Tweaking Your CPR Response
Giving your local emergency dispatchers a call to see how you can work together is one way to make your response faster and better.
As a certified First Aid/CPR/AED instructor,
I've trained many, many people during
the past few years. I've learned a great deal
from those I've trained, as well. As a certified EMT—Intermediate and former first
responder for the local fire department, I've
assisted in some cardiac emergencies and
have learned a lot there, too. Being involved
in both sides has given me the opportunity
to see the gap that can occur between the
skills we teach in the classroom versus what
we encounter in the real-world performance
of those skills. The smaller the gap
we have, the faster and more efficiently we can respond.
First aid, CPR, and AED
classes are taught according
to recognized guidelines. We
don't get much of an opportunity
to deviate from the published
methods, which is probably
a good thing. One of the key concepts
in the guidelines is the cardiac chain of
For adults, the cardiac chain
of survival is as follows:
1. Early recognition of
the emergency and access (to
911 or emergency number)
2. Early CPR
3. Early defibrillation (with
4. Early Advanced Life Support
I won't take up space here rehashing the
details just yet, but the steps are pretty well
established. They represent best practices
under current knowledge, and we strive to
follow the chain as closely as possible during
an emergency. So what can we do to improve
our response to cardiac emergencies?
We can maximize the use of the cardiac
chain of survival. Let's start thinking "earlier"
access, "earlier" CPR, "earlier" AED,
and "earlier" advanced care. Reducing the
response time for each link in the chain is
something we can achieve through planning
and practice. Let's look at each link and
see where we may be able to save some time.
1. Earlier access. When we find a victim
or see a person collapse, we have to
recognize the emergency and gain access
to help. To save time here, our responders
have to be well trained to recognize the
signs and symptoms of cardiac emergencies
and call for help. Pretty basic stuff:
They need to know what emergency number
to call, and the number must be posted
at each phone in the facility.
Nothing new here, but the basics can
take us a long way when properly applied.
During many CPR classes, the students tell
me they have to call security or a supervisor
instead of 911. If your responders are
trained and trusted to perform CPR, consider
whether requiring them to call any
number other than 911 or other emergency
number will speed the service provided
to the victim. Resolve any dispute or uncertainty
ahead of time as to what number
to call and who is authorized to make the
call. Include this info in your training and
Do the 911 dispatchers have the location
of your facility's AED(s) in their database?
Their having this piece of information
could save valuable time in facilities
where members of the general public or
laypersons could have access to your AED
but may not know where to find it. Give
your local emergency dispatchers a call to
see how you can work together to improve
2. Earlier CPR. Early CPR buys time
until an AED is brought to the scene
and is ready to use.
Time can be lost
if responders do
not have access
to basic personal
as gloves, and
barriers such as
faceshields or pocket
masks. As a safety geek,
I have an affinity for acronyms,
(and parentheses), and here's
an abbreviation I extrapolated
from something a lady said on the
local news one night a few years ago:
WDWHTTWCUTGWWN? It stands for
"What do we have today that we can use
to get what we need?" In this case, we have
fire extinguishers today, and having them
creates a time-saving opportunity.
Fire extinguishers usually are placed no more that 75 feet apart in most facilities
and even closer in others; their locations
are generally well marked and familiar
to everyone in the building. We could
place a barrier kit containing gloves and
faceshields or pocket masks at each fire
extinguisher and train our folks so they
know where the kits are. A kit would now
be no farther away than 35.5 feet from any
If the only kit we have is in the first
aid room 150 feet away, our having others
located at the fire extinguishers just gave
us a potential time savings. Of course, we
shouldn't delay care to get a barrier, but
what's going to happen in the real world?
It would be great to have an AED at each
fire extinguisher, but cost is a problem in
3. Earlier defibrillation. The sooner we
shock a patient who needs it, the more
likely that victim will survive. It is estimated
the victim loses 10 percent of his or
her chance of surviving the event for each
minute a needed shock is delayed.
During one of my recent CPR classes,
I found that the facility had its AED in a
cabinet that sounded an alarm when the
cabinet's door was opened. That is pretty
common, but I had a bit of an "Uh-oh!"
moment when I asked myself, "What is the
real purpose of the alarm?" When I asked
the class what the purpose of the alarm
was, the students told me it was to "let
people know there was an emergency."
When I got home that evening, I went
online and looked at various manufacturers'
literature for alarmed cabinets. Some
manufacturers said the alarm was to prevent
theft of the AED. Others said it was
to summon help. I was concerned that if
the alarm summoned help, the help would
most likely run to the cabinet — and that's
where the emergency is not taking place.
