Here's an article written by Mehmet Oz and Mike Roizen. It's well-written, it mentions the most important points, but stops short of getting to the tragedy of it all, and it doesn't provide a solution.
They focus on HCM, a congenital disorder that yields a thicker left ventricle wall. In times of high demand on the heart (high exercise combined with high emotion (ever read about the basketball player that made the game-winning shot just before the buzzer and then died?) the heart can't supply the blood flow needed, and the person dies. Not to be macabre, but you can see this happen at SLICC's web site: Miki, who was 24 at the time of his death, was in the middle of a professional soccer / football match when his heart stopped. He put his head down - assumedly because he felt light-headed - and then collapsed. He didn't make it - which won't surprise you if you look closely at the quality of the CPR he got in the video.
But that's not the only reason young people die during sports. There are congenital problems with the heart's electrical circuitry such as WPW and long QT syndromes. Furthermore, there are fatal conditions (such as Comotio Cordis) that can be triggered by a sudden blow to the chest during a short but critical part of the heart's natural rhythm. This is most often seen when a lacrosse player is struck on the chest with a high-speed lacrosse ball.
So why don't we screen people for these conditions? Good idea, and in fact, Holly Morrell spends her time raising money to pay for screening for numerous conditions that might cause sudden cardiac arrest, but here is no underlying defect that permits Comotio Cordis to happen, because Comotio Cordis doesn't happen because of an underlying defect.
Here is the tragedy:
- To spot HCM - the hypertrophic cardiomyopathy referred to in the article below, you need to perform an echo cardiogram, and a cardiologist has to read it. Even then, it's not a really clear-cut test in some cases, and it's expensive.
- You can spot most electrical defects with an EKG, and a cardiologist will have to review that, too.
- You can have genetic screening performed for only $2,400 per person, but it's sensitivity is only 50% or so. That means it only picks up half the people you are looking for.
- You can reduce the cost of the screening by beginning with a smaller population, for example all 7th through 12th graders, and you can begin by administering a questionnaire designed to uncover family history that might predispose a child to an elevated risk of having one of these conditions. Any child that comes from a family with a suggestive history would then be screened by one of the more expensive methods.
Making some assumptions about the cost and efficacy of the various approaches, a rough estimate is that we could prevent about half the deaths from these causes. with a program that screened all athletes from 7th through 12th grade the first year and all 7th grade students thereafter. In Chatham County, Georgia, that would cost $30,000,000 the first year and $5,000,000 every year thereafter. Or perhaps the existing 7th through 12th population could be brought into the program over a period of six years. That would cost $10,000,000 every year for the first six years and $5,000,000 every year thereafter. To approximate the cost throughout the U.S.A. multiply those numbers by 1,000. It doesn't matter whether these cost estimates are high by a factor of ten - and I don't believe they are: this funding is not available.
There is a way, however, to prevent two-thirds of not only these defect-related and two-thirds of all the Comotio Cordis deaths: have everybody who plays or coaches or referees sports where these deaths might happen be trained in Bystander CPR and to have an AED at every practice and game. The cost can be negligible. Bystander CPR can be taught in a regular class session, and a suitable course is available at a minimal charge.
Now, here's the article that triggered my rant.
When you see a cardiac arrest, your brain fights you - "No, this isn't really happening" - and the circumstances fight you - "Dang! in CPR class the manikin didn't weigh very much and wasn't sitting in a deep chair. This blog deals with practical details and presents reports of "saves." Let me have your questions and comments - they will steer the course of this blog. This blog is brought to you by the volunteers at www.slicc.org
Sunday, June 5, 2011
Bystanders Save 56-Year-Old Man's Life After Heart Attack
Phil Gaudreau
Sunday, June 5, 2011
Ottawa Paramedics are crediting a bystander's excellent CPR skills for saving a life in the Cumberland area on Sunday.
The 56-year-old man collapsed in his garage in the Frank Kenny Road area around 2:45 p.m..
