Is it ( FINALLY! ) time for a change in protocol?

[DeepSeaDan]

"Dr. Robert Harner, a Rockford cardiologist, and Dr. John Underwood, SwedishAmerican Hospital’s emergency medical director, prompted a 13-month study of the method with the Rockford and Byron fire departments. By using only continuous chest compression and automatic external defibrillators, they found that 28 percent of heart attack victims lived and 82 percent of those survivors suffered little or no ill effects to brain function. Under normal CPR protocol, which also uses AEDs, the local medical community saved only about 3.7 percent of its heart attack victims, a standard survival rate, said Bob Vertiz, training coordinator for emergency medical services at the Rockford Fire Department"

About the crappiest study protocol I can imagine, how many of each? what amount of time before help arrived?

if AEDs where so insignificant to the survival rate with standard CPR, why was the push to have them in public spaces successful? after all they aren't cheap...

as to the rest of it - it makes sense and a well designed study should be implemented.

I can't speak to the merits of the "study protocol", I can only relate what I witness in the field & what I read in the journals. I can also speak to the importance of GOOD, EFFECTIVE lay-person cpr as it relates to patient survival.

As I see it:

> Here in Ontario our save rate ( with no neurological deficit ) sits at the ( DISMAL ) 3% average.

> When a v.s.a. call comes in & it is reported that cpr is in progress, I get just a bit hopeful for the chances of the patient. The kicker is, the "cpr in progress" has to be GOOD ( read: cartilage separating deep & 100 cpm ), or they're wasting they're time & energy. Properly applied, compressions move blood & help to remove lactic acid from the ( now VERY irritated ) heart. If V-Fib. is present, effective cpr can coursen the wave, making it more convertible for the AED; it can also extend that critical :10 window of survivability for the patient, allowing us time to get there with our bags of tricks.

> Something has to change in lay-person cpr training. I've been advocating for SIMPLER procedures for years, as well as encouraging folks to push hard / fast / deep, even if they hear unpleasant sounds ( the "can't hurt a dead person" philosophy ). "Recertification" is a misnomer - "Re-Teach" says it better. People leave cpr courses & rarely if ever think of the training again until it's time to recert. If called upon, most do what they can, as best they can, but we need to find ways to make them remember it better / longer; IMHO, simplicity is the key.

> PAD's are well-worth the investment. The sooner a fibrillating heart can receive treatment, the better. We've had several saves in my area with the program only 2 years running. Combine that with EFFECTIVE lay-rescue cpr & we will see improvement.

Regards,
DSD

 

[HammerNoMore]

Getting a good seal, either with mouth-to-mouth or with a mask, is not simple.

No it isn't but newer standards are being a little more strict on the training on this. One of those things that boils down to a good instructor or not. It may not be simple but it's not so difficult that someone who practices every so often would be ineffective at it.

When you have two divers in the water, with the awkwardness and instability of both, getting positioned and stable enough to give really effective ventilation is, in my opinion, not something you can do really fast.

No dobut that rescue breating slows down the tow and that there is serious question as to wether or not it *should* be done, but I think that an inability to peform them is a failure of training that should be addressed.

James

 

[DeepSeaDan]

Getting a good seal, either with mouth-to-mouth or with a mask, is not simple. I have seen trained emergency personnel failing to deliver effective breaths with ideal equipment. When you have two divers in the water, with the awkwardness and instability of both, getting positioned and stable enough to give really effective ventilation is, in my opinion, not something you can do really fast -- The mimed rescues where we just reared up over the person and pretended are great, but in practice, I'm quite sure it would be more difficult than that. The end result is that you either don't ventilate much or your towing is slowed to where you're not making much progress at all. Towing another diver isn't particularly fast, anyway -- and no matter what you think about rescue breathing in water, you have to admit that truly effective resuscitation is going to be much better done on land.

Frankly, the situation of an unconscious victim with no spontaneous respirations any distance from the shore/boat is a very bad one, no matter what anybody does.

I'll add to that the likelyhood over "overinflation", where much of the rescuer's breath will divert down the esophagus & start to ramp up the stomach contents, causing potential regurgitation with all of it's complications.

