Technology to the Rescue

There is almost no excuse for everyone not to learn some form of rescue techniques, be they rescue breathing, CPR, or using an AED.

• By Barry R. Weissman
• Jun 01, 2010

You have just left a stressful meeting with your boss and your biggest customer. They were arguing your company was at fault. You had to hold your tongue so you wouldn't say something to embarrass your company. You feel hot and sweaty, so you get a drink of water. There is pain in your arm that goes up to your jaw. You feel weak and, while looking for a chair, you fall down. You are unconscious.

What happens next? Do your co-workers know what to do for you? Can they do more than just call 911? Your life depends on them. Have they been trained in CPR techniques? Will they administer CPR on you, or are they not confident in their abilities? Are they afraid?

This same scene is occurring every 90 seconds in the United States. At least 350,000 people will suffer cardiac arrest each year, and some will survive with the assistance of regular people, just like you and me.¹

CPR consists of two parts: mouth-to-mouth resuscitation and chest compressions. Mouth-to-mouth methods have been around for hundreds of years with various levels of success. However, not until 1950 did the armed forces and the American Red Cross began to teach both military and civilian populations.² A lot of information is available on the history of CPR because it is only about 50 years old.³

Procedure
Typically, CPR is a combination of mouth-to-mouth resuscitation (rescue breathing) and external chest compression that is taught in classes by an instructor who runs the students through a series of exercises before providing them a certificate. For those who have previously been certified, there is an online training course and a DVD refresher disk. The procedures have been changed over the years to make the actions less onerous for the general public, who may never do the skills but may need to be certified due to an OSHA requirement or a company need.

When an unconscious person is found, he is shaken to determine whether he is really unconscious or merely asleep.⁴ Next, the airway should be opened and breathing checked. Occasionally, the act of pulling the head back will be sufficient to raise the tongue from the back of the throat, and the victim will begin to breathe on his own.

The rescuer should place his ear near the victim's mouth to listen for the sound of escaping air while, at the same time, looking at the chest to see whether it is rising and falling. If it is, the victim is breathing, and the rescuer needs only to observe while waiting for medical assistance to arrive. Lacking breathing, the rescuer will provide two quick, full breaths into the victim, watching to see they go in by seeing the chest rise.

Next, the rescuer checks the carotid artery (one of the major blood vessels in the neck) to feel for a pulse. Feeling a pulse means the heart is beating, for the time being, but without breaths, the victim's heart will stop. The rescuer should provide rescue breaths. If there is no pulse, the rescuer should give chest compressions interspersed with rescue breathing. This combination of chest compressions and rescue breaths is called CPR.

Problems
Lay people are especially afraid of performing CPR on victims they don't know, for a variety of reasons. I'll detail a couple here and their answers.

Is it true that I could break someone's ribs by doing CPR?
The answer is, "Yes. Even properly performed chest compressions can cause ribs to break in adult victims. . . . Although broken ribs can cause complications, you must keep in mind that the person is in cardiac arrest." He is clinically dead, and you are trying to revive him. If you are successful, the broken ribs will heal.⁵

I don't know this person. I don't want to touch her by blowing into her mouth.
This question comes up very frequently, especially when the lay population is confronted with a stranger who collapses. To overcome this, there is a pocket mask or barrier device that can be used to provide a shield between you and the victim.

Should I just do nothing if I don't have a barrier device?
"No. If you don't have a barrier device and an unresponsive victim has no signs of circulation, do chest compressions until help arrives. Chest compressions alone are better than doing nothing."⁶ This problem has become so prevalent that the organizations involved in CPR rescue have come up with "Compression-Only CPR" guidelines. The American Red Cross says, "Compression-Only CPR is an acceptable alternative for those who are unwilling, unable, [or] untrained."⁷ Compression-only CPR is just that: chest compressions only and continuing until an AED (see below) or someone with more skill and knowledge arrives.

Technology to the Rescue
Imagine you have taken a training course in CPR techniques. One or two years have passed, and you never had to perform CPR. You haven't even looked at the book or reminder cards to refresh your memory. It's Sunday, and you and the family have gone to the mall. While walking around, Grandpa suddenly clutches his chest and collapses. What do you do? Do you yell first? Blow in the mouth first? Tilt the head first? You can’t remember.

Your son runs up to the cabinet on the wall and grabs the automated external defibrillator; you remember using it in class. You tear open Grandpa's shirt, open the AED case, and, while looking at the pictures, you place the pads on his chest. You plug the leads into the machine. As it warms up, the mall police arrive and take over.

The unit advises everyone not to touch the body while it performs an analysis on the victim. A shock is advised. After making sure no one is touching the victim, the police officer pushes a button, and an electric jolt goes through the victim. With luck, he begins to breathe again.

If not, the unit will go though some additional checks and additional shocks, then it will guide you in giving CPR and rescue breathing until the paramedics arrive to begin advanced cardiac care.

What's Next?
Only 6.4 percent of sudden cardiac arrest victims survive because the vast majority of those witnessing the arrest are people who do not know how to perform CPR.⁸ With the advent of AEDs, software applications showing us first aid and CPR on our smart phones,⁹ and training techniques being simplified, there is almost no excuse for everyone not to learn some form of rescue techniques, be they rescue breathing, CPR, or using an AED. If not for your co-workers, then learn them for your family.

References
1. Myerburg RJ, Castellanos A. Cardiac arrest and sudden cardiac death. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease. Philadelphia Pa: Elsevier Saunders; 2005: 866.
2. UKDivers.net. History of CPR. http://www.ukdivers.net/history/cpr.htm
3. Cooper, Jonas A, MD; Joel D. Cooper, MD; Joshua M. Cooper, MD. Cardiopulmonary Resuscitation: History, Current Practice, and Future Direction; http://www.circ.ahajournals.org/cgi/content/full/114/25/2839#R1-179917
4. Specific details will not be presented. Readers who are interested are urged to sign up and take a class at their local American Heart Association or American Red Cross chapter.
5. AHA Knowledge Base, Question 115. https://myportal.americanheart.org/jive/entry.jspa?externalID=115&categoryID=10
6. AHA Knowledge Base, Question 116. https://myportal.americanheart.org/jive/entry.jspa?externalID=116&categoryID=10
7. Compression-Only CPR; American Red Cross Position, April 25, 2008. http://www.njredcross.org/redCrosPositionOnCompressionOnlyCPR.pdf
8. American Heart Association's CPR Anytime Personal Learning Programs, http://www.americanheart.org/presenter.jhtml?identifier=3040526
9. American Heart Association, Pocket First Aid and CPR for Apple iPhone. http://www.americanheart.org/presenter.jhtml?identifier=3067191