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Friday, March 4, 2011

Another save in Albany CA

On Feb. 5, the Fire Department responded to a report of a woman who wasn't breathing.

"Upon arrival we found a female, supine on the ground, with bystander CPR in progress. CPR was stopped and it was determined the patient had a carotid pulse with no respirations," wrote Capt. John Weitzel on Feb. 15 in a report to Chief Marc McGinn. "The patient was place on our Phillips monitor and ventilations were initiated. Shortly after ventilations began the patient went into cardiac arrest with a shockable rhythm.... The patient was defibrillated ... resulting in a pulse with a viable rhythm and ... stable blood pressure."

Fire department personnel continued to ventilate the woman, established an intervenous line and provided further life support care, according to Weitzel. The Berkeley Fire Department continued advance life support care and took the woman to the hospital.

Weitzel said he spoke with the woman on Feb. 15.

"She told me she did not suffer any deficits as a result of this incident," he wrote. "I would like to thank all those involved, especially the bystanders at the Albany YMCA for their courageous actions. Bystander assistance and CPR is paramount to the chain of survival and recovery of anyone in such a critical situation."

The Science Behind Compressions Explained

[This is as reported by Richard Huff in JEMS]


Richard Huff, EMT-B | | Friday, March 4, 2011

The new 2010 American Heart Association ECC guidelines were designed to get around things that didn’t work for years—and were not backed by science, according to Joseph Ornato, MD, professor and chairman of the Department of Emergency Medicine at the Virginia Commonwealth University Health System.

“We’ve really had to admit in many cases, the science isn’t there to support the things we’ve done in the guidelines for decades,” Ornato told attendees at the EMS Today Conference & Exposition in Baltimore.

“We’re really trying to be brutally honest and not get distracted by things that really don’t work,” Ornato says, “and rather do a handful of things that do work, and really pound home the realization of those elements.”

Late last year, the guidelines were released, putting an emphasis on chest compressions. The guidelines upended the previous thinking that had rescuers providing ventilation before beginning compressions and the rapid introduction of defibrillation.

However, research showed that compressions first provided better results. Likewise, going to compressions first also encourages bystanders to get involved where they might not have in the past because of fears of doing mouth-to-mouth resuscitation.

Ornato says the notion of compressions first—and an emphasis on uninterrupted chest compressions—actually surfaced much earlier in Europe.

“The Europeans were kind of way ahead of us in being enlightened in terms of what the sequence is,” he says. “We’ve finally come around to admit they were kind of right from the beginning.”

The new compressions-airway-breathing model works best with witnessed cardiac arrests in public places, he says. Part of that is because folks who go down in public places tend to not be high-risk patients with underlying health issues. Part is also the ability of bystanders to get involved quickly and begin the process of resuscitation before trained rescuers arrive.

“What we’re left with us resuscitation and rescue, and that’s of course, a very time critical and very much dependent on us in EMS to stretch the window of time, to get help there quickly, and to get the help of bystanders,” says Ornato, who’s also the medical director for the Richmond (Va.) Ambulance Authority.

He says the good part is that most adults have pulseless ventricular tachycardia when they arrest in a public place have, and most of those people have plenty of oxygen in their lungs to be moved by compressions only.

Without effective chest compression, oxygen flow to the brain and heart stops, drugs that could help aren’t circulated, and ultimately, defibrillation is ineffective. Also, practice is required to minimize the interruptions in chest compressions to deliver a shock, he says.

Compressions build coronary perfusion pressure, he says. And research has indicated it can take 10 compressions after a rescuer stops compressions for ventilation or another intervention before the pressure is back up. He says data indicates an estimated three to five percent of EMS calls are for cardiac arrest.

Ornato says the National Institute of Health is preparing to launch a randomized test to measure the concept of whether everyone should be doing continuous compressions; they’re hoping to get 12,000 cases examined.

On the ALS side, quantitative waveform capnography is the most reliable method to confirm and monitor correct endotracheal (ET) tube placement, Ornato says. He noted a study in Orlando where one in four ET tubes were misplaced, a figure that dropped to zero after capnograpy was introduced.

He also says, the fifth link in the chain of survival is post-cardiac arrest care, which was added to emphasize the importance of comprehensive multi-disciplinary care through hospital discharge and beyond.

Ornato says it was “a very exciting time in resuscitation and it’s rapidly evolving.”

Tuesday, March 1, 2011

Family Of Fallen Athlete Intends To Sue

Teen Collapsed, Died During Basketball Game On 18th Birthday
POSTED: Monday, February 28, 2011
UPDATED: 4:41 pm EST February 28, 2011

JACKSONVILLE, Fla. -- For Harvetta and Phillip Jackson Jr., announcing their intent to file a lawsuit in the wake of their son's death was almost as difficult as the day he died.

"It destroyed me," Harvetta Jackson said of her son's death. "It was his 18th birthday. It was an awful day."
"It's just such a horrible tragedy," she said. "I look at pictures of him, and I can't believe he's gone."

In December 2009, Phillip Jackson III collapsed during halftime of a holiday basketball tournament at Terry Parker High School.
"When we were called back there, to see him facedown, I said, 'Son, what's wrong? What's up? And it was shocking," Phillip Jackson Jr. said.

