Continuous Chest Compression CPR
September 23, 2010 4:22 AM Subscribe
Continuous Chest Compression CPR is a hands-only CPR method that doubles a person’s chance of surviving cardiac arrest. It’s easy and does not require mouth-to-mouth contact, making it more likely bystanders will try to help, and it was developed at the University of Arizona College of Medicine. YT link for the video. The Mayo Clinic Presentation.
The "Stayin' Alive" suggestion is a nice touch.
And The Heimlich Maneuver is worth learning too.
posted by chavenet at 4:45 AM on September 23, 2010 [1 favorite]
And The Heimlich Maneuver is worth learning too.
posted by chavenet at 4:45 AM on September 23, 2010 [1 favorite]
2:25 -- You should not check to see whether the heart is stopped? Just assume it has stopped and start chest compressions?
Other songs you could use.
posted by pracowity at 4:48 AM on September 23, 2010
Other songs you could use.
posted by pracowity at 4:48 AM on September 23, 2010
chavenet: "The "Stayin' Alive" suggestion is a nice touch."
Apt choice of song title, that.
posted by bwg at 4:48 AM on September 23, 2010
Apt choice of song title, that.
posted by bwg at 4:48 AM on September 23, 2010
I wonder about the possibility of conflict with other potential rescuers who learned traditional CPR. My law office just had CPR training and I can see myself trying this, but my coworkers complaining that "that's not the right way to do it!" and "you need rescue breaths!"
posted by longdaysjourney at 4:52 AM on September 23, 2010 [1 favorite]
posted by longdaysjourney at 4:52 AM on September 23, 2010 [1 favorite]
Gordon A Ewy and Michael J Kellum wrote a chapter about cardio-cerebral resuscitation/"compression-only CPR" in Cardiac Arrest: the Science and Practice of Resuscitation Medicine.
posted by James Scott-Brown at 4:54 AM on September 23, 2010 [1 favorite]
posted by James Scott-Brown at 4:54 AM on September 23, 2010 [1 favorite]
You should not check to see whether the heart is stopped? Just assume it has stopped and start chest compressions?
I was taught that you shouldn't bother checking for a heartbeat. Its a panicked situation, and people have mistaken their own heartbeat for the patient's, and failed to administer CPR to someone who needed it. Particularly if they made the mistake of using their thumb (which has a pulse) instead of their middle and index fingers to check.
posted by PercyByssheShelley at 5:01 AM on September 23, 2010 [3 favorites]
I was taught that you shouldn't bother checking for a heartbeat. Its a panicked situation, and people have mistaken their own heartbeat for the patient's, and failed to administer CPR to someone who needed it. Particularly if they made the mistake of using their thumb (which has a pulse) instead of their middle and index fingers to check.
posted by PercyByssheShelley at 5:01 AM on September 23, 2010 [3 favorites]
The recommendation of Staying Alive for pacing is based upon a classic article: “Stayin' Alive”: A Pilot Study to Test the Effectiveness of a Novel Mental Metronome in Maintaining Appropriate Compression Rates in Simulated Cardiac Arrest Scenarios in the Annals of Emergency Medicine.
There was also an article in last year's Christmas issue of the BMJ comparing the effect of different songs on rate of chest compressions (and a reader poll - Which of these songs would you use for CPR training?)
posted by James Scott-Brown at 5:01 AM on September 23, 2010 [2 favorites]
There was also an article in last year's Christmas issue of the BMJ comparing the effect of different songs on rate of chest compressions (and a reader poll - Which of these songs would you use for CPR training?)
posted by James Scott-Brown at 5:01 AM on September 23, 2010 [2 favorites]
"Another One Bites the Dust" has the same beat as "Stayin' Alive," but I can see why you might choose one over the other.
posted by punchtothehead at 5:03 AM on September 23, 2010 [23 favorites]
posted by punchtothehead at 5:03 AM on September 23, 2010 [23 favorites]
Compression only CPR, as I understand it, is meant specifically for use by people who have not had more thorough training, or for use in situations where it may be unsafe to give rescue breaths. Trained rescuers still give breaths, but at much less frequent intervals.
posted by louche mustachio at 5:11 AM on September 23, 2010 [1 favorite]
posted by louche mustachio at 5:11 AM on September 23, 2010 [1 favorite]
As a certified CPR instructor, I always tell my students to use Compression-only CPR if they do not have a breathing barrier or if they are not comfortable giving rescue breaths to a person.
posted by lharris at 5:12 AM on September 23, 2010 [1 favorite]
posted by lharris at 5:12 AM on September 23, 2010 [1 favorite]
ALSO DO NOT STOP UNTIL THE EMERGENCY SERVICES ARRIVE AND PULL YOU AWAY.
Or, if you are so lucky, someone arrives with an AED.
posted by louche mustachio at 5:17 AM on September 23, 2010 [1 favorite]
Or, if you are so lucky, someone arrives with an AED.
posted by louche mustachio at 5:17 AM on September 23, 2010 [1 favorite]
30 compressions to 2 breaths is the current ratio. Anyone who isn't trained (docs, nurses, paramedics) are told to skip the pulse check because it can be tricky even for pros to find one, and an easier way to tell if someone's heart is stopped is to start CPR anyway: if it's not needed you'll find out pretty fast when they shove you off! It's amusing how many people get brought into hospital whose friends did unnecessary CPR - they usually think it worked because after 30 seconds of CPR the unconscious person wakes up and pushes their friends away.
In the hospital when we do CPR we tend to over-ventilate anyway; the bags we use provide a lot more air than the typical breath, so I think the next round of CPR reviews coming up are potentially going to drop the amount of air we provide. Incidentally, in an in-hospital arrest when someone's hooked up to invasive monitoring equipment it's really neat to see how much of a difference CPR can make to someone - properly done CPR will often give someone a pretty high blood pressure!
