What percent of two-person households are composed of two people who can perform 2" compression on each other? (no decimals, no fractions)

Why you need a personal AED

The previous post was a variation on the "Don't worry about rearranging the deck chairs on the Titanic" phrase.

The whole presentation from which that graph was taken is at...
http://www.slicc.org/FixCPR_2016.pdf

CPR is broken.But at least it is fixable.

Bob

p.s., btw, it you and your spouse live alone together, one or two of you aren't heavy enough to perform chest compression until the ambulance gets there - get a personal AED. One way to do that is to go to www.slicc.org and click on AED deal. We don't make a profit on this group purchase.

There is one similarity and one difference between...

(a) Teaching people how to save on airfare by wearing wings and flapping until they get to where they are going, and (b) teaching people how to perform manual CPR:

The similarity is that we're teaching something that most who need to cannot do. The difference is that a small number are able to perform guideline-compliant CPR.

It should be noted that the age distribution of the cohort approximated that of cardiac arrest victims.

For each of the four  groups, the upper-left point is what everybody in the group can do. The lower-right point is the best anybody in that group can do.

That's why my wife and I have a personal AED.

Bob

SLICC has proven that CPR is broken and has cast a plan to fix it.

Bystander  CPR as presently taught is something only one in six people can perform for ten minutes on a 40th percentile manikin! Four times as many people can compress a chest for ten minutes if they use the heel of the foot. (American Journal of Emergency Medicine, October 2015)

Further, the victim chest stiffness / rescuer weight mismatch prevents many from performing even one two-inch compression on the person with whom they live. For example, the average adult chest requires 130 pounds to be compressed two inches. Using manual compression, you need to weigh at least 156 pounds to be able to compress that average chest.

That's why I bought my wife a weight vest for Christmas.

Actually, I didn't - I bought an AED. We keep it handy and take it with us when we travel.

Things are bleak on the EMS side of the business, as well. The stiffness / weight mismatch also affects EMTs and Paramedics. If an ambulance crew is going to be able to provide two-inch compressions to 80% of adults, they both must weigh at least 216 pounds. Additionally, the 383 EMTs and Paramedics we tested tended to compress way to rapidly and tend to leave too much weight on the breast bone at the top of the supposedly full recoil stroke. This is all fixable, but it's going to take a concerted effort and mechanical chest compression devices on the ambulances.

Bob

The presentation slides I used at the ECCU - Emergency Cardiovascular Care Update - are available for download at http://www.slicc.org/ECCU_2015.pdf

The download volume has been steady and satisfying. The presentation Dr. Perez and I put together was titled "Fixing CPR: What's Wrong With CPR and What Do We Need To Do To Fix It?"

The comments and questions I've received from people at ECCU and from people who've accessed the slides online suggest there's a broad and growing interest in the topic and a greater understanding of what constitutes "Good CPR."

The rate has to be right, the depth has to be right, the recoil has to be right, the interruptions have to be limited, and the ventilations (if you are doing ventilations) can't be too fast or too slow.

And messing up on any one of those factors is enough to make sure that the victim stays dead or eventually gets discharged from the hospital in a state where the victim requires assistance to perform the activities of daily living.

I encourage any of you with an interest in the topic to download the slides, and don't hesitate to send your questions to bobt@slicc.org - that's me.

Let's focus on the details...

Whom should we be trying to train in recognizing a cardiac arrest and whom should we train in CPR?

The first one is easy - everybody needs to know when they encounter a person who is non-responsive and not breathing normally, and they need to know it well enough that they reflexively call 911 when they see someone who has arrested.

The second question's answer is not so obvious. From the standpoint of getting the job done, we should first train those most likely to witness an arrest.

With about 85 percent of arrests occurring in a private residence, it makes sense to train a population whose age distribution matches that of the victims. Here are the implications of that strategy:

From the CARES database we know that the age distribution of out-of-hospital SCA victims is skewed. We've all known that for quite a while, but the actual numbers are interesting:

Age    SCA's
 0-17   1.9% 
18-34   3.7%
35-49  13.1%
50-64  30.2%
65-79  28.8%
Older  22.3%

We could train more than 80% of the bystanders who are most likely to witness an arrest by only training those who have reached 50!

This also raises the question of what's more important? Training the kids in school or training the faculty with a CPR method they can use from the time a child arrests until the ambulance crew is "hands-on"? (Hint: only one in five can perform what's taught to bystanders for ten minutes.)

Another common - but mistaken - belief is that all it takes to get the chest compressed by two inches is strength. This would be true if you could put one hand on the back and the other on the front of the chest, but few are that strong. Your ability to get to two inches depends upon your weight, your weight distribution, the stiffness of the chest you are trying to compress, and the compression method (hands or heel of foot) you are using.

The one exception is that, if you were taught to "crunch your abs" while performing compression, that boosts the depth of your compression a little bit, but I've never seen anyone be able to do that for more than a few minutes.

Another non-obvious implication is that males and females usually have different weight distributions. Weight below your hips doesn't count at all if you are performing manual compression. Weight at your shoulders really contributes to the force you can apply. Weight half way between your hips and shoulders contributes 50%. If you are performing compression with the heel of your foot, you can get more weight on the victim's chest.

Make sure the people around you watch the videos at www.slicc.org - click on "Class Video" in the left column. You'll be safer if they do.

Some things most bystanders don’t know about CPR…and why you need an AED in your home.

A heart attack is not the same thing as a cardiac arrest.  Heart attack victims normally are able to talk and many are in pain. Cardiac arrest victims are non-responsive, clinically dead, and are either not breathing normally – or they might be gasping.

CPR is not used on heart attack victims. CPR is only used on cardiac arrest victims

CPR does not usually re-start hearts – It tries to keep the heart muscle and brain alive, and it delays the transition from a shockable rhythm to a non-shockable one. This transition drops your chance of survival seven-fold. It usually takes an AED and drugs to re-start the heart, and sooner is a lot better!

Eighty-five percent of all cardiac arrests occur in a private residence. The witness, if there is one, is usually about the same age as the victim. Heel Compression quadruples the number of people who can perform guideline-compliant chest compression ("GC3’s") for ten minutes.

If there is nobody in your home that weighs enough to perform 2" deep chest compression until the ambulance crew is "hands-on" you really ought to consider purchasing a personal AED for home and travel use. My wife and I have one. (SLICC will be running another AED Group Purchase this fall. Let bobt@slicc.org if you want to learn the details when the program is beginning. SLICC does not profit from this program.)

Your ability to perform GC3’s for ten minutes does not depend upon your strength, it depends upon the stiffness of the victim’s chest, your weight and weight distribution, and the method of chest compression you use.

The three largest flaws in how Bystander CPR is performed are:

1. Leaning i.e.,  leaving too much force on the breastbone at top of the “full recoil" stroke. Leaning keeps dead people dead. 
2. Very rapid chest compression - 120-150 compressions per minute was common in the nearly 400 EMS workers measured.  Compressions  in excess of 120 per minute reduce the probability of victims’ survival. 
3. Compressions that are too shallow reduce the probability of victims’ survival.

Please watch the video at http://www.slicc.org/ClassVideo

Thank you.