Phillip Jackson III (right) stands with his mom during his football team's senior night at Sandalwood High School.
The Sandalwood senior football and basketball player and father never regained consciousness. He died from sudden cardiac arrest.

Attorney Steve Pajcic said Jackson's death could have been prevented. He said the coaches and police officers there should have tried to save him instead of waiting for an emergency medical technician to arrive.

Pajcic also blames the 911 operator for not giving the caller CPR instructions.
"If they're in a situation where someone lost consciousness, you call 911 and you do CPR," he said.

Pajcic and Jackson's parents have sent a letter to the city, the Jacksonville Sheriff's Office, the Duval County School Board and two state agencies asking for a change in the system. They want to make sure this never happens again. "If left up to me, no one else's child will ever die from someone not calling 911 immediately or not doing CPR to help your child," Harvetta Jackson said.
The School Board said it hasn't yet received the paperwork and said it is too soon to comment.

The family is seeking monetary damages up to $200,000. The law firm said it will not take any money that comes out of the case, but if any does come, it will be given to Phillip Jackson III's son, who was 14 months old when he died.

Saturday, February 26, 2011

Bystanders’ actions save man from cardiac arrest at Milford mall Published: Saturday, February 26, 2011

See what I mean?

MILFORD — A 35-year-old man is alive today because two bystanders acted quickly after he went into cardiac arrest at a restaurant, a fire official said Friday.

Fire Capt. Chris Zak said the man was eating lunch Feb. 19 at Red Robin Restaurant inside the Westfield Connecticut Post mall when he went into cardiac arrest.

Fortunately for the victim, several people played a critical role in ensuring he was resuscitated.

The rescue began when Red Robin manager Curtis Kilburn quickly notified 911 and called mall security, Zak said.

Then two bystanders, who had emergency response training, quickly began cardiopulmonary resuscitation because the man was not breathing, and had no pulse, Zak said.

Jeanne DeMello, a nurse, and Mark Kipstein, an off-duty New York City firefighter, did the CPR.

Mall security personnel arrived with an automatic external defibrillator and hooked up the patient to the machine within minutes of his collapse, Zak said.

Mall security personnel Brian Carson and Michael Todd used the defibrillator to shock the man’s heart back into normal rhythm, Zak said.

Within four minutes of the initial 911 call, Fire Department paramedics were providing advanced life support to stabilize the man’s heart rhythm, Zak said.

The man was then taken to Milford Hospital by American Medical Response ambulance, with paramedics assisting.

“It is only because of the quick thinking of some trained individuals that this person is now alive,” Zak said.

He noted the city was recently a designated a HEARTSafe community by the state Department of Public Health.

The distinction means more than 60 city employees and residents are trained on how to use an automated external defibrillator.

There are 20 defibrillators in public facilities, including City Hall, Milford Library, Parsons Government Center, and the schools.

Fire Chief Louis LaVecchia has said if a defibrillator is applied within the first minute of a person having a cardiac episode the survival rate is 90 percent.

“This type of action and response shows that lives can be saved when all the factors are in place and performed in a timely fashion. It is only because of the actions of all the individuals mentioned that this male patient is alive today,” Zak said.

Bystanders perform CPR on runner whose heart stops during 15-kilometre race

We're seeing this more and more. Now if we could just get more public access and personal AED's deployed.

TAMPA, Fla. — Bystanders performed CPR on a runner whose heart stopped during a race in Tampa.

The Tampa Fire Rescue Department says the 54-year-old man collapsed while running Saturday in the 15-kilometre Gasparilla Distance Classic.

Bystanders performed CPR until two fire rescue medics could reach him and resuscitate him. Fire rescue officials say the man was talking by the time he arrived at a hospital. He also suffered facial injuries from the fall.

The runner's name was not released.

Fire rescue officials say they received about two dozen calls during the race for heat exhaustion and minor injuries such as trips and falls.

Monday, February 14, 2011

Dead for 16-20 minutes, he lived to tell about it


  • NICOLE BROCHU

Charles Morgan was taking a smoke break from his evening shift at a West Palm Beach car dealership when he dropped dead of a massive heart attack. He was 52.

More than two months later, Morgan has no recollection of any of it. Not his boss' CPR efforts, or the crowd that milled around in horror, or the paramedics who brought him back to life with advanced emergency equipment most fire departments have yet to acquire.

The real stunner, even to the men who saved him: He suffered no brain damage or other ill effects, even though his heart had stopped beating for 16 to 20 minutes.

"I'm a lucky man," said the grandfather of two.

Anyone who hears his story would agree. But luck played only one role in the resurrection of Charles Morgan. The car salesman's renewed lease on life is also a credit to quick-thinking co-workers, well-trained paramedics and, especially, an effective combination of cutting-edge lifesaving equipment that made all the difference that December day.

The American Heart Association estimates that fewer than 8 percent of those who suffer cardiac arrest outside the hospital survive, and the vast majority of them are left with some level of debilitating brain damage.

