Improving the odds

My family all know what to do when they witness a sudden cardiac arrest: if the victim is non-responsive and not breathing normally, they call 911, they get the victim on a hard, flat surface with the head tilted back, and they begin compressing the chest at least two inches deep at a rate between 100 and 120 compressions per minute, and they defibrillate the victim promptly if there is an AED available and immediately resume compressions. If there is no AED available, they don't stop compressions until someone else takes over.

But there's a problem with this: if they perform chest compressions the way they would be taught in an AHA or ARC or just about any other course, they won't be able to sustain the target compression rate and depth until the ambulance gets there. Most people cannot provide adequate chest compressions for three minutes. The longest I've seen is an Army Ranger Medic who lasted a little more than nine minutes.

So how long do you have to perform chest compressions in a real-world situation? and how can you overcome the three minute wall?

It all depends upon where you have the arrest and how many people are able to share the chest compression task. If you have your arrest on a farm, your chance of surviving are close to zero, probably because a long period of time elapses between the time of the arrest and the arrival of the ambulance.

In a suburban or metropolitan setting, the shortest time between the time of the arrest and the arrival of the ambulance crew at the victim's side is likely to be ten to twelve minutes. Remember that when you see the arrest, you have to figure out what's happening; you have to call 911; you have to tell the 911 operator where you are, what's wrong, what you're doing about it, and what you need; the 911 operator needs to either relay the information to the ambulance dispatcher or has to figure out which ambulance will be dispatched and contact them; and the crew on the ambulance has to get in route to the scene. By the time the wheels are rolling, two to four minutes are likely to have elapsed since the time of the arrest. It is not unusual for five to eight minutes to elapse from the time the ambulance is rolling to the time of patient contact. Do the math. Act out all the steps. it's likely that if you are alone with the victim, the victim's odds of getting out of the hospital with major brain function intact will hinge or your ability to perform adequate chest compressions for ten to twelve minutes.

My wife can perform adequate chest compressions for more than ten minutes.(That's when we stopped timing - she was still going strong at the ten minute mark.) She was using the heel of her foot at the "CPR point", standing alongside the victim, facing the manikin's feet.

Unfortunately, that's not what you learn in most CPR classes.

SLICC's current class video teaches the traditional method but also teaches the "with your heel" method. It can be downloaded from www.slicc.org - just click on "for past trainees" in the left-hand column. It's a large file. Clicking on it multiple times will simply lengthen the time it takes to download it. SLICC's next class video will feature the "heel" method, with a small segment covering the traditional method.

Bob

It is time to re-think how we're trying to deal with SCA's.

I believe that if the BLS curriculum were changed to teach what current resuscitation science teaches, many tens of thousand more people in North America would survive cardiac arrests than currently do. ("Survive" means "Get discharged from the hospital with major brain functions intact - i.e., with a CPC score of 1 or 2.")

Very few people perform CPR properly: the rate is too slow, the interruptions are too frequent and too long, and the compression depth is too shallow.

The imposition of a limit on compression interruptions didn't do much more than promote the documentation of five- and ten-second intubations and intubations without interruptions.

The CARES data shows us that two-thirds of all out-of-hospital sudden cardiac arrests occur in the home. Survival data shows that two percent of OOHSCA's occurring in the home have a survival outcome.

The Pheonix, AZ Airport has averaged a 75% survival rate for ten years.

Perhaps it's time to re-think what we take on faith as being the solution to the problem.

Bob

DACPR makes a difference

There is a growing body of evidence that Dispatcher-Assisted CPR can make a significant difference in cardiac arrest survival rate. By JERILYN FORSYTHE Cronkite News Service Longtime Mesa 911 operator LeAnn McLaws was skeptical at first. After 17 years of asking callers if they wanted to start giving CPR to a cardiac arrest victim, the department told her and others last fall to stop asking and begin telling: “I need you to start CPR.” “They’re very excited, they’re wanting help and you have to bring their focus to it,” McLaws said of the process of walking callers through CPR. “We are assertive … and have a calm voice and say, ‘This is what you’re doing,’ and not give them the option.” That seemingly simple change saved 13 lives from November to January in Mesa alone, according to the Arizona Department of Health Services, and McLaws is now a believer.

Here's what you need to focus upon

http://keranews.org/post/more-north-texans-surviving-sudden-cardiac-arrest

This is worth reading.

We're not paying attention to the data, folks.

