, call your respiratory therapist, because they are the best second opinion you're gonna have. So I'm all team respiratory.

[35:15] Michelle: Yeah, I echo those sentiments, those RTs or our wingmen in the NICU, for sure. And so I remembered what I was gonna expound upon with our last conversation, and it's something that our hospital did. I remember I don't know how many years ago, but the first 18 years of my career, I was a pediatric nurse, so I worked strictly peds unless I floated. And then we floated to, like, our sister unit, the NICU, mother, baby and so forth. The last 18 years, I was in NICU. But in our hospital, when they would call a code blue pediatrics or code blue NICU, a lot of people showed up, and it was a big problem because the house supervisor or the charge nurse, whoever was there at the code, was spending a good amount of time getting all the people out of the room that didn't need to be there, that were just bystanders. And, you know, first of all, it's not a zoo, right?It's not working. We're going to come in and watch, you know, the animals. It was like, this is a real child that is experiencing, you know, respiratory arrest, cardiac arrest, whatever it is, and, like, have some respect. So our hospital went to the pager system, and, you know, you're probably familiar with it, where they don't announce code blues overhead, at least for code for NICU and peds. They didn't announce those. So our RT's had pagers, all of our pharmacists, everybody, the charge nurse, everybody that had to be on the team and respond, and it worked out much better.

[37:09] Susan: Yeah, that's a really good point, Michelle, because there are specialty areas in the hospital. I mean, again, OR,  OB, they handle it very differently as well. They don't generally call them overhead unless perhaps it's, you know, nighttime or weekends or they're short-staffed or something. How about the cath lab? You know, the cath lab does not need that, you know, zoo, as you pointed out, coming in there, either. They have all that specialty equipment. Everybody in there should be able to handle it. But. But legal wise, you know, calling the official code does tend to get people there that might need to weigh in, you know, per your hospital policy. But there's methods to the madness, right? They can respond. They can wait outside, like, don't cross the threshold and ask if you, you know, again, like I said in my program, when they arrive, you view and you ask, is there any positions that are needed to be filled. And if they are, then you fill them. But that whole. That whole animal thing. It's interesting you say that. I actually have a background in animal medicine. I was in veterinary medicine when I started my family. And I remember when I transitioned to humans, I honestly felt like. Cause, by the way, going into trauma was the closest thing to what I was used to, you know, with large animal medicine. But I remember being the one in the room that thought, hush, you guys. Like, they're all talking about this person. The person's lying there, and we're all talking about them. They're all talking about the wound. I'm like, hello. I mean, that's a person there. They can hear you. So it's funny you should mention that. I really remember so distinctly thinking that. I can't believe. Am I the only one in the. Here in this room that knows this is a human? Gosh.

[38:47] Michelle: Yeah. And maybe it just takes somebody with deep insight into animal behavior to realize, you know, this is a person. People. They can probably hear us, and, you know, we need to respect that for sure. Okay, well, let's talk about debriefing. And what does an effective debrief look like?

