10/13/2026
"Get them to the floor first"
We need to talk about this dogma.
For decades we've drilled into EMS personnel: move the patient to a hard surface before you start compressions.
New pilot data out of Wake Forest says that rule might be costing you critical seconds you don't have.
40 EMS clinicians. Randomized. Floor vs. mattress. Continuous compressions until failure. Here's what happened:
โ Time to failure: 145 seconds on the floor vs. 140 seconds on a mattress. Statistically identical (p=0.64).
โ Compression rate: 112/min floor vs. 105/min mattress. Not significantly different (p=0.12).
โ Perceived fatigue: no difference.
โ Perceived quality: no difference.
Compression depth measured deeper on the mattress, but the authors are honest that this is likely an accelerometer artifact from measuring mattress compression along with chest compression, not real depth. Read: don't get excited about "better compressions on the bed." That number is noisy.
The dominant belief in EMS is: hard surface = better CPR, soft surface = weak, fatiguing CPR.
This data says that belief may not hold up. Your body doesn't get more tired doing compressions on a mattress. It compensates. And that compensation doesn't cost you rate, and it doesn't cost you endurance.
So what does this mean for what you do on scene?
If you roll up on a patient in bed, on a couch, wedged in a bathroom, and moving them means burning 20, 30, 45 seconds you don't have, this study is one more piece of evidence that starting compressions now, wherever the patient is, beats delaying for the "perfect" surface.
AHA guidance has already evolved to weigh feasibility of movement against delay to first compression. This pilot study backs that direction up.
Caveats matter here. This was 40 trained professionals on a manikin in a controlled setting, not laypersons, not real scenes, not real patients. The authors say it themselves: this needs to be replicated with bystanders, because that's who's actually starting CPR at home before we arrive.
But the era of automatically assuming "soft surface = bad CPR" needs to end. The data doesn't support the fear.
Question for the crews: how many times have you delayed compressions to move a patient off a bed, and how many seconds did that actually cost?
Tell me in the comments. I want real numbers from real calls.
๐ Read the full study:https://media.handtevy.com/website/Effect-of-Compression-Surfaces-on-Cardiopulmonary-Resuscitation-Quality-and-Clinician-Fatigue.pdf
