There's a large problem with 'presenting rhythm' statistics.

Here's the deal...

When you have a sudden cardiac arrest, your heart has already progressed from a perfusing rhythm to a non-perfusing rhythm.

i.e., your heart is not pumping blood to your brain,

The tracking systems report the "initial rhythm" as whatever the rhythm was when the first person with an AED or Cardiac Monitor got their gear wired to the patient.

If the rhythm was "shockable" and the device was an AED, we know that it was one of two or more well-known rhythms.

If the rhythm was described in terms of the specific rhythm, the device used was a cardiac monitor.

The officially recorded presenting rhythm is reported as "shockable" if an AED fired a blast and as whatever the paramedic on scene saw if the EMTs were the first on the scene and attached a heart monitor.

Here's where the problem comes in: If the EMT's / Paramedics took a little while to get there, the initial presenting rhythm might have been VF at the time of the arrest, but a lot different at the time the EMT's arrived.

Bob

Yawn - another one.

by Michael Berk, KGW Sports
Posted on August 24, 2011 at 6:13 AM
Updated today at 6:47 AM

PORTLAND -- Hayward Demison says he’s “dying to be great” this season.

That’s an interesting choice of words given what this young man experienced 11 months ago.

Last September, Demison scored the winning touchdown in Central Catholic’s win over Canby high school. It turned out that was only his first heart-stopping moment of the night.

“I went to the sideline and everything went black,” he said.

Everything went black because Demison was dying. Some might argue he did die when he went into full cardiac arrest.[sic]

“I walked over and saw him on the ground and they’re giving him C-P-R,” said Central head coach Steve Pyne.

Demison was brought back to life by a nurse who happened to be in attendance at the game. Their story was featured on NBC’s TODAY show. The story is now even more amazing as Demison is on the football field again, grinding it out during two-a-day practices to get ready for the season.

Cleared by physicians after surgery to repair his damaged coronary artery, Demison has a new perspective on life.

“He’s very focused on the bigger things in life,” said Pyne. “It’s been amazing to see him come though this.”

Pyne said he wasn’t overcome with emotion until the week after Demison’s heart attack, when the running back led his teammates onto the field.

“I literally dropped to a knee and cried, and thanked God he was still here with us,” the coach said.

“I have a big heart, it’s fixed now, I feel alive and healthy,” Demison said, “…and I’m dying to be great.”

There’s that expression again. Anyone who has followed his story would argue Hayward Demison has already accomplished that.

There are sometimes a few rusty and missing links in the Chain of Survival

There's a nice, tidy guide to maximizing resuscitation success when someone has a sudden cardiac arrest: (1) immediately recognize the arrest for what it is and activate the 911 emergency response network; (2) immediately begin chest compressions; (3) promptly defibrillate the victim; (4) get the victim under Advanced Life Support care; and (5) provide early post-resuscitative care. It's called the Chain of Survival.

In some parts of the real world, however, there are a surprising number of rusty or missing links. What goes wrong?

Calling 911 can be a problem. Don't laugh - this really happens - people sometimes mess up when they try to call 911. They speak too loudly and rapidly, thus needing to repeat themselves to be understood, they forget to tell the 911 operator where they are, sometimes they get involved in an unnecessarily long conversation with the 911 operator, and sometimes they hang up before the 911 system has the information it needs. What needs to be done when the 911 call is answered is to say (for example) "we are at 17 Smithtown Road in office 651. We have a non-responsive forty-five year old female, She is not breathing. We have begun CPR. We need an ambulance. Did you copy that?" And don't hang up!

CPR can be a problem:
• Not enough people are current in their knowledge of CPR.
• Not enough people who are current in their knowledge of CPR will actually use it before the ambulance arrives.
• The quality of CPR performed by both Bystanders and Health Care Providers is not uniformly good. The issues are inadequate compression depth, too many interruptions, interruption(s) that are longer than 10 seconds, too long a period between cessation of chest compressions and delivery of the shock from an AED, and failure to immediately resume chest compressions after shock delivery.

AED's are often a problem: there aren't enough of them where they need to be.

Gaining access to Advanced Life Support can be a problem, because not all EMS responses to cardiac arrest calls can be made by an ALS unit.