[39:10] Susan: So, an effective debrief is, first of all, one that happens. There's been research supporting debriefs since the beginning of time. The fact that it needs to happen. In my opinion, there should be two types of debriefs. The first one, that's just hot and fast, right immediately after. Even if the patient. If the patient expired. That's one thing. You have time. People always say, oh, we're moving them to the unit. You know, we got Rosc, and we're moving to the unit. We don't have time. You do have time. It's just super quick. It's the good, the bad, the ugly. What did you see? What'd you see? What didn't you see? Quick. Quick. It can be while everyone's moving. But honestly, something. Pick three things and then follow up with an appropriate feedback session, where we can then truly evaluate what that code looked like. Who responded? Who didn't respond? What did that timeframe look like? Did we get hands on the chest in time? Were they too shallow or too fast or too deep? Did we get the pads? Did we use the backboard? Hello. The backboard is on the back of the crash card. Did we use it? Did the joules match the rhythm? Should we have shocked earlier? There's a million things. Did you get the data out of the defibrillator? Whatever kind you have. So there is, in my opinion, always time for a quick down and dirty. And there should always be a follow-up, not only over the mechanics of what happened or what didn't happen, but the emotional toll that it may or not have taken on anyone in the room. I mean, that you want to. You want to have a quick way to lose a new nurse, have her witness one of those horrible, chaotic scenes, he or she, and maybe lose the patient and. Or have, you know, even if they get ROSC. But if it's one of those disaster code scenes and we don't talk to them and ask them if they're cool, if they're all right, how do you feel about it? You know, maybe they feel terrible because they wanted to participate, but they were just scared to death. You know, fight, flight, or freeze. Happens to all of us. What happens? Because have you seen them freeze, Michelle? I mean, they literally just freeze and they're scared to death. If we don't address that, that's the nurse who might go home and not come back. So I feel like there should be the fast and the furious and then the longer, more controlled, which also shows that you care enough to evaluate the data so that we can improve.

[41:27] Michelle: Yeah, I think that there has to be that emotional component or else it's not a true debrief. And again, you know, we were blessed in the NICU that I worked in that our CNS was just really all about the emotional impact that especially witnessing the death of a neonate or a child, you know, that effect on people can be really profound. And like you said, it can mean the difference between staying in the profession or leaving in how we handle it. So that's a really good point. I want to touch on just for a moment about your Citizen CPR Foundation because I think that is just so important for so many reasons. But tell us what you do with that.

[42:21] Susan: So I love the Citizen CPR Foundation. I discovered them and vice versa. They discovered me about a year ago. And I found out that they're doing some amazing, cool things, not only in the top of the top, research and science and implementation from mostly pre-hospital, some in-hospital, but they're the best of the best when it comes to resuscitation. They have a summit every two years that brings together truly that the most amazing things that are happening in the resuscitation of the world happens through the Citizen CPR foundation. They bring everybody together. I was very honored. I attended my first summit last year in San Diego, and I was a speaker I was able to talk about my in-hospital cardiac arrest, soap box my rescuer one, two, and three in the first two to six minutes of cardiac arrest. What does that look like? But then I learned that they have this huge arm that addresses, that works with communities to become Heart Safe, so they have a Heart Safe initiative. I am now a program advisor. I'm on the advisory committee of the Heart Safe Initiative with the Citizen CPR Foundation. And what we do is help communities put all of their ducks in a row to be Heart Safe. It involves 13 key parameters. Top evidence-based practices from hands-only CPR, AED, AED awareness registry, telephone CPR, and high-performance CPR. And it gives them a framework to dump everything that everyone's doing individually on the table and then add it up and get credit for it so that our citizens, and this is everybody, like, for instance, we're doing this right now. I'm the chair of that hardsafe initiative here in Lee County, Florida, and it's everybody, Michelle. The lead agency is Lee County EMS. I'm representing the hospital. And then we have K-12, adult, continuing education. They're on board all of the schools, the colleges, the universities, neighborhoods, organizations, you name it, sporting teams. They're all coming together. We just recently worked with the Minnesota Twins. They allowed us to come in and do Heart Safe. We did. Thousands of fans, Minnesota twins fans, on some hands-only CPR. So it's massive hands-only CPR and awareness of those first two to six minutes and what it takes to be courageous enough to put your hands on somebody else's chest. Whether you're at home, at a sporting event, and or at work, you have to be courageous enough to do it. And that's what we work on.

