The Seven Cs to Initial Emergency Care Learning
Here's how you can prepare ordinary people to provide initial life support.
AFTER nearly a dozen years of clinical, academic, and administrative work in the then-young EMS System, in the early 1980s, I ventured "outside the box" of "traditional" EMS (albeit, only 10 years old at that point) and began to teach initial emergency care to non-emergency care clinicians as a full-time venture. When I started a private training business, my primary market was the marine transportation industry, where I taught basic emergency care to the captains and crews of oil tankers and tugboats. Although I fancied myself as quite the emergency care clinical expert, I quickly received a real awakening--and an invaluable lesson--relative to my abilities and my responsibilities as a professional emergency care educator.
A very wise, senior captain took me aside during one of my first "Emergency Care at Sea" programs. With a true alpha-male gesture, he placed his fatherly hand on my shoulder and said, "Son, you have the answers to all the medical problems on my ship." My already abundant "EMS ego" was immediately overinflated to the max. However, he quickly brought me back to reality with a real zinger: "The only problem is, boy, you don't know the questions!"
In the years that followed, several colleagues and I have traveled nationally and internationally, "translating" and "interpolating" modern EMS techniques and concepts to fit emergency care needs in maritime, airline, and other industrial environments. As we refined and conducted our initial emergency care programs for people in a variety of occupational and cultural settings, we discovered the "questions" in the "Seven Cs" of emergency care learning.
I offer these "Seven Cs" as a template to provide insight to new instructors--and perhaps to validate the performance of veteran instructors--who are working with such dedication to help those who help saves lives. I hope the "Seven Cs" can serve to focus attention on the questions that must be answered if we are to share our ability to support life with the general population; make Public Access Defibrillation an integral part of on-site emergency preparedness and community EMS systems; and collectively fulfill our mission to extend life in people with "hearts and brains too good to die."
The First 'C': Capabilities
All initial emergency care training programs must be based on sound behavioral objectives. Without a clear and concise definition of "performance expectations," we are not likely to "teach the right stuff" and our students are not likely to "do the right things" when needed.
In a serious medical crisis, initial responders generally are not expected to heal, cure, or "resuscitate" the victim. (We absolutely must dispel the urban myth and false expectation CPR will "bring 'em back.") The responsibility of those first to detect and then to act at the scene of a medical emergency is to try to prevent a serious illness from becoming sudden death and, by assisting the flow of oxygen to the brain, to prevent sudden death from progressing to brain death. No matter what the nature or severity of the medical emergency, the needed general capabilities of those average people to detect it and try to help are:
- Recognize obvious emergency medical need.
- Protect themselves.
- Seek appropriate help.
- Provide initial life support.
The specific performance expectation for the detectors and initial care providers of someone in cardiac arrest can be enumerated further as:
1. Establish unresponsiveness.
2. Channel emotional energy and decide to take action.
3. Ensure personal safety.
4. Determine the absence of airway, breathing, and circulation.
5. Summon appropriate medical help.
6. Initiate effective CPR until help or an AED arrives.
If and when an AED is readily available and on scene:
7. Turn on the power.
8. Attach the electrodes to patient's bare chest.
9. Follow the voice prompts (however many there are).
10. Continue to provide initial life support until appropriate help takes over.
Whether the patient is suddenly dead or critically ill, life support can be best described as helping airway, breathing, and circulation to be as efficient and as effective as possible. We cannot expect to duplicate the sophisticated care of EMS providers in every home and every work site. We can, however, expect everyone who encounters a serious medical emergency situation to assist the victim by calmly and efficiently helping the patient deliver as much oxygen to his or her brain as possible.
The Second 'C': Context
The context of an initial emergency care and life support training is determined by several factors: Who is being trained; where will they use it; can they retain it; and are they likely to act when needed?
This article originally appeared in the June 2004 issue of Occupational Health & Safety.