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

Marin football coach: aid of off-duty nurses was a 'miracle'

By Will Jason

Marin Independent Journal

Posted: 02/03/2011 11:00:00 PM PST

With the ability to walk, talk and work on Sudoku puzzles, John Richter has come a long way since he collapsed and nearly died a month ago while bicycling in Novato.

"I feel totally normal now," he said. "I feel like I'm probably 95 percent of what I was before the incident and I have plans of being 100 percent."

The Marin Catholic High School football coach has Janet DeMers to thank. An intensive care nurse at Kaiser Permanente Medical Center in San Rafael, she happened to drive by Jan. 3 as Richter lay on Atherton Avenue in the midst of cardiac arrest. She stopped and performed CPR that doctors credit with saving his life, or at least preventing serious brain damage.

"I just think it's a miracle," Richter said. "I know if she wasn't there, I wouldn't be here."

On Jan. 3, Richter, 64, a defensive line coach at Marin Catholic, was about halfway through his routine, 30- to 40-mile bike ride when he collapsed. He has no memory of the fall — or of the previous few days — but his two cracked ribs and the three-inch split in the right side of his helmet tell him he likely fell hard.

When DeMers drove by, Richter was still entangled with his bicycle and a small crowd of passersby had gathered.

"My initial thought process was, 'Oh, he's with friends, he must have fallen off his bike and they're helping,'" she said. "I then realized he was laying on the ground. He wasn't sitting up. At that point I turned around."

When she approached Richter he was still breathing but soon the breaths and his heart beat both stopped.

"His color at that time was not good at all — dusty, kind of gray looking. I pretty much at that time knew that he was going to need chest compressions."

DeMers used simplified CPR procedures that call for rapid, deep presses on the victim's chest without the use of mouth-to-mouth.

The procedure helps maintain partial blood flow until paramedics arrive and is critical in the first few minutes of cardiac arrest, said Dr. Michael Sexton, an emergency physician for Kaiser who treated Richter.

"With every minute that goes by, your chances of survival (without CPR) decrease by 10 percent," he said.

Within minutes, Novato paramedics arrived and shocked Richter's heart back into motion with an electronic defibrillator. They administered medication and inserted a breathing tube.

By sheer coincidence a second Kaiser nurse, Margaret Petrie, also happened upon the scene and assisted medics in reviving Richter.

"It truly wasn't anything anybody else wouldn't have done," Petrie said.

Once Richter arrived at Kaiser, doctors examined his arteries and found they were not blocked. His heart attack was atypical, Sexton said.

"The vast majority of cardiac arrests are in patients who have risk factors — hypertension, cholesterol, diabetes, smoking," he said.

Richter was quickly treated with a cooling therapy to reduce the chance of brain damage.

Five days later, after his condition stabilized, he was transferred to Marin General Hospital, where doctors implanted a permanent defibrillator to help in the event of future cardiac episodes. Richter was sent home after another five days at Marin General and he appears to be recovering quickly.

The hospital care no doubt helped Richter, but the benefits of advanced treatments can be severely limited without the kind of rapid CPR that Richter received, Sexton said.

"Without the up-front, immediate institution of very simple things like hands-only CPR, our chances of being successful with technology are significantly hampered," he said.

DeMers said she was simply following her training.

"I wasn't thinking in any terms of survival," she said. "All I was thinking of was the fact that I had one particular skill. I could do chest compressions, and that was the best choice."

Richter's wife, Pat, said the aid her husband received from strangers at a crucial moment was a "pure miracle."

"A lot of people don't know CPR," she said. "People are afraid of getting involved. The fact (DeMers) wouldn't hesitate I think is pretty awesome and unbelievable."

The argument for Public Access AED

Cardiac Arrest in Homes vs. in Public Settings

Shockable rhythms are more common in public settings.

In a prospective, multicenter cohort study of 14,420 adult patients with nontraumatic out-of-hospital cardiac arrest in the U.S. and Canada between 2005 and 2007, researchers assessed initial rhythm, use of automated external defibrillators (AEDs), survival, and location of arrest (residential vs. public setting).

Among 12,930 patients who had known initial rhythms or had received at least one shock from a bystander-applied AED, arrests were witnessed by bystanders in 39%, AEDs were applied by bystanders in 2%, and arrests were witnessed by emergency medical services (EMS) in 9%. Ventricular fibrillation/pulseless ventricular tachycardia was the initial rhythm in significantly more public arrests than home arrests among those witnessed by bystanders (60% vs. 35%; adjusted odds ratio, 2.28), those witnessed by EMS (38% vs. 25%; AOR, 1.63), and those with AEDs applied by bystanders (79% vs. 36%; AOR, 4.48). The overall rate of survival to hospital discharge for patients with known initial rhythms was 7%. Among patients at home, survival rates were 2% for unwitnessed arrests, 8% for witnessed arrests overall, 10% for witnessed arrests with bystander cardiopulmonary resuscitation (CPR), and 12% for witnessed arrests with bystander-applied AEDs. For patients with bystander-witnessed public arrests, survival rates were 20% overall, 34% for those with bystander-applied AEDs, and 42% for those with bystander-administered shocks. Survival rates were comparable for patients who received bystander-administered AED shocks in public and at home.