Anyway, when it come to CPR I've always taken the maxim that I got off a nurse when I was training: they're already dead. Anything you do is a bonus.
posted by Silentgoldfish at 5:19 AM on September 23, 2010 [4 favorites]
In the hospital when we do CPR we tend to over-ventilate anyway; the bags we use provide a lot more air than the typical breath, so I think the next round of CPR reviews coming up are potentially going to drop the amount of air we provide. Incidentally, in an in-hospital arrest when someone's hooked up to invasive monitoring equipment it's really neat to see how much of a difference CPR can make to someone - properly done CPR will often give someone a pretty high blood pressure!
Anyway, when it come to CPR I've always taken the maxim that I got off a nurse when I was training: they're already dead. Anything you do is a bonus.
posted by Silentgoldfish at 5:19 AM on September 23, 2010 [4 favorites]
The "Stayin' Alive" suggestion is a nice touch.
I asked about this very issue a few years ago.
posted by TedW at 5:35 AM on September 23, 2010
I asked about this very issue a few years ago.
posted by TedW at 5:35 AM on September 23, 2010
"hands-only CPR method that doubles a person’s chance of surviving cardiac arrest"
I assume this is compared to no CPR. Anyone know the increased in survival rate using traditional CPR?
posted by batou_ at 5:36 AM on September 23, 2010
I assume this is compared to no CPR. Anyone know the increased in survival rate using traditional CPR?
posted by batou_ at 5:36 AM on September 23, 2010
Michael Scott wants to give you CPR...
"You know what, if we come across somebody with no arms or legs do we bother resuscitating them?"
[video starts out a bit pixel-y, but the picture is fine after a few seconds]
posted by JibberJabber at 5:38 AM on September 23, 2010
"You know what, if we come across somebody with no arms or legs do we bother resuscitating them?"
[video starts out a bit pixel-y, but the picture is fine after a few seconds]
posted by JibberJabber at 5:38 AM on September 23, 2010
There is a lot of ongoing research in this area; it seems counterintuitive and goes against the ABC's (airway, breathing, and circulation, in that order of priority) that have been taught for years to medical professionals. But there is mounting evidence that not oxygenating the blood when the circulation is restarted after a cardiac arrest actually is a good thing in that it prevents reperfusion injury. The idea being that if you can maintain the circulation with CPR until measures to prevent reperfusion injury can be instituted (such as hypothermia) then the patient has a better chance. There was a good book on this issue I read recently, but it is at home and I can't recall the title right now. If I do I will post it here.
posted by TedW at 5:46 AM on September 23, 2010
posted by TedW at 5:46 AM on September 23, 2010
When I took CPR, the point was made that the person is already effectively dead (no pulse, not breathing) so it's unlikely that you can make them any worse off by doing something even if you don't remember the exact correct technique.
posted by Jacqueline at 5:50 AM on September 23, 2010 [1 favorite]
posted by Jacqueline at 5:50 AM on September 23, 2010 [1 favorite]
"Another One Bites the Dust" has the same beat as "Stayin' Alive," but I can see why you might choose one over the other.
The instructor we had for a CPR/basic first aid class a few months ago made exactly this point.
When I took CPR, the point was made that the person is already effectively dead (no pulse, not breathing) so it's unlikely that you can make them any worse off by doing something even if you don't remember the exact correct technique.
He made that point, too!
Good thing the training for trainers is so consistent.
posted by rtha at 5:59 AM on September 23, 2010
The instructor we had for a CPR/basic first aid class a few months ago made exactly this point.
When I took CPR, the point was made that the person is already effectively dead (no pulse, not breathing) so it's unlikely that you can make them any worse off by doing something even if you don't remember the exact correct technique.
He made that point, too!
Good thing the training for trainers is so consistent.
posted by rtha at 5:59 AM on September 23, 2010
This is wonderful information. My dad's life was saved by someone administering CPR in the middle of a Starbucks and I can hardly express how much gratitude we feel toward them. The kindness of strangers really blew me away that day as they helped out in any way they could from calling 911 to driving my mom to the hospital (she was much too shaken to drive) to comforting us while we waited in the emergency room. So definitely, anything you can do is really a bonus.
posted by hoppytoad at 6:04 AM on September 23, 2010 [7 favorites]
posted by hoppytoad at 6:04 AM on September 23, 2010 [7 favorites]
I've given CPR in an emergency situation and did rescue breathing without a pocket mask. There is no thinking involved. If you are trained you just do it. It was a roller coaster ride. The person had a head injury. The screaming wife was next to him on the side of the road. No hesitation. No pulse, no breath, begin CPR.
After 5 minutes someone came along and did the breathing. I did CPR for 15 minutes until the ambulance arrived. They took over the breathing with the bag and I continued CPR. They hooked the person up to an EKG and I could see my compressions on the monitor. They told me to stop and the EKG flatlined. They then hit them with the defibrillator paddle and amazingly I saw the heart begin beating on its own, on the monitor.
I gave the wife a a thumbs up, thanked the person who did the breathing, and got back in my car and drove away. I was suddenly overwhelmed with some sort of feeling like WTF was that? I could almost call it PSTD. I was alone at home, totally overwhelmed with emotion and none to talk to.
I found out the the next day the person had died of a severe head injury. The CPR only prolonged the inevitable. Afterwards were HIV testing and depositions to lawyers and insurance companies about the person's state when I found them. I remained in this weird emotional nowhere land for about six weeks afterward. But..... I would do it again without even taking a second to consider the consequences because another person needs help. I urge you to the same. With this new method it may be far easier than my experience.
posted by Xurando at 6:05 AM on September 23, 2010 [24 favorites]
After 5 minutes someone came along and did the breathing. I did CPR for 15 minutes until the ambulance arrived. They took over the breathing with the bag and I continued CPR. They hooked the person up to an EKG and I could see my compressions on the monitor. They told me to stop and the EKG flatlined. They then hit them with the defibrillator paddle and amazingly I saw the heart begin beating on its own, on the monitor.
I gave the wife a a thumbs up, thanked the person who did the breathing, and got back in my car and drove away. I was suddenly overwhelmed with some sort of feeling like WTF was that? I could almost call it PSTD. I was alone at home, totally overwhelmed with emotion and none to talk to.
