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 survival.

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 AED)
      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 drills.

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 your response.

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 protective equipment (PPE), such as gloves, and barriers such as faceshields or pocket masks. As a safety geek, I have an affinity for acronyms, abbreviations (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 given emergency.

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 most places.

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?

But, WDWHTTWCUTGWWN?

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 location.

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.

About the Author

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.

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