Fact: two thirds of all cardiac arrests in the U.S.A. occur in the home. (First five years of CARES data)

Fact: average survival rate in the U.S.A. is 7+% ("survival" is defined as getting discharged from the hospital with CPC=1 or 2. A score of "1" means no neurological damage; "2" means some damage, but still able to perform the activities of daily living without assistance.)

Fact: any bystander involvement can raise the survival percentage into the low-to-mid-twenties. (recent 29,000+ cohort Danish study.)

Fact: the Phoenix Airport CPC=1 or 2 survival rate for witnessed cardiac arrests has averaged 75% for ten years.

When you see an out-of-hospital sudden cardiac arrest - and there's a fourteen percent chance that you will at least once in your lifetime - there is a greater than 85% chance that the victim will be a family member, a friend, or an associate. That means that we each have a greater than ten percent chance of seeing a family member, friend, or associate die - at least once in our lifetime.

When that happens, you will call 911 and unlock the front door, if you are at home. If this is all you do, the ambulance will usually arrive in 8-12 minutes (that's probably 10-14 minutes after the victim arrested, because of the time it takes to figure out what's going on, the time it takes to call 911, and the time it takes for 911 to figure out which ambulance is to respond, and for that ambulance to get rolling.) If this is the scenario that unfolds, the victim will have about a 7% chance of getting out of the hospital with at least major brain functions intact. (If the arrest happened at home, the odds drop to 4% if witnessed or 2% if either not witnessed or not recognized as being a cardiac arrest by those present.)

Thus, the first major battle to win is that of making your home more like the Phoenix Airport. I'm not talking about putting runway lights on the sidewalk and driveway. What I'm talking about is:

1. Get trained in Bystander CPR so that you will be able to recognize a cardiac arrest when you witness one and will be able to react appropriately.
2. Get a personal AED. Keep it in a place where you can get to it quickly - for example, while you're hurrying to unlock the front door while you are calling 911 on your portable or cell phone. If you have a personal AED, you will be able to use it before the ambulance even starts rolling, and using the AED within a minute or two or three of the arrest carries a far, far higher probability of a good outcome. The best the ambulance is going to be able to do is 10-14 minutes.
3. Practice what you are going to do, and keep your training current.

If you cannot find a CPR class, go to www.slicc.org, click on the "For Past Trainees" link in the left-hand column, and download the class video. 

If you want to survive, have an AED nearby. My wife and I do.

Retired firefighters use AED to save golfer

By GEORGIA ZERMENO, Reporter, The Friday Flyer

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"It was about 4:15 or 4:30 p.m.," says Liz Hefferon. "I was picking my husband up after he completed a game of golf, and we went into the clubhouse for a drink – that's when it happened."

A moment that changed some lives, a moment that saved another's life.

According to Golf Course employee Ian Nelson, he was working the desk when someone opened the door and yelled, "Call 911, we have someone down on the 18th hole!"

Ian immediately called 911 and gave them the location, had someone watch the desk and headed out to see how he could help.

Ian says what he witnessed was amazing. "They were doing CPR, then they did the defibrillator. The guy was blue, lifeless, and then suddenly he took a gasp of air. They saved his life."

A mix of the right people at the right place, at the right time, with knowledge of resources around them, saved the life of golfer Dave Roscoe on Monday, April 30.

The heroes were three retired firefighters and one former employee and his wife sitting at the bar, getting a refresher after their game of golf. Jim Brown, retired captain/paramedic from Ontario Fire Department, looked out the window and saw a man performing CPR on another man on the 18th hole. Witnesses say he yelled out that a man was down on the green and to call 911 as he headed out the door. Bill Trembly, retired captain for Santa Barbara City Fire, along with Jerry Hefferon, jumped off their seats to head out with him.

"Grab the defibrillator guys, its behind the register," yelled Jerry's wife Liz. The men grabbed the AED (automatic external defibrillator) and ran down the grass. The bartender called 911. The third firefighter, Bill Iverson, a retired Orange County firefighter, headed out to meet the Riverside County firefighters to help direct them in.

According to Bill Trembly, when he got to the area where Dave Roscoe was, Jim Brown had taken over the CPR from Dave's friend, Mark Bora, who had been doing CPR for a few minutes already. Since he wasn't confident the AED machine was the same as what he was used to, Bill took over CPR and handed the machine to Jim. Jim began the defibrillation, administering the controlled electric shock in order to allow restoration of the normal rhythm of the heart.

"It saved his life," Bill says. "He didn't have a pulse, he wasn't breathing, I don't think he would have made it without the AED."