Early post-resuscitative care can be a problem in that not all hospitals are staffed 24 x 7 with the professionals required to deal with a resuscitated arrest patient. Not all hospitals have cath labs, let alone one that can be ready for the patient by the time the patient gets there. And not all EMS units and hospitals are equipped to treat a resuscitated comatose SCA victim with therapeutic hypothermia.

The good news is that we have a road map, we can segment the problem and attack it in pieces, and a lot of people are doing just that. Improvements are being made. This is not a bleak picture. "True Bleakness" is when you have a bad situation but no clue as to how to fix it.

The other good news is that you can do some touch-up on your personal chain of survival and those of your family members and friends. Make sure you are current in Bystander CPR, and make sure (for your sake) that your family and friends are, too. Go to www.slicc.org/ClassVideo/ and download a 35 minute video that covers Bystander CPR, AED use, resolving choking emergencies and recognizing when someone is having a stroke. It's low budget. It's free. If you are prompted for an access code, use 2020.

There is a one in seven chance that you're going to need the CPR skills at least once in your lifetime, and when you do, it's most likely going to be on a family member or friend. Thirty-five minutes.

Thanks for being part of the solution.

What's wrong with this story? See the next-to-last paragraph.

Train Passengers Perform CPR After Man Collapses at West Newton Station
After a man collapsed on the platform in West Newton, Commuter Rail passengers stepped in to help out.
By Melanie Graham

It was an exciting commute for a few passengers on the Framingham/Worcester Commuter Rail line this morning.

David Perry, an Ashland resident, as well as Framingham resident Dean Bonis, helped perform CPR on a man at the West Newton station after the man collapsed and went into cardiac arrest.

"I knew I had the training and I knew what to do," Perry told Newton Patch.

Newton Fire Chief Paul Chagnon told Newton Patch this morning that the man was reported to be "awake and alert" in the hospital.

As the train pulled into the West Newton stop around 8 a.m., Perry and Bonis explained that someone ran onto their cars asking if there was a doctor available, as a man had just collapsed on the platform.

Perry, who is a trained CPR instructor, went out to the platform and met another man who had already started chest compressions.

Soon after, Bonis, who is originally from Auburdale, took over the chest compressions on the platform until EMS arrived. Bonis said he is an EMT in New York and works in Boston at Children's Hospital.

"It was a classic example of everyone coming together for bystander CPR," Perry said.

Perry said he received his CPR training and teacher certification a few years ago through his job in downtown Boston, where he works as an environmental engineer. With his certification, he says he mostly trains other people in his workplace and helps coordinate office safety.

According to Chagnon, the 58-year old male collapsed on the platform and was shocked with a defibrillator one time by EMS crews and resuscitated in the ambulance.

Scanner reports indicated the man was transported to Newton-Wellesley Hospital. Chagnon said this morning the man was transferred to a hospital in Boston, but could not indicate which hospital.

This morning's incident was not the first bystander CPR situation for Perry, though. A few years ago, Perry said he was stuck in traffic in the Lincoln Tunnel on his way to New York City when he saw a man kneeling by the side of the road. After getting out of the car to see what was wrong, Perry found out the man was having a heart attack and stepped in to help out.

During the Lincoln Tunnel incident, Perry recalls the ambulance "taking forever." But today, he said EMS crews were on the scene in no time.

Andrea Wheeler, a spokesperson for the Massachusetts Bay Commuter Rail, said the train conductors did not need to provide much assistance as Newton EMS was on scene shortly after the train arrived.

Perry noted that the train conductors did not need to use the Automated External Defibrillator (AED) on the train, as the bystander CPR and fast EMS response jumped to the task quickly and eventually restored a pulse to the patient.

"It speaks well to the mentality of people out there willing to step up and help out," Perry said.
_________________________

[Blogger's note: I'll bet the conductors could have gotten the on-train AED to the victim faster than the EMT's got to the victim.]

Agnes Cinat died and later thanked paramedics

WINDSOR, Ont. -- Agnes Cinat died the night the Canadian and American women’s hockey teams faced off for the Olympic gold medal game.