I found out the the next day the person had died of a severe head injury. The CPR only prolonged the inevitable. Afterwards were HIV testing and depositions to lawyers and insurance companies about the person's state when I found them. I remained in this weird emotional nowhere land for about six weeks afterward. But..... I would do it again without even taking a second to consider the consequences because another person needs help. I urge you to the same. With this new method it may be far easier than my experience.
posted by Xurando at 6:05 AM on September 23, 2010 [24 favorites]
Anyone who isn't trained (docs, nurses, paramedics) are told to skip the pulse check because it can be tricky even for pros to find one, and an easier way to tell if someone's heart is stopped is to start CPR anyway: if it's not needed you'll find out pretty fast when they shove you off!
I hope liability law protects these people when they kill someone having a seizure. If the sternal rub isn't adequate, I could imagine some oaf breaking the ribs on round 1 of a person who collapsed for any other reason.
I'd rather see AEDs in most public places; as I understand it they're much more effective.
posted by a robot made out of meat at 6:16 AM on September 23, 2010
I hope liability law protects these people when they kill someone having a seizure. If the sternal rub isn't adequate, I could imagine some oaf breaking the ribs on round 1 of a person who collapsed for any other reason.
I'd rather see AEDs in most public places; as I understand it they're much more effective.
posted by a robot made out of meat at 6:16 AM on September 23, 2010
"hands-only CPR method that doubles a person’s chance of surviving cardiac arrest"
I assume this is compared to no CPR. Anyone know the increased in survival rate using traditional CPR?
They showed a graphic near the end of the video comparing the survival rates. I believe it was 14% for traditional CPR and 23% for Continuous Compression.
Another important point that I feel should have been brought up earlier in the presentation was that traditional CPR with rescue breathing is still considered the best method for infants & small children and for drowning victims. I am also a bit concerned about the lack of an initial airway check, because there is always the chance that you may be dealing with a choking victim. I haven't gotten to the Mayo Clinic link yet to see if the reasoning is explained there, though.
posted by gimli at 6:17 AM on September 23, 2010
I assume this is compared to no CPR. Anyone know the increased in survival rate using traditional CPR?
They showed a graphic near the end of the video comparing the survival rates. I believe it was 14% for traditional CPR and 23% for Continuous Compression.
Another important point that I feel should have been brought up earlier in the presentation was that traditional CPR with rescue breathing is still considered the best method for infants & small children and for drowning victims. I am also a bit concerned about the lack of an initial airway check, because there is always the chance that you may be dealing with a choking victim. I haven't gotten to the Mayo Clinic link yet to see if the reasoning is explained there, though.
posted by gimli at 6:17 AM on September 23, 2010
a hands-only CPR method that doubles a person’s chance of surviving cardiac arrest
One thing that's under-stressed in CPR training (at least in mine) is that the survival chances in bystander CPR outside of hospital situations is around 5 percent (that's per the Wikipedia citation; the 14 percent base rate in the video is just for Arizona and seems high). So this doubling may bring it to 10 percent (or 23 percent in Arizona), but providers of CPR should realize that they will still fail, statistically, 80-90 percent of the time. That's not a reason not to do it; the point is that failure should not be seen as a failing on the part of the CPR provider, but to realize that the chances are never good at the outset to begin with.
posted by beagle at 6:18 AM on September 23, 2010 [4 favorites]
One thing that's under-stressed in CPR training (at least in mine) is that the survival chances in bystander CPR outside of hospital situations is around 5 percent (that's per the Wikipedia citation; the 14 percent base rate in the video is just for Arizona and seems high). So this doubling may bring it to 10 percent (or 23 percent in Arizona), but providers of CPR should realize that they will still fail, statistically, 80-90 percent of the time. That's not a reason not to do it; the point is that failure should not be seen as a failing on the part of the CPR provider, but to realize that the chances are never good at the outset to begin with.
posted by beagle at 6:18 AM on September 23, 2010 [4 favorites]
I hope liability law protects these people when they kill someone having a seizure. If the sternal rub isn't adequate, I could imagine some oaf breaking the ribs on round 1 of a person who collapsed for any other reason.
Uh, yeah. Even if what you suggest were possible there's a million good-Samaritan laws in every first world country (even sue-happy USA) to stop this line of thinking.
There was a case in Australia a while back where someone sued some first-aiders because they moved her when they shouldn't have and gave her a spinal injury, but she still lost because of the horrible precedent it would set.
posted by Silentgoldfish at 6:25 AM on September 23, 2010
Uh, yeah. Even if what you suggest were possible there's a million good-Samaritan laws in every first world country (even sue-happy USA) to stop this line of thinking.
There was a case in Australia a while back where someone sued some first-aiders because they moved her when they shouldn't have and gave her a spinal injury, but she still lost because of the horrible precedent it would set.
posted by Silentgoldfish at 6:25 AM on September 23, 2010
When I took CPR, the point was made that the person is already effectively dead (no pulse, not breathing) so it's unlikely that you can make them any worse off by doing something even if you don't remember the exact correct technique.
This is why I always start by taking their wallet.
posted by Ritchie at 6:28 AM on September 23, 2010 [2 favorites]
This is why I always start by taking their wallet.
posted by Ritchie at 6:28 AM on September 23, 2010 [2 favorites]
Would people not do CPR if they had to have mouth-to-mouth contact? Like, "Sure, I'd love to save that person's life, but I'd have to touch their MOUTH with MY MOUTH! That's icky / I'm not gay!"
Or is there some medical reason why it's a bad idea to touch mouths? Other than the possibility of getting a cold?
posted by Galaxor Nebulon at 6:37 AM on September 23, 2010
Or is there some medical reason why it's a bad idea to touch mouths? Other than the possibility of getting a cold?
posted by Galaxor Nebulon at 6:37 AM on September 23, 2010
If the sternal rub isn't adequate, I could imagine some oaf breaking the ribs on round 1 of a person who collapsed for any other reason.
Properly done, CPR on adults often fractures ribs. The bigger problem is actually not pushing hard enough.
Even if what you suggest were possible there's a million good-Samaritan laws in every first world country (even sue-happy USA) to stop this line of thinking.