Two women who saw him fall rushed over and began giving CPR.
Paramedics arrived on scene and rushed him to hospital where he's recovering.
They're reminding you that free CPR courses are available through the City, and more information in on the City's website.
Sunday, June 5, 2011
Ottawa Paramedics are crediting a bystander's excellent CPR skills for saving a life in the Cumberland area on Sunday.
The 56-year-old man collapsed in his garage in the Frank Kenny Road area around 2:45 p.m..
Two women who saw him fall rushed over and began giving CPR.
Paramedics arrived on scene and rushed him to hospital where he's recovering.
They're reminding you that free CPR courses are available through the City, and more information in on the City's website.
2,000 learn to save lives in Viera
Operation CPR offers rescue basics
VIERA — Iveth Nunez works at the Veterans Affairs Outpatient Clinic, where she is required to be certified in cardiopulmonary resuscitation and sees the benefits of the life-saving technique.
Nunez covered the bases in CPR basics with her family Saturday morning near her workplace, joining a crowd of about 2,000 people on the outfield of Space Coast Stadium for Health First's "Operation Civilians Prepared to Respond."
Operation CPR offered a short, effective and free session in CPR and the use of an automated external defibrillator, AED. Nunez said she couldn't pass up the chance to get such training for her 13-year-old daughter, Shailine, and Nunez's two nephews, Eric Gibbons, 9, and Maurice Gibbons, 15.
"My daughter is at home with me when I'm baybsitting and I wanted her and my nephews to know what to do in case of an emergency," said Nunez, a medical support assistant.
"I have to stay up-to-date in training and I know how important this is."
Health First's third-annual CPR training event shared new guidelines that make the breaths-and-compression technique easier than it's ever been, the crowd was told.
While the event was intended to educate residents on how to perform CPR, official certification can be obtained through courses offered by Health First and the American Red Cross.
But those gathered took matters seriously, despite '70s disco music that attendees were advised to keep in mind as they did compressions and the rampant jokes about being surrounded by dummies.
Health First volunteers assisted attendees, from school and church groups to large and small families and individuals, throughout the training.
Just three years ago, the first session drew about 125 people.
Mike Means, Health First president and CEO, told Saturday's huge crowd they are a "tremendous help in Health First's mission to make Brevard County a healthy, safer and better place to live and work and raise a family."
Hundreds of families, who received money-saving coupons, Brevard Manatees tickets and T-shirts for attending, agreed. As "Stayin' Alive" played over the speaker system, Chris and Tami Fung of Viera took seats beside adult-size and baby-size CPR dummies.
The Fungs, who are members of the Health First gym, learned about the training through e-mail and thought it would be good for the entire family. So they brought their children, Katelyn, 4, and Connor, 2, along for the hour's worth of activity and instruction.
As Chris Fung placed his hands on a dummy to practice compressions, Katelyn crouched in front of him and put her small hands on the dummy's chest, too.
A volunteer watched, saying, "Good job," as dad and daughter worked together.
"We want the children to know to call 9-1-1 if there's an emergency and be able to help someone if we can, too," Tami Fung said.
Contact Kennerly at 321-409-1423 or bkennerly@floridatoday.com.
VIERA — Iveth Nunez works at the Veterans Affairs Outpatient Clinic, where she is required to be certified in cardiopulmonary resuscitation and sees the benefits of the life-saving technique.
Nunez covered the bases in CPR basics with her family Saturday morning near her workplace, joining a crowd of about 2,000 people on the outfield of Space Coast Stadium for Health First's "Operation Civilians Prepared to Respond."
Operation CPR offered a short, effective and free session in CPR and the use of an automated external defibrillator, AED. Nunez said she couldn't pass up the chance to get such training for her 13-year-old daughter, Shailine, and Nunez's two nephews, Eric Gibbons, 9, and Maurice Gibbons, 15.
"My daughter is at home with me when I'm baybsitting and I wanted her and my nephews to know what to do in case of an emergency," said Nunez, a medical support assistant.
