Dr. Dustin Ballard: A hands-on approach to saving a life

[NB: Dr. Ballard is using "Heart Attack" to mean "Cardiac Arrest". It's not accurate, but it's likely intentional in order to better communicate with the public.]

By Dr. Dustin Ballard
correspondent

Posted: 05/30/2011 05:33:00 AM PDT

WHEN RENE ISMAEL Martinez collapsed while playing soccer on Nov. 7, his friend and teammate, Luis San Ramon, could think of just one thing: Rene's young children and what they would do without their dad.

The thought was grimly real; 44-year-old Rene had just suffered a sudden cardiac arrest. This notion would be enough to paralyze most people — freezing them like a driver at a red light. But not Luis, he managed to block out the background noise so he and another teammate could attempt to resuscitate Rene.

The other man was Alejandro Higareda, the assistant director of operations at Marin Academy High School; he's trained in CPR and basic life support as a prerequisite for his job. Alejandro knew to perform chest compressions fast and deep, sternum to backbone while keeping count in his head and giving direction to Luis (who was providing rescue breathing) and others.

This powerful CPR, the force of which at first worried some onlookers, proved to be life-saving. Later described by one of the responding paramedics from Novato Fire as "simply awesome," Alejandro's forceful chest compressions kept blood circulating through Rene's body for the five or so minutes it took help to arrive. Alejandro was just doing what he'd been trained to do — with the help and support of bystanders who urged him on — and he had no idea how profoundly important his actions were for Rene.

On May 19, atthe first Marin EMS survivors' celebration, Rene Martinez walked onstage with Luis, Alejandro, and a crowd of paramedics, firefighters, doctors, nurses and medical communications specialists (dispatchers and interpreters). It had been a little more than six months since that day on the soccer field, and if we hadn't just heard the story, no one in the audience would have guessed that Rene had so recently suffered a cardiac arrest. Through an interpreter, Rene tearfully thanked everyone onstage for saving his life.

Rene is one of the lucky ones. Nationwide, more than 200,000 people a year suffer a cardiac arrest and of these only 2 percent to 2 percent to 8 percent survive long enough to be discharged from the hospital. Some of these never fully recover brain function.

But Rene regained mental faculties by the time he reached the hospital. I know, because I was there that day and asked his doctor, Bob Stein, how it could be that his patient, who had just suffered a prolonged cardiac arrest, was now awake and talking to the staff. I don't recall exactly what Stein replied, but I now know the explanation.

Without a doubt, Rene's remarkable recovery was because of the simply awesome CPR he received from Alejandro. This CPR kept his brain oxygenated while his heart was stalled. Thus, after the Novato Fire paramedics used an electronic defibrillator to restart his heart, Rene's brain was able to quickly recover.

Rene was one of 17 Marin residents who survived an out-of-hospital cardiac arrest last year. This number represents a 15 percent survival rate — much better (albeit with a small sample size) than national averages. But could it be better? What would it take to do better? A new hospital? Defibrillators in every home? No, nothing that drastic.

All it would take is every citizen knowing how to do CPR. And now, it's easier than ever to learn CPR, as new evidence and guidelines suggest that hands-only CPR is at least, if not more, effective in adult patients with cardiac arrest than traditional CPR with mouth-to-mouth breaths.

I asked our new County Public Health Officer, Dr. Jason Eberhart-Phillips, about the importance of bystander training for CPR.

"Heart attacks," he wrote, "remain one of the leading causes of out-of-hospital death in Marin County. When heart attacks happen, bystanders who phone 911 and begin CPR can greatly increase the chances of survival. Effective chest compressions can move oxygen-rich blood to the heart and brain, keeping a victim alive until emergency responders arrive on the scene."

So, wondering how you can be prepared to be a hero among us like Luis and Alejandro? Or how you can feel confident that your fellow citizens would save you like they did Rene Martinez? It's simple, really. Rehearse. Learn something, practice it and when the time comes, memory will kick in. So, for those interested in learning proper CPR, here are some options:

• You can sign up for a basic life-support course or encourage your employer to offer one.

• You can pay attention to where Automated External Defibrillators (AEDs) are kept — you will notice them in gyms, at malls and in airports. And yes, there is an app for this, too.

• You can come June 4 to one of multiple sites in Marin and receive free (non-certified) training in hands-only CPR and AED use from local EMTs, paramedics, nurses and doctors. The training will take less than 10 minutes of your time and just might help you save someone's life.

As Alejandro Higareda will attest, this is both an opportunity and an honor, and one best informed by rehearsal.

Dr. Dustin W. Ballard is an emergency physician at Kaiser Permanente San Rafael and the author of "The Bullet's Yaw: Reflections on Violence, Healing and an Unforgettable Stranger." His Medically Clear column appears every other Monday; follow him on Twitter at http://twitter.com/dballard30.