Comment: This large multicenter study reaffirms the clear survival benefit of AED programs for public settings. AEDs do not substantially improve the benefits of bystander CPR for arrests at home, suggesting that CPR training should take precedence over widespread deployment of AEDs for the home setting.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine January 26, 2011

Competitive cyclist credits CPR from saving his life

Competitive cyclist Brian Fouche has spent more than a decade racing toward finish lines.

But two months ago, Fouche found himself racing toward death.

"My heart just stopped," Fouche said.

Fouche, 28, of Hagerstown, went into cardiac arrest during a Nov. 20 cyclocross race in Howard County, Md.

The experience has inspired Fouche to start a blog — "Heart Disease, Racing and All That Other Stuff" at Bafouche.blogspot.com.

He's also regained the courage to get back on the bike.

"At one point I thought I wasn't going to be able to ride again," said Fouche, who had a defibrillator implanted in his chest. "To be out there riding again, it was really emotional."

Fouche said his memories about specific details were fuzzy.

He said he was told that a fellow cyclist — who was also a physician — found him on the ground motionless and started performing CPR. "I was really lucky that he was there," Fouche said, who said he was told that two other people joined to help the doctor.

Paramedics arrived and transported Fouche to the hospital, said Jackie Cutler, spokeswoman for the Howard County Department of Fire & Rescue. Fouche said he spent three days at Howard County General Hospital and another three days at Johns Hopkins Hospital in Baltimore.

Fouche was released just before Thanksgiving Day.

He said doctors still aren't sure why he went into cardiac arrest, but he has since been told they couldn't detect major problems with his heart or any anomaly.

Fouche is a single, athletic twentysomething and former high school soccer player with no known health issues. He picked up cycling 11 years ago as a way to stay in shape and began cycling competitively eight years ago, racing with the local Antietam Velo Club and, more recently, with Annapolis Bicycle Racing Team. He is also enters in cyclocross races, an iteration of mountain biking, where riders compete in fast races over varied terrain.

His training is rigorous, calling for as many as 20 hours of riding a week. He competes in 25 to 30 cyclocross races a year.

Fouche said he thought he was in good shape; going into cardiac arrest was the furthest thing from his mind.

"I'm glad to be alive," Fouche said. "This makes me realize that you can just go at any moment. But you have to move each day pushing forward, live each day, keep going."

So on Wednesday, Dec. 15, weeks after he was released from the hospital, Fouche decided it was time to get back on his bike.

"My body and mind all of a sudden just said, ‘it's time to get on the bike,'" Fouche wrote in a December blog post. "I listened and headed out for the best 1 hour ride of my life."

Fouche said he decided to ride to River City Cycles in Williamsport and back to his home in Hagerstown, during a phone interview with The Herald-Mail.

"I think I cried on that ride," Fouche said. "I couldn't believe it."

Fouche said after the first ride, getting back into his old habit was easy. He said he's up to 15 hours of riding a week and is preparing the Tour of the Bahamas, a two-day bike race that starts Saturday, Jan. 29, in Nassau.

He said he plans to keep blogging about biking, and heart disease — hopefully raising more awareness about his experience and finding other athletes who've had similar experiences.

In between the blogging, training and competing, Fouche said there is still one more change he'd like to make in the future.

"I don't know CPR," Fouche said. "That's something I want and need to do. I think it's really important. That's something I plan to do in the next few months."

Copyright © 2011, Herald Mail

The AHA Scores A Bullseye!

I rejoice in the AHA's recommendation that all State Legislatures pass legislation requiring middle and high school students learn CPR in school.

At the same time, I would argue that the legislatures would benefit from additional guidance, and I would urge the AHA to provide some specific guidance to those legislatures in order to maximize the impact an minimize the unintended consequences of this wonderful initiative. I respectfully suggest that the guidance address the following:

Background: SLICC is a presence in the public school system, the parochial school system, and in several private schools in Chatham County and in South Georgia. SLICC has been teaching CPR, AED use, the Heimlich maneuver, and stroke recognition to students ranging from fifth grade through 12th grade for several years. The course takes less than one hour. The students are given a test during the week before the class and they are given the same test during the week following the test. The pre-test tells us where were are starting. The post test tells us how well we did our teaching job. Here is what we have learned:

1. With some exceptions, fifth and sixth grade students are often without the physical strength or emotional maturity to adequately benefit from the experience.
2. Middle school students are quite capable of absorbing the material, but by the eighth grade, it is best to segregate the classes by gender, if you hope to have anything approaching their undivided attention.
3. Toward the end of the hour, the eyes start to glaze over, and the attention wanders. There is no question in my mind that running a longer class would be a waste of everyone's time.
4. Communication is enhanced by using blunt, accurate language and by relating the material to the students' family and friends.
5. There is, in general, a great deal of confusion in most students' minds with respect to the difference between a heart attack, a stroke, and a cardiac arrest.
6. What the students see on TV represents the foundation of their medical education. (Thank you, Hollywood.)