In many states Good Samaritan laws only protect trained medical personnel (which may be as simple as having completed a certified first aid course), not just anybody.
I'd rather see AEDs in most public places; as I understand it they're much more effective.
AEDs have only proven remotely cost effective in areas that are high-traffic, have at least a fair number of older people, and have staff on hand who know how to use the AED (e.g., casinos and airports).
posted by jedicus at 6:48 AM on September 23, 2010 [1 favorite]
Properly done, CPR on adults often fractures ribs. The bigger problem is actually not pushing hard enough.
Even if what you suggest were possible there's a million good-Samaritan laws in every first world country (even sue-happy USA) to stop this line of thinking.
In many states Good Samaritan laws only protect trained medical personnel (which may be as simple as having completed a certified first aid course), not just anybody.
I'd rather see AEDs in most public places; as I understand it they're much more effective.
AEDs have only proven remotely cost effective in areas that are high-traffic, have at least a fair number of older people, and have staff on hand who know how to use the AED (e.g., casinos and airports).
posted by jedicus at 6:48 AM on September 23, 2010 [1 favorite]
I think it's the opposite?
Any first aid provided must not be in exchange for any reward or financial compensation. As a result, medical professionals are typically not protected by good Samaritan laws when performing first aid in connection with their employment.[11] Certain states make specific provisions for those trained medical professionals acting as volunteers and for members of volunteer rescue squads acting without expectation of financial compensation.[12]
If a responder begins rendering aid, he must not leave the scene until it is necessary to call for needed medical assistance, a rescuer of equal or higher ability takes over, or continuing to give aid is unsafe.[13] The responder is not legally liable for the death, disfigurement or disability of the victim as long as the responder acted rationally, in good faith and in accordance with their level of training
At least that's what they told us in CPR/First Aid training.
posted by Comrade_robot at 6:50 AM on September 23, 2010
Any first aid provided must not be in exchange for any reward or financial compensation. As a result, medical professionals are typically not protected by good Samaritan laws when performing first aid in connection with their employment.[11] Certain states make specific provisions for those trained medical professionals acting as volunteers and for members of volunteer rescue squads acting without expectation of financial compensation.[12]
If a responder begins rendering aid, he must not leave the scene until it is necessary to call for needed medical assistance, a rescuer of equal or higher ability takes over, or continuing to give aid is unsafe.[13] The responder is not legally liable for the death, disfigurement or disability of the victim as long as the responder acted rationally, in good faith and in accordance with their level of training
At least that's what they told us in CPR/First Aid training.
posted by Comrade_robot at 6:50 AM on September 23, 2010
I'd rather see AEDs in most public places; as I understand it they're much more effective.
AEDs can be very effective, but not all fatal heart arrhythmias are shockable. Some can convert to a shockable rhythm after a couple of rounds of CPR, so you really shouldn't devalue one over the other.
posted by makonan at 6:50 AM on September 23, 2010 [1 favorite]
AEDs can be very effective, but not all fatal heart arrhythmias are shockable. Some can convert to a shockable rhythm after a couple of rounds of CPR, so you really shouldn't devalue one over the other.
posted by makonan at 6:50 AM on September 23, 2010 [1 favorite]
Or is there some medical reason why it's a bad idea to touch mouths? Other than the possibility of getting a cold?
Well, one thing to consider is that it's not unlikely the victim may barf into your mouth. Plus, if there's blood on their face or in the mouth, I can see how someone might hesitate.
posted by Menthol at 6:52 AM on September 23, 2010 [3 favorites]
Well, one thing to consider is that it's not unlikely the victim may barf into your mouth. Plus, if there's blood on their face or in the mouth, I can see how someone might hesitate.
posted by Menthol at 6:52 AM on September 23, 2010 [3 favorites]
One little point about AEDs... they won't re-start a heart that has STOPPED. They only restore rhythm to a fibrillating heart - and then not ALL types of fibrillation. But they're better than nothing.
As they say, imperfect action is better than no action at all.
posted by matty at 6:56 AM on September 23, 2010
As they say, imperfect action is better than no action at all.
posted by matty at 6:56 AM on September 23, 2010
I hope liability law protects these people when they kill someone having a seizure.
What kind of seizure would that be, exactly? I'm asking because I have epilepsy and while I may collapse and look like I'm asleep, I certainly do not appear dead and am obviously still breathing.
If you have a seizure to the point where breathing isn't apparent, I think someone trying to do CPR is really the least of your worries - a cracked rib sucks, but your brain clearly needs some emergency assistance and whatever is going to get you into the ER at that point is a bonus.
Unless there are types of seizures that I don't know about where a person goes into suspended animation - in which case a medic alert bracelet (which lots of epileptics have) is probably a good move. "DON'T WORRY, I'M NOT ACTUALLY DEAD. UNLESS OF COURSE, I AM."
posted by sonika at 7:08 AM on September 23, 2010 [1 favorite]
What kind of seizure would that be, exactly? I'm asking because I have epilepsy and while I may collapse and look like I'm asleep, I certainly do not appear dead and am obviously still breathing.
If you have a seizure to the point where breathing isn't apparent, I think someone trying to do CPR is really the least of your worries - a cracked rib sucks, but your brain clearly needs some emergency assistance and whatever is going to get you into the ER at that point is a bonus.
Unless there are types of seizures that I don't know about where a person goes into suspended animation - in which case a medic alert bracelet (which lots of epileptics have) is probably a good move. "DON'T WORRY, I'M NOT ACTUALLY DEAD. UNLESS OF COURSE, I AM."
posted by sonika at 7:08 AM on September 23, 2010 [1 favorite]
I think it's the opposite?
"medical professionals are typically not protected by good Samaritan laws when performing first aid in connection with their employment."