[44:54] Michelle: Yeah, it sounds like an amazing organization. Just what I was reading about them. I imagine a world where everybody knew the mechanics, the properties of CPR. It's like, wouldn't that change things? I'm going to just tell a personal story here that, you know, I'm coming at it from a medical professional who had to resuscitate somebody not in a hospital. And so almost eight years ago, I came home from work to find my husband down in our home. And I didn't know how long he had been down. He was not breathing, he was pulseless. So, you know, I was under the effects of a lot of adrenaline, I started CPR. I called 911. One of the things that really sticks out to me after, you know, having done CPR on a lot of babies is his chest was very, very difficult for me to compress. And, you know, I don't know if that's because he was 69 years old and obviously, you know, not a baby, but that just really sticks out to me. So, you know, I did my best. And thankfully, the fire crew got there very quickly and they, you know, resumed CPR and did that for about 20 minutes and had some rounds of epinephrine, three or four rounds of epinephrine, and there was no return of, you know, spontaneous circulation. And so my husband passed away. And, you know, the trauma about that is obviously twofold because first of all, you know, he was my beloved and he passed away. And then second, you know, I dealt for a long time with guilt about not being able to resuscitate him. And I'm a medical professional, right, I'm a nurse. So, you know, those things have stayed with me over the years. And I just find an organization like this that really works hard to have citizens, regular lay people, be as prepared as they can be for an event like this. I think it's just amazing, and I'm glad that you're involved with it.

[47:39] Susan: Wow, Michelle, that's a heck of a story to share. I can't even imagine your heart and your mind and your body and your soul before, during, and after that event. There's really no unseeing that. You're not going to ever unsee or unfeel that. And so, and in your particular situation, Michelle, unwitnessed cardiac arrest, which 50% of cardiac arrests are unwitnessed, he was pulseless and he was apneic, and you don't know for how long. And we know the reason in my niche is two to six minutes is because that's all you have. So chances are that the timing of you finding him was the worst part about it and knowing what to do. But you know what? Being a healthcare professional at that minute, that kind of went out the door, right? You were a wife. You were. It changes when it's you and it's your hands on your loved one's chest. So, extremely dramatic situation. And I'm so sorry for that outcome because I know your heart aches on that one. And anyone listening their heart aches, because there are many, I work now also through the Citizen CPR Foundation, Michelle. There are groups of survivors and groups of those who did not survive. And, you know, I would recommend, you know, I can share those links, too, of both those groups, because they do amazing things and they support each other quite, quite a bit. Parents who've lost loved ones who have lost co-survivors and co-loss. So recognizing the problem, calling for help and acting, you just proved it. You know, if you were home, you would have called for help and began those compressions. But also from you going from the NICU to a 69-year-old man, those are seriously different types of compressions. And real compressions on a big man are hard. It's hard work. And I know you gave it everything that you could have. And the best compressions are the ones that he received, and they were the ones you gave him. So if he did have a chance, it was through your efforts. But let's just say you were there. I teach what they learn in telephone CPR, you know, no, no go. Are they responding? No. Are they breathing normally? No time to go. Call for help, and begin CPR. So we don't often talk to people about what to do until help arrives. You know, people stand around flustering off a similar kind of what happens in a room in the hospital sometimes. You know, like maybe someone will get on the chest, but the room is still a disaster. There's still stuff in the way. 50 people show up, you know, no backboard, no pads. Who's, who's, who's running the show? Too many cooks in the kitchen, as you talked about earlier. But when it comes right to down to the story you shared, it was you and him, and it doesn't get much scarier than that. So we do work. You got to know what to do, Michelle. And the reason the american heart created the course called Friends and Family, is you're likely to be surrounded by friends. If you're fortunate, you'll be surrounded by friends or family when this horrible thing happens. And so they would know what to do. So really, I often say, if you have a heart, you qualify. Everybody should know how to do at least hands-only CPR and work on AED.

[51:01] Michelle: Yeah, I just can't state that enough. I think it's so, so important. So thank you so much for that. All right, well, we're nearing the end, and we've talked so much today about compressions, but I would like to know, what does Susan do to decompress?