I sincerely hope that all the legislatures do pass the legislation requested. What I fear is that the legislators will write the bills in terms of certificated courses - normally a three and one half hour ordeal. The negatives associated with this are:

1. As Drs. Roppollo, Pepe et al. showed in 2007 (Resuscitation (2007) 74, 276-285)) a thirty minute treatment of CPR and AED use is as good as (CPR) or better than (AED) the traditional certification class. There is no good to be gained by taking three and one-half hours to accomplish what can be covered in a far shorter time.
2. The choking / stroke recognition portion of the course is roughly as important in terms of preventing death and disability as is the CPR and AED segment and could be included without exceeding the normal class length.
3. Scheduling a three and a half hour session for each student will be a significant burden on the individual schools.
4. Certification courses are not without cost: if nothing else, the cost of the card must be paid.
5. Remember that the application of the skills learned by the students will be primarily as Bystanders. Please require that they teach a Bystander course, not a full CPR course. Those students who need certification for employment as baby-sitters, lifeguards, and the like can still take those mandated courses from the AHA or ARC.

Specifically, what I am urging is that the committee that made the "required in the schools" recommendation go one step further. I am asking that the recommendations specify that the course to be taught be a bystander course that includes CPR, AED use, choking emergencies, and stroke recognition. I would further suggest that they develop such a course and make it available to all the schools for no more than the cost of producing, reproducing, and mailing the DVD. I would also urge that the recommendation be expanded to include suggested training cycle definitions that would result in providing courses every year with attendance staggered so that every new student in the school is trained in the year of their entrance and that every student in the school is trained every other year. The students' ability to retain what they learned is not the issue. Rather, as the students mature, they will get different insights from the same material, Further, if history is any guide, the guidelines will continue to evolve through the period a student passes through middle and high school, and they should benefit from that improvement.

I sincerely hope that this initiative succeeds. The volunteers at SLICC would like nothing more than to be able to withdraw from the battle as the school systems take over. We have plenty to do to keep us busy.

Bob Trenkamp

‘Bystander CPR' helps save Mustang woman

By SONYA COLBERG NewsOK.com

Published: 1/18/2011 9:47 AM

He couldn't really say why, but the associate pastor gulped down his lunch at home and then got back to Chisholm Heights Baptist Church within 30 minutes.

In the church gym, church preschool coordinator Martha Rhodes took a lunch break with others who volunteered in the kitchen. They were kidding around, talking about being tired. As if to demonstrate how tired she really was, Rhodes slumped against a friend's shoulder. Everyone laughed at her antics.

But the laughter turned to gasps of terror.

When they realized she had knocked over her glass of iced tea, they knew she wasn't joking around.

Somebody had the presence of mind to call the main office, where Badgett heard the cry over the speaker phone.

“Call 911! It's Martha, and it's bad!”

Badgett heard enough.

“I just took off running to the gym,” he said.

“By the time I got there, you could see that Martha was white. Her lips were already blue.”

Rhodes' heart had stopped. Some people were scrambling around in fear, and someone had the 53-year-old Rhodes on her knees in the floor.

“Somebody help me lay her out flat!” Badgett yelled. Badgett would have a hand in saving someone that day. This time, it was physically instead of spiritually.

For the first time on a human, Badgett began “bystander CPR,” in which he did chest compressions. He learned cardiopulmonary resuscitation on a mannequin about three decades earlier and got a refresher course about a decade ago.

Hands-only chest compression, without breathing into the victim's mouth, is now recommended by the American Heart Association to help an adult who has suddenly collapsed.

“She was really nonresponsive the whole time,” Badgett said. “I'll be honest. I didn't have much hope at that time.”

He kept doing chest compressions until the Mustang Fire Department and Emergency Medical Services Authority paramedics arrived. EMSA paramedic Kimberly Maze said Rhodes wasn't breathing and had no pulse when they arrived. Probably the difference in Rhodes surviving was continuing the bystander CPR until paramedics were in place to take over, she said.

“In my 13 years with EMSA, this was probably the best bystander CPR that I have ever seen,” Maze said.