In other words, you can't avoid medical malpractice by saying "oh, but I was acting as a Good Samaritan" when actually you were just doing your job, but medical professionals are indeed typically protected by Good Samaritan laws. Here's an example of an actual state Good Samaritan law (Missouri's):
The practical upshot is that, indeed, trained medical personnel are covered as long as they aren't paid, but unless you've at least been trained in a recognized first aid program, you aren't protected (except in the case of suicide prevention at the scene of a threatened suicide). And even if you've been trained, you're only covered up to the level of your training.
posted by jedicus at 7:20 AM on September 23, 2010
"medical professionals are typically not protected by good Samaritan laws when performing first aid in connection with their employment."
In other words, you can't avoid medical malpractice by saying "oh, but I was acting as a Good Samaritan" when actually you were just doing your job, but medical professionals are indeed typically protected by Good Samaritan laws. Here's an example of an actual state Good Samaritan law (Missouri's):
1. Any physician or surgeon, registered professional nurse or licensed practical nurse licensed to practice in this state...or licensed to practice under the equivalent laws of any other state and any person licensed as a mobile emergency medical technician under the provisions of chapter 190, RSMo, may:There's also a blanket provision allowing anybody, trained or not, to render suicide prevention interventions at the scene of a threatened suicide.
(1) In good faith render emergency care or assistance, without compensation, at the scene of an emergency or accident, and shall not be liable for any civil damages for acts or omissions other than damages occasioned by gross negligence or by willful or wanton acts or omissions by such person in rendering such emergency care;
(2) [this part basically says they can do the same thing for minors without first obtaining parental consent]
2. Any other person who has been trained to provide first aid in a standard recognized training program may, without compensation, render emergency care or assistance to the level for which he or she has been trained, at the scene of an emergency or accident, and shall not be liable for civil damages for acts or omissions other than damages occasioned by gross negligence or by willful or wanton acts or omissions by such person in rendering such emergency care.
The practical upshot is that, indeed, trained medical personnel are covered as long as they aren't paid, but unless you've at least been trained in a recognized first aid program, you aren't protected (except in the case of suicide prevention at the scene of a threatened suicide). And even if you've been trained, you're only covered up to the level of your training.
posted by jedicus at 7:20 AM on September 23, 2010
Heard this for awhile and I wonder about it, given that a friend of the family suffered brain damage when his dad gave him CPR... and forgot the assisted breathing part. A duration issue, I suppose.
posted by Durn Bronzefist at 7:24 AM on September 23, 2010
posted by Durn Bronzefist at 7:24 AM on September 23, 2010
Heard this for awhile and I wonder about it, given that a friend of the family suffered brain damage when his dad gave him CPR... and forgot the assisted breathing part
Well, thing is, I imagine that if he hadn't had any CPR, he wouldn't be around to have brain damage. Sucks, but the idea is that anything is better than nothing and people trying to do rescue breathing who aren't specifically trained often fail at compressions (which are more important because if the oxygenated blood isn't *getting anywhere* it's not really all that helpful) and/or pass out from light-headedness because they get over enthusiastic.
It's controversial, but the studies have shown that compressions-only is easier for the lay person to understand and do effectively and thus saves more actual lives than compressions + rescue breathing. It's not perfect, for sure, but if you look at it from the perspective of "Some assistance vs. none" - your friend is really lucky to be alive. And alive really is the goal.
The best way to achieve that is to tell someone to call 911 as soon as you start compressions. Don't assume someone will, because they probably are making the same assumption. Look at someone directly and tell them specifically to call. Start doing compressions if you can assess that the person isn't breathing/probably has no pulse. Don't do compressions on someone who is breathing. Keep performing CPR until someone else forcibly pulls you off of that person. That's absolutely the best you can do in an emergency when someone is suffering cardiac/respiratory arrest.
(Full disclosure: I am not currently certified, but I have been trained as an EMT-B.)
posted by sonika at 7:45 AM on September 23, 2010 [1 favorite]
Well, thing is, I imagine that if he hadn't had any CPR, he wouldn't be around to have brain damage. Sucks, but the idea is that anything is better than nothing and people trying to do rescue breathing who aren't specifically trained often fail at compressions (which are more important because if the oxygenated blood isn't *getting anywhere* it's not really all that helpful) and/or pass out from light-headedness because they get over enthusiastic.
It's controversial, but the studies have shown that compressions-only is easier for the lay person to understand and do effectively and thus saves more actual lives than compressions + rescue breathing. It's not perfect, for sure, but if you look at it from the perspective of "Some assistance vs. none" - your friend is really lucky to be alive. And alive really is the goal.
The best way to achieve that is to tell someone to call 911 as soon as you start compressions. Don't assume someone will, because they probably are making the same assumption. Look at someone directly and tell them specifically to call. Start doing compressions if you can assess that the person isn't breathing/probably has no pulse. Don't do compressions on someone who is breathing. Keep performing CPR until someone else forcibly pulls you off of that person. That's absolutely the best you can do in an emergency when someone is suffering cardiac/respiratory arrest.
(Full disclosure: I am not currently certified, but I have been trained as an EMT-B.)
posted by sonika at 7:45 AM on September 23, 2010 [1 favorite]
(If you are totally alone, CALL FIRST and then start compressions as otherwise you have absolutely no guarantee that you won't be at it for the rest of your own life.)
posted by sonika at 7:47 AM on September 23, 2010
posted by sonika at 7:47 AM on September 23, 2010
...have staff on hand who know how to use the AED...While I agree that AED's are not the end-all of therapy for out of hospital arrests, I would like to point out that the point of Automated External Defibrillators is that not training is required for their use. To prove this point, the leader of an ACLS class I was helping with got her 5th grade daughter, with no prior practice, to use an AED on a mannequin successfully. This was several years ago and AEDs have only gotten easier to use since then. So even if you have no training, if an AED is available hook it up to the patient and follow the directions.
Another place AEDs may be valuable is in high school athletic venues, where sudden cardiac arrest for a variety of reasons kills about 100 athletes a year in the US; the jury is still out on whether they would be cost-effective there, though.
posted by TedW at 7:51 AM on September 23, 2010
Another place AEDs may be valuable is in high school athletic venues, where sudden cardiac arrest for a variety of reasons kills about 100 athletes a year in the US; the jury is still out on whether they would be cost-effective there, though.
posted by TedW at 7:51 AM on September 23, 2010
Or is there some medical reason why it's a bad idea to touch mouths? Other than the possibility of getting a cold?