Asked the question, "Now that you have seen it work, do you think the AED was easy to use?" Bill responded, "Definitely, it told us everything to do step by step." He acknowledge that Jim, being a paramedic, knew what to do anyway, but Bill is confident anyone could use the machine.

By the time Fire Engine 94 arrived, Dave was awake and asking questions. Jim gave a quick report to the crew and the guys returned to the clubhouse.

Witness Terry O'Rouke sent a Letter to the Editor to acknowledge the heroes and Travis Montgomery made a call to the paper to share the miraculous story.

Jim Brown's wife, Gerri, said, "He was just so calm about it, it's what he does." She told The Friday Flyer he had just left town and was unable to do an interview, but she agreed the men were heroes and that "firefighters are just amazing."

Liz Hefferon was asked how she knew the machine was there. "When my husband worked there, they were all trained on it, we were all made aware where it was, and how easy it is to use! I was happy I remembered."

Dave's friend Mark stopped by the Pro Shop to update the staff on the condition of his friend. When asked how he was doing, he responded "He's alive!" Mark shared that his friend is in ICU and is being treated for an irregular heartbeat, but is in good hands.

The importance of AEDs have been the topic in communities, school settings, recreational parks and business offices for years. Medical personnel continuously advocate for everyone to invest in taking a CPR class in which training on AEDs is included.

Canyon Lake residents should be aware that, within the community, the POA has purchased a total of six AED stations. The machines are located at the Country Club, Lodge, POA office, Campground, Senior Center and the Pool. City Manager Lori Moss announced that the City will be purchasing two more to be placed in the Special Enforcement vehicles and on Marine Patrol boats during the summer months.

Residents are encouraged to take note when entering the above facilities to see where the device is located. Emergency Preparedness Committee President Nancy Carroll has scheduled a CPR/First Aid Class for June 1, and is hoping to provide both a daytime class and evening class.

...and that's why you need an AED at every athletic event and practice!

Coaches Credited With Saving Student’s Life

April 26, 2012 12:06 AM

Reporting Carol Cavazos

GARLAND (CBSDFW.COM)- A couple of Garland High School coaches are credited with helping to save a player’s life after he collapsed during an indoor drill last week.

It turns out, the student had an undiagnosed heart problem. Doctors at Medical City Children’s Hospital implanted a defibrillator in his chest Wednesday. Now, everyone is breathing easier.

By all accounts, Richard Young was healthy. He was 15-years-old. He was a freshman on the Garland High School football team, #82.

So, it was a shock when he collapsed during an indoor drill at school last Wednesday, April 18th.

It happened around 1 o’clock in the afternoon. He and his teammates were just beginning their conditioning exercises when Richard collapsed.

Teammates were the first to see Richard fall. They alerted a coach.

Coach Jeff Middleton remembers thinking, “It looked like he was having a seizure.”

He wasn’t. His heart stopped pumping – the result of a rare, previously undiagnosed congenital heart defect.

Scott Smith, the school’s Athletic Trainer said, “And then, he almost acted like he wasn’t breathing at all.”

“That was a scary point. When you’re sitting there looking at a young teenage kid who’s supposed to be in good physical condition, laying on the ground not breathing,” Coach Middleton said.

The coaches performed CPR on Richard and brought over the school’s Automated External Defibrillator. The machine was still analyzing Richard when the paramedics arrived.

“It’s one of those deals where you hope it doesn’t happen to you. Hopefully, you’re prepared when it does happen,” Coach Smith said.

Richard doesn’t remember much. He only knows this.

“They said I almost died. So, I feel kind of blessed,” he said.

His mother, Tina Young, does too.

“They said it could have easily happened when he was asleep, when he was at home playing with his dad or with one of his sisters or even being with me. We could’ve been at the grocery store somewhere and it could’ve happen. So, I’m
thankful it happened the way it did and at the time that it did.”

To keep it from happening again, doctors at Medical City Children’s Hospital implanted a defibrillator inside his chest.

“It makes contact with the heart muscle itself and then it provides a little bit of an electrical stimulus if it senses an abnormal heart rhythm,” Dr. Stromberg said.

Dr. Stromberg said they’re looking at two things in particular that may have caused the problem.

“One is a heart rhythm problem or a problem with the conduction system or the electrical system of the heart. And, the other is a primary heart muscle problem,” Dr. Stromberg said.

Richard should be back on his feet in about a week.

“It’ll be a good day to see him walking the halls at school,” Coach Middleton said.

Coach Smith said something like this has never happened in his 24 years at Garland High School. But, he knows it can happen anywhere. He’s urging people to learn CPR