[51:20] Susan: Decompress? Oh, well, Michelle, I don't seem to have much problem in that area. I'm often the first to ski daddle away from it all. I'm as much of an introvert as I am an extrovert. People don't believe that. Cause I do a lot of a lot of big talk out there, but I like to be quiet. I like to get out into the woods. I like to be as far away from humanity as possible. I do live here in southwest Florida, I'm on the water, and I'm extremely blessed and fortunate to have my little super duper speedboat right outside my back door. So often I just hop on that sucker and get the heck out of here. My mom is my favorite bestie beer-drinking buddy, and she loves the boat more than anything. So, in fact, this afternoon, as soon as office hours are wink, wink, over, I'm gonna hop on that sucker and get out of here. So I love to hop on my boat, get on the water, and we hit the Gulf of Mexico, and I'm out there in just a few minutes flat.

[52:22] Michelle: That sounds idyllic. And, yeah, your mom's a rock star, too. Like you, right? It's like mother, like daughter. You posted some pictures of you guys. I think it was LinkedIn.

[52:36] Susan: Yeah. Yeah. I do like a Saturday or Sunday boat picture. It's kind of, I just want people to know that I'm, you know, a real person. And I hang out with my mom. She's my bestie, so I love it. Loves the boat, so. And off we go.

[52:53] Michelle: That's amazing. All right. Is there someone that you recommend as a guest on this podcast?

[52:59] Susan: Oh, my gosh. There's so many amazing nurses doing so many amazing, neat things these days. So I could think off the top of my head, I would suggest. Let me see. Maggie Ortiz. I know I've been. I've been doing a lot of work with her lately, and she's kind of blowing my mind with her intelligence. She's really coming into herself with her, and she's getting ready. She's a nurse with a master's and going to law school. She's going back to law school. So I'm super impressed with that human right now. And then Angie Gray. Angie Gray is another person I've been talking to lately, and we have some really interesting things up our sleeve. She's got a hashtag right now called #lovingdisruption. And I'll just leave it like that because isn't that curious? What does that mean? It just means. It means just that. Amazing things coming in support of nurses, nursing early, mid, and late in our careers, personally and professionally, and how can we come together to just be the amazing nurses that we are? And how many can we help mentor and inspire to do more?

[54:02] Michelle: Those are great recommendations. And Maggie and I are in the works trying to get her on the schedule. So I totally agree with you there. And I just recently found Angie, so thank you so much for those. I will, I will definitely reach out. Well, where can we find you?

[54:22] Susan: You can find me on LinkedIn. Doctor Susan B. Davis because there's a lot of Susan Davis in the world. So B is my middle initial. So you can find me on LinkedIn or rescuern.com. You can reach me there and read all about my resuscitation program and where the rescue RN is going. Getting to ready? Let me see. I'm getting ready to go to NTI. So I'm going to NTI 2024 and presenting both my timeout protocol and my code drills, my basic code drills. I'm going to be doing them with Zol on the Zol stage at the AACN NTI in Denver, NTI 2024. So you can find me there, too. I dare you. Can you shock in two minutes or less? Let's see what you got, kids.

[55:11] Michelle: I love it. You're doing amazing things. I'm so thankful for you and all of your knowledge and expertise that you're sharing with my audience today. So thank you so much, Susan.

[55:22] Susan: Michelle, what a pleasure. Thanks for having me.

[55:25] Michelle: I will definitely put all those links in the show notes so everybody can find you. And we're at the end. So we're ready for the five-minute snippet. Are you ready?

[55:36] Susan: Right? Shoot.

[55:38] Michelle: All right. And, you know, I had to keep it real. Yes. You know, the other day when we did the five-minute snippet, I thought, well, when we do it again, I have to give her some different questions, so.

[55:49] Susan: Oh, yeah. Oh, yeah. Bring it, bring it, bring it.

[55:55] Michelle: Okay, here we go. If animals could talk, which one do you think would be the most annoying?

[56:02] Susan: Oh, the most annoying, I would say for sure a dog.

[56:07] Michelle: Oh, really?