Herpes, hepatitis B, some forms of bacterial meningitis are possible contagions via saliva. If you've got someone with open sores on their mouth and/or bleeding gums, that increases not only the "ick" factor but the risk factor.
People revived through mouth-to-mouth sometimes vomit into the resuscitator's mouth, which is why they make mask barriers that are optional for EMTs to carry.
posted by availablelight at 8:00 AM on September 23, 2010
I would like to point out that the point of Automated External Defibrillators is that not training is required for their use.
Ah, but liability issues have resulted in big warnings on them saying things like "for emergency use by trained rescuers." Most state Good Samaritan laws have been updated to provide immunity for the use of AEDs by laypersons, but some have not. Rhode Island, for example:
posted by jedicus at 8:12 AM on September 23, 2010
Ah, but liability issues have resulted in big warnings on them saying things like "for emergency use by trained rescuers." Most state Good Samaritan laws have been updated to provide immunity for the use of AEDs by laypersons, but some have not. Rhode Island, for example:
(a) No person, whether acting in an official capacity or as a private volunteer, who gratuitously renders emergency assistance in the nature of cardiopulmonary resuscitation or automated external defibrillation to a person in need thereof, shall be liable for civil damages for any personal injuries which result from acts or omissions by such persons rendering the emergency care, which may constitute ordinary negligence; provided, however, that this immunity applies only to persons who have been trained in accordance with standards promulgated by either the American heart association or the American national red cross. This immunity does not apply to acts or omissions constituting gross, willful, or wanton negligence.(emphasis added).
posted by jedicus at 8:12 AM on September 23, 2010
Or is there some medical reason why it's a bad idea to touch mouths? Other than the possibility of getting a cold?
It's could be a pretty good way to expose yourself to TB.
There are other reasons for moving away from it, though. Its effectiveness is disputed during arrests, and it seems to distract people from doing chest compressions--the real lifesaver--correctly. Also, many people tend to overblow, which can cause its own problems.
Properly done chest compressions (where you pull your hands up off the chest and let it recoil fully) move air in and out of the lungs to some extent anyway, and you really don't need that much airflow to stay alive. It's moving the blood around that you really need to concentrate on.
There are still situations (peds, drowning) where it's apparently quite useful, but I wouldn't be surprised if no-breaths CPR becomes the dominant training for bystanders in the near future, with 'traditional' CPR reserved for healthcare providers, lifeguards, people working with children, etc.
The last time I took a CPR refresher we had an interesting discussion on CPR standards and how they've changed. The instructor made what I thought was a good point: the standards are trying to hit a moving target. Not only has medical knowledge changed, but the typical patient has changed as the US's demographics have. Drowning and choking might have been statistically more common when the population was younger, and thus a more breathing-oriented CPR might have actually been more effective at the time than it is now. (I'm skeptical of this in absence of any statistics; I think it's more likely that the old standards were just not that evidence-based ... but it's an interesting thought.)
The thing that I have noticed about the new CPR methods (not just this one, but also the latest versions of 'traditional' compression-and-breaths CPR) is that as they've increased the number of breaths they have become much more physically intense for the rescuer doing compressions. Doing CPR well for anything more than a few cycles is a lot of work. One of the things that I think CPR classes ought to focus on is realizing when you're exhausted or about to become exhausted, and transferring smoothly to another rescuer (who might need to be instructed). This is touched on in the CPR for healthcare providers course, but I don't know if it's a part of the typical bystander courses.
posted by Kadin2048 at 8:39 AM on September 23, 2010
It's could be a pretty good way to expose yourself to TB.
There are other reasons for moving away from it, though. Its effectiveness is disputed during arrests, and it seems to distract people from doing chest compressions--the real lifesaver--correctly. Also, many people tend to overblow, which can cause its own problems.
Properly done chest compressions (where you pull your hands up off the chest and let it recoil fully) move air in and out of the lungs to some extent anyway, and you really don't need that much airflow to stay alive. It's moving the blood around that you really need to concentrate on.
There are still situations (peds, drowning) where it's apparently quite useful, but I wouldn't be surprised if no-breaths CPR becomes the dominant training for bystanders in the near future, with 'traditional' CPR reserved for healthcare providers, lifeguards, people working with children, etc.
The last time I took a CPR refresher we had an interesting discussion on CPR standards and how they've changed. The instructor made what I thought was a good point: the standards are trying to hit a moving target. Not only has medical knowledge changed, but the typical patient has changed as the US's demographics have. Drowning and choking might have been statistically more common when the population was younger, and thus a more breathing-oriented CPR might have actually been more effective at the time than it is now. (I'm skeptical of this in absence of any statistics; I think it's more likely that the old standards were just not that evidence-based ... but it's an interesting thought.)
The thing that I have noticed about the new CPR methods (not just this one, but also the latest versions of 'traditional' compression-and-breaths CPR) is that as they've increased the number of breaths they have become much more physically intense for the rescuer doing compressions. Doing CPR well for anything more than a few cycles is a lot of work. One of the things that I think CPR classes ought to focus on is realizing when you're exhausted or about to become exhausted, and transferring smoothly to another rescuer (who might need to be instructed). This is touched on in the CPR for healthcare providers course, but I don't know if it's a part of the typical bystander courses.
posted by Kadin2048 at 8:39 AM on September 23, 2010
One danger of rescue breathing that hasn't been touched on: it's wicked easy to accidentally blow air into the *stomach* and not the lungs. This, as you can imagine, doesn't help at all and tires out the breather.
(And yeah, keep breathing for kiddos. I was trained with a ratio of 5 compressions: 1 breath. This may or may not have "officially" changed.)
posted by sonika at 8:47 AM on September 23, 2010
(And yeah, keep breathing for kiddos. I was trained with a ratio of 5 compressions: 1 breath. This may or may not have "officially" changed.)
posted by sonika at 8:47 AM on September 23, 2010
Correction to the first sentence in the last para of my comment: As they've DECREASED the number of breaths.