On Friday, the 81-year-old grandmother was on hand to talk about it during a reunion of emergency workers and the patients they helped revive.

Cinat said that she was watching the game on television Feb. 25, 2010, when she collapsed.

Her daughter Mary-Lou Cinat-Tino had been popping popcorn in the kitchen when Cinat called to her in a strange voice.

Cinat-Tino, a nurse, performed CPR before paramedics arrived. Paramedics shocked Cinat many times with a defibrillator and gave her several injections of drugs to get her heart pumping, said paramedic Mona Hansen, who had attended Assumption high school with one of Cinat’s daughters.

“My heart just dropped,” Hansen said of recognizing her patient. “It was so hard working on her.”

It took more than 15 minutes to revive Cinat.

“We weren’t sure how it would turn out,” paramedic Dawn Newman said. “When we heard she made it, we were shocked.”

“Usually when we have to work that hard on a patient, there aren’t good results,” Hansen said Friday at the Essex-Windsor EMS’s first survivors’ day, an event to connect patients who survived cardiac arrest with paramedics, dispatchers and firefighters who helped save them.

Newman, who had worked more than six years as a paramedic, said Cinat was the first of her cardiac arrest patients to be revived. It was the second for Hansen.

Barely five per cent of patients who exhibit no vital signs are brought back to life, said Randy Mellow, chief of the Essex-Windsor EMS. If a patient receives CPR, which is comprised of chest compressions and breaths for the distressed patient, the chance of survival jumps 10-fold, said Dr. Paul Bradford, who works in the emergency room at Hotel-Dieu Grace Hospital. Only 20 people in Essex County recovered from not having any vital signs in 2010. Ten attended Friday’s celebration.

Thom Racovitis, owner of Tunnel Bar-B-Q, collapsed in the parking lot of the restaurant on Oct. 26. An employee performed CPR until paramedics arrived. Paramedic Prentice Scott recognized Racovitis right away. It had been 13 years since Racovitis gave the paramedic his first job in Windsor, delivering baked goods. On his first day of work he gave Racovitis his two-weeks’ notice because he got his EMS job.

“I haven’t saved anyone else in 13 years. Isn’t that karma?” Scott said.

Every day since his recovery and every time he saw an ambulance or a paramedic, Racovitis wondered if that was the person who had saved his life.

Getting a chance to meet Scott and the other colleagues who saved Racovitis gave the family a chance for some closure, said Marilyn Racovitis, his wife.

On July 17 2010, Sasha Suvajdzin, 37, jumped into his cousin’s above-ground pool and struck his head on the bottom.

“I heard a crunch and I couldn’t move,” said Suvajdzin, a former tool and die maker. With a broken neck, Suvajdzin was paralyzed, unable to move his arms or legs. His cousin was in the pool with him and he thought Suvajdzin was fooling around. His cousin even brushed against him, but Suvajdzin was unable to touch him to alert him to his distress.

“I was holding my breath and I couldn’t anymore,” he said. His mouth popped open and his lungs filled with water.

“I drowned,” he said. His cousin pulled Suvajdzin out of the water and performed CPR — water gushed from Suvajdzin’s mouth like a fountain.

Suvajdzin was revived by paramedics before he was loaded into an ambulance.

After months of rehabilitation he has full use of his body, although he said his hands don’t work properly.

“It’s a chance at a second life,” said Suvajdzin, who has a son. “I have a chance to do it right.”

Even if a patient is revived, the vast majority die after arriving at hospital because resuscitation is done too late.

“The body might survive, but not the brain,” Bradford said. The window to revive a patient with no vital signs is very small and it takes a minimum of four to six minutes for paramedics or firefighters to respond to an emergency call, Mellow said.

Newman said people are often too embarrassed to do CPR.

“Even if you are doing bad CPR, it’s better than no CPR,” Hansen said.


mwolfson@windsorstar.com or 519-255-5709 or Twitter.com/WinStarMonica

© Copyright (c) The Windsor Star


Read more: http://www.windsorstar.com/health/Back+from+dead+survivors+thank+emergency+workers/5280594/story.html#ixzz1VWhae78O

One more time...