Morgan is not the first to beat those ugly odds, though he joins a rare fraternity of symptom-free survivors.

But experts say his miraculous revival grows less shocking every year, as more fire-rescue agencies around the country share West Palm Beach's foresight and invest in progressive equipment that not only got Morgan's heart beating again, but protected his brain from cell damage. It's the kind of equipment that until recently you'd find only in hospitals. Think AED-level technology, but for EMTs in the field, and with much broader application.

"You gotta love it when a plan comes together," said city Fire-Rescue First Platoon Battalion Chief Malcolm Bomford.

Like any plan with a miraculous outcome, this one, as Morgan noted, "had so many things" that had to go right to give the story a happy ending, and Morgan a new beginning.

And it all started with Rich Harward. Morgan's general manager at Schumacher Volkswagen, and his regular smoke break buddy, Harward was about to join Morgan outside when another co-worker noticed the salesman on the ground, his face in the dirt and his legs twitching. Harward ran to the dying man's side and, as someone else dialed 911, years of training as a former police officer and Marine kicked in.

Harward saw that Morgan's tongue had sunk into the back of his throat, so he reached in and pulled it out to clear his airway. Moments later, the deteriorating patient began gurgling, then took his last breath. Harward immediately began chest compressions — updated AHA guidelines say this is theessential component of CPR — and kept them going until paramedics arrived.

Call Harward's intervention Difference Maker No. 1. The AHA credits bystander CPR with doubling, even tripling, heart attack victims' chance of survival, because it keeps blood flowing to the brain.

"It's all about saving the brain, really," said Dr. Richard Howard, an interventional cardiologist forBroward Health in Fort Lauderdale. "That's what saved this guy's life, having someone there to do CPR."

Harward was the first key player in Morgan's survival. The others came in a fire truck outfitted with state-of-the-art lifesaving gear and an emergency team that knew how to use it.

When the crew from Fire Station 5 reached the scene, Morgan was "purple, not breathing, without a pulse, and we found a crowd around him that was very distressed," said Capt. Danny Collazo, recounting the scene with crew members around a table inside Station 5. Next to him sat his former patient, his eyes rimmed with tears, listening to a story of death and revival retold, Morgan said, "like it was happening to somebody else."

Collazo and his team consider three high-tech devices instrumental in the Dec. 11 rescue. Meet Difference Makers Nos. 2, 3 and 4:

• A $12,000 to $15,000 automated CPR machine that delivered computer-timed chest compressions through a strap fit snugly around Morgan's torso — with 80 percent greater effectiveness than manual compressions.

• A $10,000 glide scope, with a camera at the end, that allowed paramedics a clear view, via a computer screen, of Morgan's airway so they could intubate him more quickly and without injury to his throat.

• A $600 dorm-sized refrigerator that kept IV bags cold enough to lower the patient's body temperature, inducing hypothermia and staving off the swelling in the brain that causes tissue death and destroys function.

The first two gadgets were key to getting Morgan's heart beating on its own again — six to 10 minutes after paramedics began working on him, and 16 to 20 minutes after they estimated he hit the ground. The hypothermia therapy was what saved his brain from long-term damage.

All of it combined into one stunning rescue, one Collazo says he's seen only a few times in his 15-year career. West Palm Beach fire-rescue officials wonder why the technology, as available as it is, is not more commonplace on fire trucks, even in a down economy. "For us, it's become a standard of care," Bomford said, crediting the city for its foresight. "Nationally, it's not a standard of care."

"These guys are more excited to see [Morgan] than probably he is to see them," said Battalion Chief Brent Braunworth. "I implore other fire departments to research this [technology] … because sitting right here is an example that it works."

The magnitude of serving as such a remarkable example is not lost on the man who remembers none of it. Unaware even that his coronary arteries were 90 percent blocked until his collapse, Morgan has stopped smoking, he sees his cardiologist once a month, and he's taken up a new habit — thrice-weekly workouts.

He can think of no better way to honor the second chance he's been given, and the men who worked so hard to see him get it.

nbrochu@Tribune.com, 561-243-6603, Twitter: @nicolebrochu

Monday, February 7, 2011

This is really disgusting.

A participant in the Kaiser Permanente San Francisco Half Marathon died near the finish line on Sunday.

According to the San Francisco Chronicle, the initial response was confused and slow, bystanders and race participants became involved, and the paramedics took twenty minutes to get there.

Witnesses were quoted as saying, "When the runner collapsed, someone pointed it out to the announcer at the finish line, who called over the loudspeaker for medical staff, witnesses said. But it took repeated calls before any staff arrived, and ultimately runners and spectators began performing CPR, witnesses said."

"Finally a woman came up and started yelling at (the announcer), 'You need to start pleading for anyone to help. We need a doctor,' "

This was not a small race: there were 10,000 participants.

The article focuses on the failure of an ambulance to be at the finish line on a timely basis, but the phrase that turns my stomach is "ultimately runners and spectators began performing CPR." With that large a crowd, it's hard to believe that someone wasn't immediately pumping on that runner's chest. Evidently San Francisco is no Seattle.

The complete story is at:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/02/06/BAOM1HJLKG.DTL&tsp=1