The new standards have increased compressions and decreased the breaths. I think the very early standards were as much as 1 breath per 5 compressions (on preview, as sonika recalls); the trend has been towards fewer and fewer breathing stops from there.
posted by Kadin2048 at 8:50 AM on September 23, 2010
The new standards have increased compressions and decreased the breaths. I think the very early standards were as much as 1 breath per 5 compressions (on preview, as sonika recalls); the trend has been towards fewer and fewer breathing stops from there.
posted by Kadin2048 at 8:50 AM on September 23, 2010
Wow, this is handy. Just yesterday at work, one of the guys doing landscaping next door keeled over, and one of my coworkers was the one to do the CPR until the paramedics got there. Unfortunately, we're pretty sure he died (he was aspirating all kinds of blood when she was giving the traditional CPR).
As a side note, if any of you are taking medication for a lung infection that means that your lungs sometimes burst and fill with blood, you probably shouldn't be doing a lot of shoveling and lifting, even if you're a hip Australian 30-something.
posted by klangklangston at 9:01 AM on September 23, 2010
As a side note, if any of you are taking medication for a lung infection that means that your lungs sometimes burst and fill with blood, you probably shouldn't be doing a lot of shoveling and lifting, even if you're a hip Australian 30-something.
posted by klangklangston at 9:01 AM on September 23, 2010
I did CPR training in 2002 and again last year. At the 2002 training I was overwhelmed by the information. After the 2009 training, which encouraged chest-compression only, I left thinking "I could do that! I could save a life!"
Simplifying CPR, and making it much less intimidating, is a great move. I hope to never have to use it, but I think that I'll be much more confident -- and thereby more likely to help and less likely to panic -- knowing that really I just have to jump in there and start the compressions and not worry about counting breaths and the rest of it.
posted by The corpse in the library at 9:23 AM on September 23, 2010
Simplifying CPR, and making it much less intimidating, is a great move. I hope to never have to use it, but I think that I'll be much more confident -- and thereby more likely to help and less likely to panic -- knowing that really I just have to jump in there and start the compressions and not worry about counting breaths and the rest of it.
posted by The corpse in the library at 9:23 AM on September 23, 2010
sonika i : "(And yeah, keep breathing for kiddos. I was trained with a ratio of 5 compressions: 1 breath. This may or may not have "officially" changed.)"
My training last year was aimed at parents and caretakers of small children, and they didn't tell us to do that.
posted by The corpse in the library at 9:24 AM on September 23, 2010
My training last year was aimed at parents and caretakers of small children, and they didn't tell us to do that.
posted by The corpse in the library at 9:24 AM on September 23, 2010
I love the top YouTube comment from the people who posted the video:
Unfortunately the nature of YouTube is that it "suggests" related videos. Evidently someone must think bikini work outs are related to continuous chest compression. The video also exists on the ahsc dot arizona dot edu website
posted by spiderskull at 10:28 AM on September 23, 2010
Unfortunately the nature of YouTube is that it "suggests" related videos. Evidently someone must think bikini work outs are related to continuous chest compression. The video also exists on the ahsc dot arizona dot edu website
posted by spiderskull at 10:28 AM on September 23, 2010
My training last year was aimed at parents and caretakers of small children, and they didn't tell us to do that.
As I said, it may have changed. The last time I was formally re-certified in Infant/Child CPR was 2006.
posted by sonika at 10:42 AM on September 23, 2010
As I said, it may have changed. The last time I was formally re-certified in Infant/Child CPR was 2006.
posted by sonika at 10:42 AM on September 23, 2010
Paediatric CPR algorithm is the same as adults - 30:2. Mind you, this is for in-hospital arrests so maybe they're teaching different in first aid courses.
posted by Silentgoldfish at 11:04 AM on September 23, 2010
posted by Silentgoldfish at 11:04 AM on September 23, 2010
One thing that people haven't seemed to touch on yet is that CPR done properly is really hard work. If your rescuer is at all out of shape or there aren't other people around to take over, they might not have the wind for rescue breaths on top of that.
posted by estelahe at 11:33 AM on September 23, 2010
posted by estelahe at 11:33 AM on September 23, 2010
Just curious, with all the changes to resuscitation, is there a point where we are just going to dump people in a giant tub of ice water and then leave them alone until after they get transported to the hospital?
posted by BrotherCaine at 11:48 AM on September 23, 2010
posted by BrotherCaine at 11:48 AM on September 23, 2010
Just curious, with all the changes to resuscitation, is there a point where we are just going to dump people in a giant tub of ice water and then leave them alone until after they get transported to the hospital?
Funnily enough the current trend is to cool people who've had a cardiac arrest to 33 degrees in order to limit hypoxic brain injuries. My hospital's part of a study that's doing the same to traumatic brain injuries as well. It's all started in the ambulance en-route to the hospital.
So to answer your question, in a way, yes!
posted by Silentgoldfish at 12:03 PM on September 23, 2010 [2 favorites]
Funnily enough the current trend is to cool people who've had a cardiac arrest to 33 degrees in order to limit hypoxic brain injuries. My hospital's part of a study that's doing the same to traumatic brain injuries as well. It's all started in the ambulance en-route to the hospital.
So to answer your question, in a way, yes!
posted by Silentgoldfish at 12:03 PM on September 23, 2010 [2 favorites]
When the American Heart Association endorsed compression-only, about two years ago, there was a flurry of coverage, from which I seem to recall that interrupting compressions for breaths just destroys the effectiveness of the compressions. Pump-priming effect, they said—takes about five compressions to get the flow going, so if you're stopping every thirty, you're wasting 17% of your effort.
An AED-trained civilian informs me that it's not as simple as dropping the device on. Only a live rescuer can verify that the victim's situation is electrically safe, and it may also be necessary to shave the victim's chest if it is hairy.
Also 100 beats per minute: Mötley Crüe's Kickstart My Heart. "Hope it never stops" indeed.
posted by eritain at 12:07 PM on September 23, 2010
An AED-trained civilian informs me that it's not as simple as dropping the device on. Only a live rescuer can verify that the victim's situation is electrically safe, and it may also be necessary to shave the victim's chest if it is hairy.