"I have to stay up-to-date in training and I know how important this is."
Health First's third-annual CPR training event shared new guidelines that make the breaths-and-compression technique easier than it's ever been, the crowd was told.
While the event was intended to educate residents on how to perform CPR, official certification can be obtained through courses offered by Health First and the American Red Cross.
But those gathered took matters seriously, despite '70s disco music that attendees were advised to keep in mind as they did compressions and the rampant jokes about being surrounded by dummies.
Health First volunteers assisted attendees, from school and church groups to large and small families and individuals, throughout the training.
Just three years ago, the first session drew about 125 people.
Mike Means, Health First president and CEO, told Saturday's huge crowd they are a "tremendous help in Health First's mission to make Brevard County a healthy, safer and better place to live and work and raise a family."
Hundreds of families, who received money-saving coupons, Brevard Manatees tickets and T-shirts for attending, agreed. As "Stayin' Alive" played over the speaker system, Chris and Tami Fung of Viera took seats beside adult-size and baby-size CPR dummies.
The Fungs, who are members of the Health First gym, learned about the training through e-mail and thought it would be good for the entire family. So they brought their children, Katelyn, 4, and Connor, 2, along for the hour's worth of activity and instruction.
As Chris Fung placed his hands on a dummy to practice compressions, Katelyn crouched in front of him and put her small hands on the dummy's chest, too.
A volunteer watched, saying, "Good job," as dad and daughter worked together.
"We want the children to know to call 9-1-1 if there's an emergency and be able to help someone if we can, too," Tami Fung said.
Contact Kennerly at 321-409-1423 or bkennerly@floridatoday.com.
Saturday, June 4, 2011
Girl revived after being found unconscious and not breathing in local hotel pool
Posted: Saturday, June 4, 2011 1:37 am
By Michael Farnworth For the Journal | 3 comments
POCATELLO — Quick thinking and a good memory helped a poolside bystander save the life of an 8-year-old girl after her father found her face down in the pool at the Red Lion Hotel Friday evening.
The 911 call came in just after 9 p.m. that the unidentified girl was found unconscious and not breathing. However, when paramedics arrived, the bystander, who identified herself only as Karen, managed to use CPR to resuscitate the girl with the help of Red Lion accounting employee Heidi Steele, who is also a part-time certified nursing assistant.
Karen is in town to attend her son’s basketball tournament today, and just happened to be by the pool when the girl’s father started screaming for help and jumped into the pool. After pulling his daughter to the side of the pool Karen helped to pull her out and immediately began CPR.
“I was amazed that I could even remember how to do it,” Karen said. “It’s been 14 years since I had any training in CPR.”
Steele came to the pool shortly after Karen had begun CPR, and as Karen worked to revive the girl, Heidi, who works part time for Need-A-Nurse Medical Staffing in Pocatello, coached her to keep going even after the girl began to cough.
“You have to keep going to try to clear out the airway completely,” Steele said.
“It felt good to be able to help,” Karen said. “I’m just glad that that little girl is still with us.”
“The paramedics are so very thankful for the bystander’s CPR,” Pocatello Fire Department Battalion Chief Tom Sanford said. “It definitely made a difference in this case.”
When the girl was placed in the ambulance just after 9:20 p.m., she was groggy but in stable condition. The name of the girl and her parents were not released.
The girl was transported to Portneuf Medical Center. Her condition was not immediately known.
By Michael Farnworth For the Journal | 3 comments
POCATELLO — Quick thinking and a good memory helped a poolside bystander save the life of an 8-year-old girl after her father found her face down in the pool at the Red Lion Hotel Friday evening.
The 911 call came in just after 9 p.m. that the unidentified girl was found unconscious and not breathing. However, when paramedics arrived, the bystander, who identified herself only as Karen, managed to use CPR to resuscitate the girl with the help of Red Lion accounting employee Heidi Steele, who is also a part-time certified nursing assistant.