7:32 p.m. CDT, August 18, 2011

ST. Charles, MO (KTVI-FOX2Now.com)— An Old Monroe woman is lucky to be alive. Sherry Howard suffered a heart attack but then a series of very fortunate events, including some cool technology, kept her alive. Sherry Howard said, "I feel very lucky to be alive I really do. I wouldn't know what to do without my kids my husband."

Her husband, Doug used C.P.R. when she collapsed more than 2 weeks ago in their Lincoln County Home. He hadn't used C.P.R. in decades. Doug Howard said, "I learned it at St. Charles High in health class, a health class deal I learned it in there and thought I would never use it."Dr. Mark Taber, with SSM Heart Institute, said, "The husband was a crucial component of her successful outcome."

Paramedics airlifted the woman to St. Joseph Health Center in St. Charles. Her doctor quickly opened the blocked artery and inserted a stent. But it she was not responding well and doctors feared her brain would be badly damaged. Dr. Taber added, "It was definitely life or death."Nurses began cooling Sherry's body with hypothermia technology. Her body was wrapped in a device for 24 hours. Her temperature dropped to 90 degrees. It's something medical experts learned from near drownings in cold water. A victim can be submerged for an hour and the frigid water protects the brain. Dr. Taber said, "Almost certainly had it not been for her receiving hypothermia cooling down her body after we put the stent in, her brain would have not survived."

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Now Sherry's prognosis is excellent. She's grateful to the doctors, paramedics and her husband. She said, "I love him very much I'm very glad he did what he did." Her husband said, "Afterwards everyone says I contributed to saving a life I just did what needed to be done." The couple recommends C.P.R. training for everyone.

It Works...

RHINEBECK — An advocacy organization is searching for the people who saved a woman's life Monday at the Beekman Arms.

Linda Cotter-Forbes, co-founder and director of the Heart Safe Club of Rhinebeck, said her organization wants to thank the three customers who used an automated external defibrillator to aid a woman having sudden cardiac arrest.

"It was around 1 p.m.," said Denise Cvijanovich, the tavern's assistant manager. "It was busy. Our greenhouse area was full."

Cvijanovich said the unidentified woman, who she described as "older," was seated for lunch in the greenhouse room with a couple of her friends.

"Suddenly, one of the customers came over to the desk saying another customer had passed out and to call 911," Cvijanovich said.

The woman appeared to be having cardiac arrest.

"At that point, a man asked if we had a defibrillator, which we do," Cvijanovich said.

The automated external defibrillator, or AED, a portable electronic device used to restore normal heart rhythm, had been donated to the restaurant by the Heart Safe Club, with funding from the Rhinebeck Rotary Club a few years ago.

Cvijanovich said the man and two other customers, one who said she was a nurse, first conducted compressions and mouth-to-mouth resuscitation on the woman. They then used the AED.

"They definitely knew what they were doing," Cvijanovich said.

The woman began regular breathing again about 10 minutes later, Cvijanovich said, shortly before an ambulance arrived from Northern Dutchess Hospital.

Friends, who later returned to thank restaurant staff, reported that the woman was stable at Vassar Brothers Medical Center in Poughkeepsie, she said.

"They said her prognosis was good," Cvijanovich said.

The longtime Beekman Arms employee said it was the first time the AED had been used at the restaurant.

"I was thrilled to hear that not only did someone use the skills of cardiopulmonary resuscitation to save someone's life but they used an AED donated by the heart club, which was instrumental in saving the woman's life," Cotter-Forbes told the Journal Monday evening.

The Heart Safe Club of Rhinebeck was founded shortly after Cotter-Forbes' daughter, Kaitlin, had a sudden cardiac arrest while playing softball at Rhinebeck High School in 2006. She was 15 years old at the time.

"Our main objective is to provide low-cost CPR and AED training," she said, adding that the moments following a sudden cardiac arrest are crucial.

"This highlights the importance of people not only learning the skills of CPR, (but) it also emphasizes the importance of public access to AEDs," she said.

To the unidentified heroes who used the AED to save the woman, Cotter-Forbes said, "We want to find out who they are and thank them."

To contact the Heart Safe Club of Rhinebeck, visit them on Facebook, or send an email to heartsafeclub@gmail.com.