[56:09] Susan: Wait a minute. Wait a minute. A donkey.

[56:11] Michelle: Oh, gosh, that screech, right?

[56:13] Susan: Yeah, they drive me crazy. Or a dove. Dove. A dove. A dove. Or a doggie. Or a dog. So all the D's.

[56:21] Michelle: It is dove season here right now, and my patio has, I think, three nests on it right now. So. Yeah, I agree. Okay, complete this sentence. My favorite thing to do on a lazy day is.

[56:35] Susan: My favorite thing to do on a lazy day is lay in the sun, make a giant buttery popcorn, and maybe piles and piles and hours of Netflix of something really good that doesn't take a whole lot of brains.

[56:52] Michelle: I love it. Sign me up. If you were a sea creature, which one would you be?

[56:58] Susan: I would be a dolphin, for sure. Oh. I might even be a whale. I think I'd be a whale. I think I'd be a blue whale.

[57:05] Michelle: You know, that's funny, Susan, that you say that, because I've always felt like the whale is, like, my. My alter ego or something. I found this great app. It's called Atmosphere, and it's free, and it's just hundreds of different sounds. And the whale sounds. I can listen to those if I can't sleep. And it just. They feel like my people, and I fall right to sleep.

[57:30] Susan: They're so amazing. I mean, I look at them, and I'm just stunned by their grandness, by virtue of their size, how they live, how they swim. I mean, their sounds. I don't know. I'm amazed by them.

[57:49] Michelle: I agree. Okay, if you could live with any famous family for one week, who would it be?

[57:57] Susan: Ooh, live with a famous family. I would live with Jane Goodall and her chimpanzees.

[58:09] Michelle: Wouldn't that be amazing?

[58:11] Susan: Yes.

[58:12] Michelle: Amazing. Okay, complete this sentence, and it needs to rhyme. There once was a dog named Bark...

[58:21] Susan: And he annoyed me every time he wanted to go to the park. I love it.

[58:29] Michelle: I love it. Okay, see? Would you rather have a pet dragon or a pet unicorn?

[58:36] Susan: Dragon. Absolutely. Hands down.

[58:39] Michelle: Yeah, I see that. Game of Thrones. You riding your dragon.

[58:43] Susan: Oh, yeah, I'm riding that dragon and shooting fire where people need it every now and again.

[58:49] Michelle: That's right. Okay, well, you already alluded to this one. Popcorn or potato chips? So we know. Is it really popcorn?

[58:58] Susan: Oh, you know, I. Oh, that's tough, because I'm like. I'm a Lays. Plain Lays and or plain kettle cook kind of a gal. Wow. What? That. Extra butter, homemade popcorn, but white. It's got to be the white kernel. And then I pile the butter, so it's a tough battle. That's a tough battle. I couldn't give up. Not one of those carbs. They're not gonna. It's not gonna happen.

[59:21] Michelle: Yeah. And I agree. The popcorn has to be homemade.

[59:25] Susan: Oh, for sure. Oh, no. My mom makes it, and it's just not nearly as good. So I just. We give it. She gave it up. She had to.

[59:34] Michelle: Okay, last question. According to Susan, the best way to start the day is...

[59:42] Susan: Oh, I get up early before the sun. I start my day with a little quiet meditation. And then often, you'll find me in my sauna. So I take a hot sauna and then I read and then I work out. So that's my perfect morning.

[59:59] Michelle: That's beautiful. And you are a beautiful person, a beautiful soul. And I just thank you so much, first of all, for sharing everything that you are so adept in, and secondly, for sharing it twice.

[01:00:19] Susan: Susan and Michelle 2.0, as we said, dootie happens. Dootie happens. It's a pleasure. And I got more time to spend with you. So that was the 2.0 benefit. Cherry on top.

[01:00:31] Michelle: Love it. All right. You take care, Susan.

[01:00:34] Susan: Thank you so much. Michelle.