"Bystander" is more an environment than a level of training

When we hear "Bystander CPR" the image that comes to many minds is a person at home or at the shopping mall who isn't a medical professional but who has just seen someone have a sudden cardiac arrest. (You can thank TV for that shopping mall image - 85% of all out-of-hospital arrests occur in a private residence.)

The bystander environment is usually one where the witness has to call 911 and perform hands-only CPR  alone for an average of ten minutes. The ambulance environment and the hospital environment have other people there to help.

When tested on a manikin exhibiting a chest stiffness at the 32nd percentile - a little less than 65% as stiff as the AVERAGE adult's chest - one-in-six of the subjects tested made it to ten minutes using their hands, but four times as many made it to ten minutes using the heel of their foot.

When talking with EMTs, Paramedics, Nurses, and Doctors about heel compression CPR, the typical reaction I get is "no thanks - I'm CPR certified." The problem is that those medical professionals are certified in a manual technique that that usually cannot be performed on a real adult for ten minutes! When you are by yourself, you are a Bystander, regardless of your training.

Here's where you can watch a demonstration of Heel Compressions. And while you're at it, why not brush up on AED use, choking emergencies, and stroke recognition - they're all in the same folder.

...and to belabor the obvious, after you've watched the videos, you won't be any safer - the folks around you will be safer. So make sure those who are around you frequently watch the videos, too.

Bystanders, use your Heels!

A novel chest compression technique was explored in 1978 and 1980. It was good, but not necessary, because compressing an adult chest one inch wasn't all that tough for the subjects tested in CPR studies.

Time marched on and in 2005 the compression depth guideline went to 1.5 inches. An alarming number of CPR instructors flunked their re-qualification trials, because they were unable to complete five  cycles of 30 compressions and 2 breaths.

Guess what happened when the guidelines went to 2 inches in 2010? You guessed it.

As SLICC began training residents in 31411 - an older community - it noticed that many students either couldn't get down on the floor or couldn't apply much force to the manikin's chest because of problems with their hands or wrists. In those cases we instructed them to take their shoes off, stand over the victim's head facing the victim's feet, place one heel on the CPR point and use the leg / heel to compress the chest a full two inches. In a study published recently in the American Journal of Emergency Medicine Dr. Perez and I demonstrated that use of the heel quadruples the number of rescuers that can perform guideline-compliant chest compressions for ten minutes. Ready for the BIG news? The group of subjects tested had approximately the same age distribution as do cardiac arrest victims!

To see the technique demonstrated, go to www.slicc.org/ClassVideo and select the Adult CPR video. (And while you are there, there are some other useful videos at that site.)

After you watch the Adult CPR video, you won't be any safer - the people you live with and the people you spend a lot of time with will be safer. Hence, it's in your interest that those people watch the videos, too!

Get safer!

A way to make yourself safer in less than an hour!

Eighty-five percent of Sudden Cardiac Arrests occur in the home. Fewer than half are witnessed. For the arrests that are witnessed, the witness is usually about the same age as the victim and off a different gender. The best chance of getting discharged from the hospital with major brain functions intact is immediate CPR and prompt defibrillation.

The way to make yourself safer is to make sure that the person(s) you live with watch the videos at www.slicc.org/ClassVideo/

If he or she is of the thinking type, he or she will figure out that they, too, will be safer if YOU watch the videos, as well.

...and while you're at it, think about the folks you see frequently, too.

And if you want to make the defibrillation happen faster - and that really, really helps - go to www.slicc.org and click on AED Deal in the left column.

A lot of survival depends upon what the other person does!

Bob

It's been a while. My last post was just after presenting our research on the prevalence and magnitude of "leaning" at the AHA's Resuscitation Science Symposium. ("Leaning" is having too much (more than 1.5 pounds) of force on the sternum at the top of the "full recoil" up-stroke when performing chest compressions.

In the past eight months SLICC has...
- Invented a Force Meter that permits the user to:
-- Discover the percentage of the adult population to which a person can administer compliant CPR
-- Measure the instantaneous rate of chest compressions
-- Measure leaning, the residual force on the sternum at the top of the 'full recoil' stroke.
- Invented a device that keeps on clicking when the leaning is within the safe limit (1.5#)
- Been invited to speak at ECCU about how CPR is broken and what we need to do to fix it.
- Had a paper on Heel Compressions vs Manual Compressions published in the AJEM
- Measured the CPR capacity, rate, and leaning of 383 Healthcare Professionals (anonymously)

Currently, we're trying to invent a BVM that cannot be operated more than 10 times per minute.

No offence, but this is so much more fun than playing golf.

...and that's why it's been eight months since I last posted.

Bob

SLICC presented its leaning research at the AHA Resuscitation Science Symposium on November 15th.

The Sudden Cardiac Arrest Foundation's coverage of that includes the slides from the presentation at the end of their article.

Are you sure you want to vacation in Maine?

Veto of Bill on CPR Training in Schools Holds

06/07/2013 10:27 AM ET

The bill sought to train high school students in life-saving techniques including CPR and the use of automatic external defibrillators.

AUGUSTA, Maine (AP) _ Gov. Paul LePage's veto of a bill calling for cardiopulmonary resuscitation training in Maine schools will stand. A 22-13 Senate vote Thursday fell two short of the number needed to override the governor's veto. The bill sought to train high school students in life-saving techniques including CPR and the use of automatic external defibrillators. The House had voted to override the governor's veto Wednesday. Supporters said the bill will save lives. But Republicans supporting the governor's veto said that while school districts should implement CPR training, the state shouldn't order them to do so through laws. It was the ninth veto this session lawmakers have failed to override. [From the Maine Public Broadcasting Network.]

The supreme court has weighed in on the issue of whether Target can be forced by federal mandate to have an AED in all its stores. I am not surprised.

There is another issue that weighed heavily: I suspect the court would unanimously support each city's, each county's, or each state's requirement for universal deployment of AEDs. The problem is with asking the Federal Government to decree it. Fire extinguishers are not required in big box stores by federal mandate - it's usually the state or county - and in some cases - the municipal codes that require fire extinguishers.

It's all about concentration of power.

Unfortunately, that means that to achieve what we want - a world where an AED is no more than 400 feet away - we will need to get a lot of folks bugging their local leaders.

So in the end, it will be up to each of us to promote the broad deployment of AEDs. Given that nearly 70% of all cardiac arrests in this country happen in the home, the most logical place to start is to make sure you have one in your home. Not only is the home the most likely place where an AED will be needed, it is also the place where it is MOST needed, because that's a place where a (usually) lone rescuer is going to have to perform guideline-compliant chest compressions for an average of ten minutes, and fewer than 20% of adults can do that.

Bob
Notes
1. the 70% figure is from the CARES 2005-2013 data
2. the ten minute figure and the percentage who can comes from a presentation at the AHA Resuscitation Science Symposium in 2012: Using CPR training manikins and a test cohort whose age distribution matched that of cardiac arrest victims, only the youngest 20% were able to make it to ten minutes. The manikins used were at the 25th percentile of adult chest stiffness. See www.slicc.org/ReSS_2012_359.pdf and www.slicc.org/ReSS_2013_030.pdf