011 - Intermittent High-Quality CPR: A Tactical Upgrade for EMTs & First Responders



CPR Isn’t Just About TechniqueStrength & Endurance Matter

  • Upper limb & core strength directly impact compression depth, which is critical for CPR effectiveness.

  • Stronger responders delivered more consistent chest compressions, reinforcing the need for physical preparedness.

  • Tactical professionals should be training for CPR strength the same way they train for load-bearing tasks.

Short Rest Intervals Improve CPR Quality & Reduce Fatigue

  • CPR-20s (20-second rest intervals) resulted in the lowest fatigue scores (RPE = 12.36 ± 2.23) without sacrificing compression effectiveness.

  • Compression quality remained high, and chest compression fraction (CCF) peaked at 97.08% with intermittent rest.

  • Going beyond 20-second rest intervals negatively impacted effectiveness, proving that controlled, brief recovery is key.

How to Optimize CPR Performance & Responder Endurance

1. Train Strength & Endurance for CPR-Ready Performance

  • Develop upper body and core strength through resistance training for improved compression depth.

  • Incorporate HIIT & anaerobic conditioning to simulate CPR intensity and sustain physical output.

  • Train for prolonged exertion—because in the field, CPR fatigue is a reality.

2. Use Intermittent CPR in Long-Duration Scenarios

  • Implement structured rest durations (≤20 sec) to sustain high-quality compressions.

  • Train for real-world. conditions—adapt to high-fatigue environments like transport settings.

3. Monitor Fatigue & Adjust CPR Effort in Real-Time

  • Use the Borg RPE scale in training & live events to measure fatigue and optimize performance.

  • Incorporate CPR feedback devices and manikins to ensure compression depth and rate stay within optimal ranges.

Thick Necks, Strong Hands, No Weak Links

  • A responder who gasses out in minutes is a liability. A team that doesn't account for fatigue is gambling with survival rates.

  • Train like it’s realbecause it will be.

Stay Thick.


Chang CH, Hsu YJ, Li F, et al. The feasibility of emergency medical technicians performing intermittent high-quality cardiopulmonary resuscitation. Int J Med Sci. 2021;18(12):2615-2623. Published 2021 Apr 29. doi:10.7150/ijms.59757

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012 - Maximizing Strength: What Really Drives Gains?

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010 - Physical Therapists on the Frontline: Keeping Tactical Operators in the Fight