Karen is in town to attend her son’s basketball tournament today, and just happened to be by the pool when the girl’s father started screaming for help and jumped into the pool. After pulling his daughter to the side of the pool Karen helped to pull her out and immediately began CPR.
“I was amazed that I could even remember how to do it,” Karen said. “It’s been 14 years since I had any training in CPR.”
Steele came to the pool shortly after Karen had begun CPR, and as Karen worked to revive the girl, Heidi, who works part time for Need-A-Nurse Medical Staffing in Pocatello, coached her to keep going even after the girl began to cough.
“You have to keep going to try to clear out the airway completely,” Steele said.
“It felt good to be able to help,” Karen said. “I’m just glad that that little girl is still with us.”
“The paramedics are so very thankful for the bystander’s CPR,” Pocatello Fire Department Battalion Chief Tom Sanford said. “It definitely made a difference in this case.”
When the girl was placed in the ambulance just after 9:20 p.m., she was groggy but in stable condition. The name of the girl and her parents were not released.
The girl was transported to Portneuf Medical Center. Her condition was not immediately known.
Janet's Law, if passed, will help save lives
Published: Saturday, June 04, 2011, 9:43 AM
By Letters to the Editor/Hunterdon County Democrat
To the Editor:
On April 5, I was involved in the lifesaving efforts of a 16-year-old girl who suddenly collapsed during cheerleading tryouts at North Hunterdon High School.
She was a victim of SCA (sudden cardiac arrest). Because there was an AED close by and the coaches, patrolman and I were all trained in CPR, her life was saved that day. She was one of the lucky ones.
Sudden cardiac arrest in youth is not a rare occurrence. It happens to thousands of kids each year, at sporting events and in classrooms.
AED/CPR Awareness Week is June 1-7. It is critical that our community recognizes the importance of having AEDs available everywhere that youth congregate and that we encourage AED/CPR training and have an emergency plan should someone collapse due to SCA.
A group in New Jersey that is trying to stop these tragic instances is the Janet Fund. They have been pushing for the passage of Janet’s Law for over four years. Janet’s Law would make it mandatory that an AED be available at all schools and that every school has trained responders and an emergency action plan. The law also recommends that an AED be at all playing fields and camps.
When a child has a sudden cardiac arrest, there is a critical 3-5 minute window for that child to be saved. Know the chain of survival:
- Early recognition of SCA, which may include any of the following: collapsed and unresponsive, gasping, gurgling, seizure-like activity
- Early access to 9-1-1
- Begin CPR immediately
- Retrieve and begin use of an AED immediately
- Early advanced care from first responders.
As a parent who has saved a child from SCA, I urge you to contact your state representatives and ask them to support Janet’s Law.
Visit online thejanetfund.org. It is our responsibility as a community to shed light on SCA in youth — and save lives.
KELLY A. STRAUSS
Clinton Township
By Letters to the Editor/Hunterdon County Democrat
To the Editor:
On April 5, I was involved in the lifesaving efforts of a 16-year-old girl who suddenly collapsed during cheerleading tryouts at North Hunterdon High School.
She was a victim of SCA (sudden cardiac arrest). Because there was an AED close by and the coaches, patrolman and I were all trained in CPR, her life was saved that day. She was one of the lucky ones.
Sudden cardiac arrest in youth is not a rare occurrence. It happens to thousands of kids each year, at sporting events and in classrooms.
AED/CPR Awareness Week is June 1-7. It is critical that our community recognizes the importance of having AEDs available everywhere that youth congregate and that we encourage AED/CPR training and have an emergency plan should someone collapse due to SCA.
A group in New Jersey that is trying to stop these tragic instances is the Janet Fund. They have been pushing for the passage of Janet’s Law for over four years. Janet’s Law would make it mandatory that an AED be available at all schools and that every school has trained responders and an emergency action plan. The law also recommends that an AED be at all playing fields and camps.