Also 100 beats per minute: Mötley Crüe's Kickstart My Heart. "Hope it never stops" indeed.
posted by eritain at 12:07 PM on September 23, 2010
sonika i: "(And yeah, keep breathing for kiddos. I was trained with a ratio of 5 compressions: 1 breath. This may or may not have "officially" changed.)"
Silentgoldfish: Paediatric CPR algorithm is the same as adults - 30:2. Mind you, this is for in-hospital arrests so maybe they're teaching different in first aid courses.
UK Resuscitation Council Paediatric Basic Life Support guidelines:
"The publication, 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR), recommends that the compression:ventilation ratio should be based on whether one or more rescuers are present. CoSTR also recommends that lay rescuers, who usually learn only single-rescuer techniques, should be taught to use a ratio of 30 compressions to 2 ventilations. This is the same ratio as recommended for adults and enables anyone trained in BLS techniques to resuscitate children with minimal additional information. Two or more rescuers with a duty to respond should learn a ratio with more rescue breaths (15:2), as this has been validated by experimental and mathematical studies.. This latter group, who would normally be healthcare professionals, should receive enhanced training targeted specifically at the resuscitation of children.
Although there are no data to support the superiority of any particular ratio in children, ratios of between 5:1 and 15:2 have been studied and there is increasing evidence that the 5:1 ratio delivers an inadequate number of compressions. There is certainly no justification for having two separate ratios for children greater or less than 8 years, so a single ratio of 15:2 for multiple rescuers with a duty to respond is a logical simplification."
The Paediatric Advanced Life Support guidelines, being intended for healthcare professionals, recommend a 15:2 ratio, and do not mention a 30:2 ratio.
["A child is between 1 year and puberty."]
posted by James Scott-Brown at 1:27 PM on September 23, 2010
Silentgoldfish: Paediatric CPR algorithm is the same as adults - 30:2. Mind you, this is for in-hospital arrests so maybe they're teaching different in first aid courses.
UK Resuscitation Council Paediatric Basic Life Support guidelines:
"The publication, 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR), recommends that the compression:ventilation ratio should be based on whether one or more rescuers are present. CoSTR also recommends that lay rescuers, who usually learn only single-rescuer techniques, should be taught to use a ratio of 30 compressions to 2 ventilations. This is the same ratio as recommended for adults and enables anyone trained in BLS techniques to resuscitate children with minimal additional information. Two or more rescuers with a duty to respond should learn a ratio with more rescue breaths (15:2), as this has been validated by experimental and mathematical studies.. This latter group, who would normally be healthcare professionals, should receive enhanced training targeted specifically at the resuscitation of children.
Although there are no data to support the superiority of any particular ratio in children, ratios of between 5:1 and 15:2 have been studied and there is increasing evidence that the 5:1 ratio delivers an inadequate number of compressions. There is certainly no justification for having two separate ratios for children greater or less than 8 years, so a single ratio of 15:2 for multiple rescuers with a duty to respond is a logical simplification."
The Paediatric Advanced Life Support guidelines, being intended for healthcare professionals, recommend a 15:2 ratio, and do not mention a 30:2 ratio.
["A child is between 1 year and puberty."]
posted by James Scott-Brown at 1:27 PM on September 23, 2010
My hospital's advanced life support manual has it at 30:2 for paediatric with 15:2 only if there's two or more people responding. I'd provide a cite if I had an electronic version!
posted by Silentgoldfish at 1:50 PM on September 23, 2010
posted by Silentgoldfish at 1:50 PM on September 23, 2010
This thread is getting me excited about my CPR refresher / AED training in a week and a half. One of my coworkers is kinda old and I might get to zap him someday.
posted by Jacqueline at 1:51 PM on September 23, 2010 [1 favorite]
posted by Jacqueline at 1:51 PM on September 23, 2010 [1 favorite]
I suffered Sudden Cardiac Death (SCD) 2.5 years ago while working out. I was at a gym, on an elliptical machine. I think I was 30 minutes into my workout, and I fell over. A person that saw me said that I went stiff and dropped.
Thankfully, the staff was well prepared with recent CPR training, and they have an AED on site. CPR was started within 2 minutes, and the AED shocked my heart back to a normal rhythm.
I was 38 at the time, and had been working out at the gym for a little over a year. I had lost 30 lbs since joining the gym (6'3"-190# at the time). My cholesterol is low (145 total - my good cholesterol is too low).
My doctors said that I was dead before I hit the ground. if it wasn't for the quick actions of the staff, I wouldn't be here now. The change in CPR technique to continuous compressions was in the news about 1 month after my event. I encourage everyone to get certified in CPR. You never know when you might be able to save a life.
posted by bonofasitch at 11:29 AM on September 24, 2010 [2 favorites]
Thankfully, the staff was well prepared with recent CPR training, and they have an AED on site. CPR was started within 2 minutes, and the AED shocked my heart back to a normal rhythm.
I was 38 at the time, and had been working out at the gym for a little over a year. I had lost 30 lbs since joining the gym (6'3"-190# at the time). My cholesterol is low (145 total - my good cholesterol is too low).
My doctors said that I was dead before I hit the ground. if it wasn't for the quick actions of the staff, I wouldn't be here now. The change in CPR technique to continuous compressions was in the news about 1 month after my event. I encourage everyone to get certified in CPR. You never know when you might be able to save a life.
posted by bonofasitch at 11:29 AM on September 24, 2010 [2 favorites]
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ALSO DO NOT STOP UNTIL THE EMERGENCY SERVICES ARRIVE AND PULL YOU AWAY. EVEN IF YOU ARE CERTAIN THE PERSON IS DEAD, DO NOT STOP UNTIL THE EMERGENCY SERVICES ARRIVE AND PULL YOU AWAY.
As a general rule, the only time you can safely assume someone is dead is when you see their head lying some meters from the body.
posted by three blind mice at 4:35 AM on September 23, 2010 [5 favorites]