Paramedics had to use a defibrillator to electrically shock her heart three to four times before Rhodes showed signs of life. Once she was rushed to the hospital, doctors found three blood clots — in her shoulder, arm and heart — had knocked Rhodes to the edge of death.

“They said people like me are usually found dead,” Rhodes said.

Bystanders are sometimes fearful of mouth-to-mouth contact through regular CPR when they witness cardiac arrest, EMSA spokeswoman Lara O'Leary said. That's one reason the heart association's new recommendations on deep compressions without mouth contact are important. And a study published in the Journal of the American Medical Association shows survival rates were higher in the compression-only group, compared with those people who received no bystander help and those who received conventional CPR.

O'Leary said, just as in the Rhodes' case, EMSA paramedics who are dispatchers will advise callers on what to do: How quickly to push on the chest and other details while EMSA medics are en route.

Without bystander CPR, a sudden cardiac arrest victim's chance of survival decreases 7 to 10 percent per minute, studies have found.

A USA Today study shows Oklahoma City and Tulsa are among the top 12 cities in terms of surviving cardiac arrest. O'Leary said the success rate could rise even more as more Oklahomans learn CPR.

Rhodes said she had been encouraging the church to host free CPR classes. After her experience, the church held a CPR class that attracted about 15 students.

Rhodes said every time her husband, Steve, sees Badgett, he thanks the pastor for saving his wife that day in September. She is well now and plans to stand up at a Mustang City Council meeting tonight to thank Maze and her EMSA partner, Mustang firefighters and her pastor for saving her life.

“Words just fall so far short. Words are just words, and it's a heartfelt thing. I can't begin to thank them enough,” Rhodes said.

Read more: http://newsok.com/bystander-cpr-helps-save-mustang-woman/article/3533173#ixzz1BQMLiGF4

DCTS student’s lessons help to save dad’s life

By SUSAN L. SERBIN
Times Correspondent

FOLCROFT — Youngsters routinely wonder, how am I going to use what I’m being taught in the classroom? One Delaware County Technical School (DCTS) student got a swift and remarkable answer to that question by applying what she learned in a life-saving event.

In early in December, Darlene Dougherty was able to put into action the DCTS slogan, “Real School for the Real World.”

Dougherty, a sophomore at Academy Park High School, attends the DCTS Emergency and Protective Services program at the DCIU Folcroft campus and the Delaware County Training Center taught by instructor Paul Tresca and assistant Rich Caruth. Like many other DCTS students, Dougherty said the hands-on learning approach of the technical school programming appealed to her and brought more meaning to regular classroom disciplines, especially with her career goals in emergency services and law enforcement.

Only weeks after she was one of 40 students in the class receiving CPR/AED certification, Dougherty was at home in Folcroft, ready to run an errand with her dad, Joe. She looked out the window and saw him on the ground next to his truck.

“I was the only one home who could handle this. I jumped over a table and down 13 steps,” said Dougherty, noting her little brother, grandmother as well as mother returning home all added to a sense of chaos she had to overcome.

Dougherty ran outside, calling 911 on the way, and yelled to a neighbor for help. She instructed the neighbor to hold her father’s head to prevent any further head or spinal injury while she performed “textbook CPR,” according to Tresca’s recounting of the incident.

Paramedics arrived within minutes, taking over CPR and administering an AED (Automated External Defibrillator), bringing Joe Dougherty back to life. The Doughertys learned later kidney stones had created the crisis.

“My teachers really taught me something that I could use. It’s so different when you are in class for two hours and studying what you like,” said Dougherty.

At the January DCIU Board Meeting, Dougherty was recognized as well as the teaching mastery of Tresca and Caruth. While Tresca expressed appreciation for the recognition, he said it was like “giving an award to Albert Einstein’s geometry teacher.

“There’s a lot to be said about Darlene. She was a firecracker since the first day of class. On this occasion, she did everything right,” said Tresca, clearly proud of his student’s accomplishment. Admiration between teacher and student was mutual.

The DCTS website (www.delcotech.org) describes each program available to students. Skills needed for the Emergency and Protective Services course include critical thinking, judgment and decision-making, problem solving and a high degree of motivation and self discipline.

Dougherty gave those attributes a true-to-life face, saying, “I would have given the same care to anyone, but it was my dad. I had to stay calm, do what I was taught and make no mistakes.

“What she did was unbelievable. But I have to thank Paul (Tresca) a lot for doing what he does in the class,” said Joe Dougherty, a retired corrections officer.

Although only 16, Darlene Dougherty has a clear view of what she wants to achieve in the future. She will further study EMT courses at DCTS, join the U. S. Marines for a stint, and then become a police officer.

“Darlene wanted me to stay in law enforcement, but it was time for me to retire,” said her dad, who now has the luxury of watching his daughter fulfill her ambitions.