When a child has a sudden cardiac arrest, there is a critical 3-5 minute window for that child to be saved. Know the chain of survival:
- Early recognition of SCA, which may include any of the following: collapsed and unresponsive, gasping, gurgling, seizure-like activity
- Early access to 9-1-1
- Begin CPR immediately
- Retrieve and begin use of an AED immediately
- Early advanced care from first responders.
As a parent who has saved a child from SCA, I urge you to contact your state representatives and ask them to support Janet’s Law.
Visit online thejanetfund.org. It is our responsibility as a community to shed light on SCA in youth — and save lives.
KELLY A. STRAUSS
Clinton Township
Thursday, June 2, 2011
Interesting quiz, with answers...
A lot of people confuse heart attacks with cardiac arrest. Most heart attack victims don't die. Most cardiac arrest victims stay dead when they arrest.
There is a lot of folklore in circulation, most of which is incorrect. There is an interesting "What do you know about heart attacks?" quiz at
http://www.webmd.com/heart-disease/rm-quiz-heart-myths?ecd=wnl_hyp_060211
Cardiac arrests are a lot simpler: tens of millions of people have Coronary Artery Disease in North America. For more than half, the first symptom they experience is death.
Of these people who arrest, a 'theoretical maximum' of two thirds can be saved, if chest compressions begin immediately and defibrillation happens promptly. Unfortunately, this doesn't happen most of the time, because most of our population doesn't know how to recognize when someone needs CPR, doesn't know how to perform it, and doesn't have an AED (automatic external defibrillator) nearby when they witness a sudden cardiac arrest.
Take the quiz. Then watch the SLICC class video at www.slicc.org/ClassVideo and take it again.
Best
Bob
There is a lot of folklore in circulation, most of which is incorrect. There is an interesting "What do you know about heart attacks?" quiz at
http://www.webmd.com/heart-disease/rm-quiz-heart-myths?ecd=wnl_hyp_060211
Cardiac arrests are a lot simpler: tens of millions of people have Coronary Artery Disease in North America. For more than half, the first symptom they experience is death.
Of these people who arrest, a 'theoretical maximum' of two thirds can be saved, if chest compressions begin immediately and defibrillation happens promptly. Unfortunately, this doesn't happen most of the time, because most of our population doesn't know how to recognize when someone needs CPR, doesn't know how to perform it, and doesn't have an AED (automatic external defibrillator) nearby when they witness a sudden cardiac arrest.
Take the quiz. Then watch the SLICC class video at www.slicc.org/ClassVideo and take it again.
Best
Bob
Art Couldn't have said it better...
Bystander CPR: The biggest links in the chain of survival
Educating bystanders on basic life-support techniques presents a huge opportunity for improving survival rates
By Art Hsieh
The release of the American Heart Association 2010 Emergency Cardiac Care Guidelines marks the 50th anniversary of CPR. It is perhaps with some irony that some of the biggest changes in the resuscitation guidelines have occurred at the most basic level of care – public participation in managing sudden cardiac arrest (SCA). It may be that the greatest opportunity for EMS providers to improve patient survival from SCA is in the encouragement and support of the lay person to recognize cardiac arrest, activate the emergency response system, and perform effective chest compressions and defibrillation.
Scope of the problem
Approximately 350,000 people each year in the United States and Canada experience SCA and undergo resuscitation efforts1. Approximately half occur outside of the hospital. Despite 50 years of understanding the causes of sudden death and developing techniques to reverse it, out-of-hospital survival rates remain low, ranging from 3 to 16 percent in one multi-system study2. In another words, survival from out-of-hospital cardiac arrest has not improved significantly in decades.
Professional resuscitation comes of age
It has become apparent that the "professional" side of cardiac resuscitation has come of age. The number of medications that are routinely recommended for cardiac arrest management has been reduced, and advanced medical procedures such as endotracheal intubation has not been shown to reliably improve survival outcome.