Thing is - we can't actually TRY to do this skill for real, nor do we have any means of measuring it's effectiveness if we could. Add to that the fact that even in benign conditions, this skill is extremely fatiguing when not towing, & absolutely exhausting if trying to tow & breathe!

So ask yourself - how is the casualty better served? Every minute of delay in re-starting the heart decreases the odds for successful resucitation by 10%...

As the good Doctor says, any way you slice it, it's bad news for the casualty. If real estate is all about "Location, Location, Location", then safe diving is all about PREVENTION X 3!

DSD

 

[DeepSeaDan]

It may not be simple but it's not so difficult that someone who practices every so often would be ineffective at it.

If it could only be so simple! Take a few rides with a busy EMS crew James - get a feel for what is REAL about all of this. Fact is, as the Doctor stated, it is NOT simple. Proper airway management is a difficult skill ( maintaining proper head/tilt position, proper rate & volume, dealing with obstruction...)

No dobut that rescue breating slows down the tow and that there is serious question as to wether or not it *should* be done, but I think that an inability to peform them is a failure of training that should be addressed.

What I do know for sure is that I'm not happy about a casualties airway until the tube is & secure. Perhaps we could teach "Offshore Intubation 101!" Seriously, the quality of Instruction in this instance is a moot point because the Instructor has no way of verifying the effectiveness of the student's efforts, save an ability to "follow the steps"

DSD

 

[ReefHound]

Will the Good Samaritan law - which protects first responders as long as they stay within the scope of their training - protect you if you choose to forgo the techniques you were repeatedly taught in CPR classes and instead try a technique that you read about on the internet as being "better"?

 

[DeepSeaDan]

Will the Good Samaritan law - which protects first responders as long as they stay within the scope of their training - protect you if you choose to forgo the techniques you were repeatedly taught in CPR classes and instead try a technique that you read about on the internet as being "better"?

A lay-person could not legally apply any new techniques until the protocols have been accepted / established & they have been fully trained / certified in their use.

Professional responders operate under the auspices / protocols of their governing base hospital ( at least in my response area ), & are bound to them.

Best,
DSD

 

[Walt1957]

"Dr. Robert Harner, a Rockford cardiologist, and Dr. John Underwood, SwedishAmerican Hospital’s emergency medical director, prompted a 13-month study of the method with the Rockford and Byron fire departments. By using only continuous chest compression and automatic external defibrillators, they found that 28 percent of heart attack victims lived and 82 percent of those survivors suffered little or no ill effects to brain function. Under normal CPR protocol, which also uses AEDs, the local medical community saved only about 3.7 percent of its heart attack victims, a standard survival rate, said Bob Vertiz, training coordinator for emergency medical services at the Rockford Fire Department"

About the crappiest study protocol I can imagine, how many of each? what amount of time before help arrived?

if AEDs where so insignificant to the survival rate with standard CPR, why was the push to have them in public spaces successful? after all they aren't cheap...

as to the rest of it - it makes sense and a well designed study should be implemented.

I'm just curious what it is that you know about the protocol used, and what was so flawed?

Who said AEDs were insignificant? They were used in both sides of this study.

Amount of time before help arrived? This study concerned "the help" that arrived, EMS crews. This method is not (at this time at least) even remotely suggested for non-professionals.

 

[serambin]

University of Arizona developed this technique -

http://www.heart.arizona.edu/publiced/lifesaver.htm

Please note that in the fine print, it states that, "* For cases of suspected drowning, drug overdose or collapse in children, follow standard CPR (2 mouth-to-mouth breaths for every 30 chest compressions). For more information about learning standard CPR, visit the American Red Cross."

Stan

 

[serambin]

Will the Good Samaritan law - which protects first responders as long as they stay within the scope of their training - protect you if you choose to forgo the techniques you were repeatedly taught in CPR classes and instead try a technique that you read about on the internet as being "better"?

According to the link I posted above, the new technique is "legal" for application by anyone.

Stan

 

[Walt1957]

According to the link I posted above, the new technique is "legal" for application by anyone.

Stan

I would still not do it until certification, since any variation from how you were trained could cause legal issues. But you are right, that they are providing training in this method. But AHA, who does most of the training and certification (for non-professionals at least), has not approved this method yet. I suspect it will not take long though because the success rates everywhere that it has been tested are so amazing compared to traditional CPR.