Responders may run to the cabinet only
to find that someone has already grabbed
the AED and has run to the victim — but
where is the victim?
We can lose some time here pretty
quickly. The purpose should be explained
in your training.
We had discussed this situation in class
earlier in the day. One of the students
asked, "What if the AED made the noise?"
Now, there was a thought! A little more
Internet research revealed there are personal
alarm devices you can buy for about
$10 that are the size of a key fob and will
emit 120-130 db sound. What if we used
one of those to alert others while we carried
the AED to the scene?
We already have fl oor plans and evacuation
routes posted all through the facility.
We could post additional ones in glass
frames at each AED cabinet, along with
a dry erase marker. Make everyone in
the facility a "Fetcher," meaning anyone
in the building can call 911 or the emergency
number, fetch the AED, and bring
it to the emergency scene even if he or she
isn't trained to use it. Train the Fetchers
to mark the location of the emergency on
the fl oor plan before they leave the cabinet.
Train responders to check the posted
fl oor plan for directions when they hear
the cabinet alarm. Benefits here include
having people who may not be trained on
CPR do a vital task while trained CPR personnel
immediately begin CPR. Responders
who go to the AED cabinet can tell at
a glance where the emergency is and save
time by knowing immediately where to go.
Even if you don't have a cabinet with an
alarm, marking the location of the emergency
whenever the AED is deployed can
reduce confusion and speed the response.
4. Earlier advanced care. Treatment by
trained personnel who are equipped with
advanced life support (ALS) techniques
and materials further increase the victim's
chance of surviving the event.
We can save some time here by taking
steps to get the ALS personnel to our
victim as soon as we possibly can. We can
designate escorts to meet the various EMS
people who arrive at our door and usher
them to the scene. I used the plural, escorts,
for a reason. Typical EMS responses
generally include the arrival of several first
responders, many of whom are volunteers
affiliated with the local fire department
but located throughout their assigned
districts, followed by the arrival of the Advanced
Life Support (ALS) crew.
First responders may arrive from a
few seconds to a few minutes apart, based
on whether or not they are driving their
personally owned vehicles, as volunteer
responders often do, and on how far they
have to travel. We may need several escorts
to be available due to the differing arrival
times of the first responders and the paramedic
or ALS crew.
Time can be lost if the only escort we
have grabs the initial first responder to
arrive and disappears into the maze of a
plant or large office filled with cubicles,
leaving subsequent rescuers at the door
to try to figure out where to go. We could
also train people to form a "human chain"
to guide responders to the emergency's
One last WDWHTTWCUTGWWN?
We have Job Hazard Analysis (JHA)
techniques today that we can adapt to
our new purpose of tweaking our CPR
response. Try breaking a cardiac emergency
down into individual tasks. List the
individual tasks, using the cardiac chain
of survival as a rough outline, and refine
each link using your own site's unique
traits. Then, apply corrective actions, just
as you would for a bona fide JHA.
Develop your response protocol to
maximize the cardiac chain of survival in
a way that aids your people in your facility.
Got walkie-talkies? Use them in your
response plan. Got an overhead public
address system? Use it to its fullest extent.
Train all of your emergency responders to
automatically bring the AED to the scene
of any emergency.
Lastly, train, train, train. Use your protocol
(written down and communicated
by this time) to conduct regular drills. Do
written critiques of each drill, and use the
knowledge you gain to shave even more
time off the response. Close the gap between
the classroom and the hands-on
emergency. The real currency here is time;
let's spend it wisely.
This article originally appeared in the September 2009 issue of Occupational Health & Safety.
Michael E. Bingham (919-218-9045) is the Western Area Safety Representative for the North Carolina Industrial Commission. He has five years’ experience in the lumber industry and 27 years in the manufacturing industry, working in various positions from entrylevel assembly work through numerous technical and managerial positions. He has served as a volunteer firefighter, medical first responder, and is a North Carolina EMTIntermediate. He has an A.A.S degree in Electronic Engineering Technology and a second A.A.S. in Computer Engineering Technology. He earned a Manager of Environmental Safety and Health Certificate (MESH) through the Safety and Health Council of NC, N.C. State University, and the N.C. Department of Labor, and is one of only four people to date in North Carolina to earn the Construction MESH (CMESH) certificate. He has the National Safety Council’s Advanced Safety Certificate. In May 2008, he earned the Certified Safety Auditor (SAC) credential from the National Association of Safety Professionals. He is an authorized OSHA General Industry Outreach Trainer.