This evolution is reflected in the 2010 Advanced Cardiac Life Support Guidelines; there have been relatively few changes in the recommended care provided by the advanced healthcare provider. The AHA has clearly organized its resuscitation guidelines around the delivery of high quality chest compressions to increase perfusion through the coronary arteries and the need to defibrillate early in cases of ventricular fibrillation. This makes sense – there is no reason to believe that the ALS "house" would stand if the BLS "foundation" is weak.
The effect of bystander participation
If the above statement is to be believed, then the greatest opportunity to improve survival is to turn to the first three links in the chain of survival: early recognition and activation, early CPR, and early defibrillation. In its executive summary of the 2010 Guidelines, the AHA states that, for the management of cardiac arrest "no initial intervention can be delivered to the victim of cardiac arrest unless bystanders are ready, willing, and able to act."3 Recent studies show that the sooner the CPR begins during cardiac arrest, the better the outcome.4,5
Where EMS plays a role
Prehospital care providers own the fourth link in the chain of survival in the out-of-hospital cardiac arrest. We are portrayed as heroes in television shows, movies, and newspaper reports when someone survives after a cardiac arrest. It is critical that the profession plays its part in getting the public to participate in the saving of a life.
While providing certification courses in CPR, AED and First Aid is helpful, there are additional ways to increase public knowledge of CPR. The AHA has endorsed the concept of "hands only" CPR, where recognition of cardiac arrest, activation of the emergency response system, and high quality chest compressions are the key knowledge points.
A casebook example of public participation would be the San Francisco Paramedic Association sponsorship of "sidewalk CPR," which began two years ago. During National CPR & AED Awareness week, volunteer instructors coaxed and cajoled people passing by the SFPA’s building during rush hour, and encouraged them to spend less than 5 minutes practicing hands only CPR on manikins that were laid out on the sidewalk.
Music such as the Bee Gee’s "Staying Alive," "Quit Playing Games with my Heart" by the Back Street Boys, and "Rock It" by Master P provided a soundtrack that allowed participants to practice a rate of about 100 beats per minute. Over the course of two hours, more than 50 individuals stopped and practiced CPR. The cost was low, and the fun factor was high. Last year the event expanded to San Francisco City Hall, where more than one hundred individuals trained during a short period.
Conclusion
EMS providers play a pivotal role in educating and encouraging their community in the management of cardiac arrest management. The level of respect and expectation from the public places us in a unique position to provide the leadership necessary to improve survival from cardiac arrest.
References:
1. Lloyd-Jones D et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–e215.
2. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:1423–1431.
3. Field, et al. Part 1: Executive Summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122;S640-S656.
4. Yoneomoto N. The Effect of Time to Bystander Cardiopulmonary Resuscitation on Survival From Out-of-hospital Cardiac Arrest From All-Japan Utstein Registry Data: A Validation of 3-Phase Sensitive Model. Circulation 2010;122:A260.
5. Bobrow B et al. Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest. JAMA 2010;304(13):1447-1454.
About the author
EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P is the Chief Executive Officer of the San Francisco Paramedic Association. In the profession since 1982, Art has worked as a line medic and chief officer in both third service and fire-based EMS. He has directed both primary and EMS continuing education programs. A Past President of the National Association of EMS Educators, and a scholarship recipient of the American Society of Association Executives, Art is a published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.
Educating bystanders on basic life-support techniques presents a huge opportunity for improving survival rates
By Art Hsieh
The release of the American Heart Association 2010 Emergency Cardiac Care Guidelines marks the 50th anniversary of CPR. It is perhaps with some irony that some of the biggest changes in the resuscitation guidelines have occurred at the most basic level of care – public participation in managing sudden cardiac arrest (SCA). It may be that the greatest opportunity for EMS providers to improve patient survival from SCA is in the encouragement and support of the lay person to recognize cardiac arrest, activate the emergency response system, and perform effective chest compressions and defibrillation.
Scope of the problem
Approximately 350,000 people each year in the United States and Canada experience SCA and undergo resuscitation efforts1. Approximately half occur outside of the hospital. Despite 50 years of understanding the causes of sudden death and developing techniques to reverse it, out-of-hospital survival rates remain low, ranging from 3 to 16 percent in one multi-system study2. In another words, survival from out-of-hospital cardiac arrest has not improved significantly in decades.
Professional resuscitation comes of age
It has become apparent that the "professional" side of cardiac resuscitation has come of age. The number of medications that are routinely recommended for cardiac arrest management has been reduced, and advanced medical procedures such as endotracheal intubation has not been shown to reliably improve survival outcome.
This evolution is reflected in the 2010 Advanced Cardiac Life Support Guidelines; there have been relatively few changes in the recommended care provided by the advanced healthcare provider. The AHA has clearly organized its resuscitation guidelines around the delivery of high quality chest compressions to increase perfusion through the coronary arteries and the need to defibrillate early in cases of ventricular fibrillation. This makes sense – there is no reason to believe that the ALS "house" would stand if the BLS "foundation" is weak.
The effect of bystander participation
If the above statement is to be believed, then the greatest opportunity to improve survival is to turn to the first three links in the chain of survival: early recognition and activation, early CPR, and early defibrillation. In its executive summary of the 2010 Guidelines, the AHA states that, for the management of cardiac arrest "no initial intervention can be delivered to the victim of cardiac arrest unless bystanders are ready, willing, and able to act."3 Recent studies show that the sooner the CPR begins during cardiac arrest, the better the outcome.4,5
Where EMS plays a role
Prehospital care providers own the fourth link in the chain of survival in the out-of-hospital cardiac arrest. We are portrayed as heroes in television shows, movies, and newspaper reports when someone survives after a cardiac arrest. It is critical that the profession plays its part in getting the public to participate in the saving of a life.
While providing certification courses in CPR, AED and First Aid is helpful, there are additional ways to increase public knowledge of CPR. The AHA has endorsed the concept of "hands only" CPR, where recognition of cardiac arrest, activation of the emergency response system, and high quality chest compressions are the key knowledge points.
A casebook example of public participation would be the San Francisco Paramedic Association sponsorship of "sidewalk CPR," which began two years ago. During National CPR & AED Awareness week, volunteer instructors coaxed and cajoled people passing by the SFPA’s building during rush hour, and encouraged them to spend less than 5 minutes practicing hands only CPR on manikins that were laid out on the sidewalk.
Music such as the Bee Gee’s "Staying Alive," "Quit Playing Games with my Heart" by the Back Street Boys, and "Rock It" by Master P provided a soundtrack that allowed participants to practice a rate of about 100 beats per minute. Over the course of two hours, more than 50 individuals stopped and practiced CPR. The cost was low, and the fun factor was high. Last year the event expanded to San Francisco City Hall, where more than one hundred individuals trained during a short period.
Conclusion
EMS providers play a pivotal role in educating and encouraging their community in the management of cardiac arrest management. The level of respect and expectation from the public places us in a unique position to provide the leadership necessary to improve survival from cardiac arrest.
References:
1. Lloyd-Jones D et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–e215.
2. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:1423–1431.
3. Field, et al. Part 1: Executive Summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122;S640-S656.
4. Yoneomoto N. The Effect of Time to Bystander Cardiopulmonary Resuscitation on Survival From Out-of-hospital Cardiac Arrest From All-Japan Utstein Registry Data: A Validation of 3-Phase Sensitive Model. Circulation 2010;122:A260.
5. Bobrow B et al. Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest. JAMA 2010;304(13):1447-1454.
About the author
EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P is the Chief Executive Officer of the San Francisco Paramedic Association. In the profession since 1982, Art has worked as a line medic and chief officer in both third service and fire-based EMS. He has directed both primary and EMS continuing education programs. A Past President of the National Association of EMS Educators, and a scholarship recipient of the American Society of Association Executives, Art is a published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.
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