This is … interesting, because it completly contradicts what every medical trained person teaching first aid to me (different organisations, different people, different level of training*) told me about CPR:
if you do CPR wrong, you might break ribs, but if you do nothing, the victim will be surely dead; and it’s certainly preferable to be alive with a broken rib (that will heal again) than be dead with unbroken ribs.
Maybe the difference is that in Germany a first-aid course is required for a drivers license, so the majority of adults will have at least a cursory knowledge of CPR, even if it’s old and rusty. Maybe that’s different from trying to coach completly untrained people over the phone?
I try to repeat the first aid course every couple of years to stay current, and practise on the dummy doing the chest compression whenever a medical volunteer org. puts up a try-out booth at some local fair.
If you’re in a situation where CPR is genuinely called for, and if professional help is far enough away that they wouldn’t be able to arrive in time otherwise, then this is true. But if a person’s heart hasn’t actually stopped, or if the professionals are imminently arriving, then it can’t do any good, and is likely to do harm.
This is true, and if you take a basic CPR class here in the US, they’ll tell you the same thing. But if you’ve taken even a basic CPR class, then you’re not entirely untrained. The hardest part about administering CPR is also the hardest part to deal with over the phone: is there a pulse, or isn’t there? If there is, then you can certainly do more harm than good if you go ahead with compressions. If there isn’t a pulse, then there’s no more harm to be done since the person is dead (well, dead enough for field work, anyhow.)
The simple training of people to check for a pulse - where, how much pressure to apply, what fingers to use, how long to feel for it - is probably the most important and hardest part of CPR training. If you’re sure there’s no pulse, then yes, there’s no harm in doing CPR. Sure you might break ribs (more commonly, they tear at the sternal cartilage) or rupture a liver or something. If there wasn’t a pulse, all you’ve done is beat up a corpse.
Huh. Strange. At the last personnell meeting at my workplace the company doctor told us about the new CPR method which had been recommended by the AHA, the American Heart Association, in 2010 (although I had heard about it from other sources before).
It goes: you check for consciousness. If person doesn’t wake up, you check for breath. If no breath, you start CPR, with 30-2 (or 15-1) compressions to breathing; if squeamish or unsure at all, skip the breathing.
The reasons for this are: most people have apparently trouble with checking the pulse or finding it correctly, even after you’ve taught them to not use the thumb - most people hear their own pulse, esp. in a stress situation, even trained people like EMTs, because in trouble, the pulse at neck or wrist is too weak against the excited pulse of the helper.
Second reason: if there’s no breath, the person will need chest compression soon anyway, so checking for pulse is just a waste of time.
As for not giving breath, just doing compressions: apparently so many people are squicked out at the thought of touching a strangers mouth/ nose (and too few carry a mask) that they will rather not help; and the left-over air in a normal lung is sufficient for normal CPR when professional help will arrive in 10-15 min. anyway.
Where in the world do you live that help arrives “immediatly/ imminently”? In my city of Munich, when in the inner city I call rescue, the EMTs will arrive in 5 min. That’s still long enough for somebody to get brain damage if nothing is done.
The only place I can think of is a hospital or suchlike - but in such a place, the nurses and doctors go to work immediatly, so there’s no need for first aid helpers. Every other place, help will need longer to arrive than damage to occur.
I ahd the same training recently - forget about checking for a pulse, and they’re dead anyhow so forget about causing harm, better to attempt than to do nothing.
Googling suggests there are two states where if you have CPR training, you are expected to use it. Presumably this means there are no states where if you dont have it you are required to try it. The OP doesnt say whether they were trained or not.
Well, my last class was almost 2 years ago, and the American Heart Association just rolled out (or is about to roll out) new guidelines for CPR for laypeople, so you may very well be correct for here, as well. It wouldn’t surprise me, because of the difficulty finding a pulse. Will some people be harmed by compressions they didn’t need? Possibly. But really, if someone pushing on your chest doesn’t wake you up, you’re seriously in trouble anyway!
Healthcare provider’s CPR (which is what I have), from what I understand, will continue to teach breaths and compressions *and *checking for a pulse. Yeah, it can be tricky to find, even for healthcare providers. I got to help with a hospital resuscitation (in the ER - the patient was “unresponsive” in the field) last week, and even the doctors had trouble deciding if the patient had a pulse or not.
IN EMT school we called this “Don’t worry about it day”
If the head is not attached to the body…dont worry about it
if they are over 90% 3rd degree burns… dont worry about it
blood pooling…dont worry about it
frozen solid… dont worry about it
This is completely contrary to what I was taught. I learned that if there’s no breathing, but there is a pulse, then mouth-to-mouth alone will usually work just fine. Thankfully I’ve never had opportunity to test this, and it’s possible I was taught wrong, but if that’s true, then you absolutely should not jump straight from “no breathing” to chest compressions.
The way I see it, the 911 dispatchers and responders are calm, trained professionals, but the folks on the other end of the line are often panicked. The EMTs are probably on their way almost immediately, but it’ll take some time for the dispatchers to relay instructions to the caller. It doesn’t seem implausible at all to me that, by the time the dispatcher gets the caller to actually do anything, the EMTs might really be right at the door.
I’m not saying wrong, as much as “science marches on”. One of the trained people who told me the new guidelines said that they learned this through animal testing (not what I wanted to know); but obviously, also observations in the field - including the difficulties even trained personnell, as WhyNot mentioned, EMTs and nurses - have of finding a weak, fluttery pulse - went into the new guidelines.
Yes, 10 years and more ago, I, too learned more steps: check for breath and pulse, if breath no, pulse yes, then only mouth-to-mouth, and keep checking, and only when pulse stops, start chest compression.
But when the AHA revises their guidelines. I assume they do have tons of research behind that.
I dimly remember that the rates of compression have changed a few times until now it’s 30 to 2 (mouth to mouth), with 100 in a minute (which is pretty quick and really tiring), but I think it used to be a different ratio.
If you look at old movies from the 60s, they don’t do chest compressions at all, they do the arms-over-thead-and-back thing, which was the recommendation at that time (when doctors were just developing external stimulation and trying out what worked best), so change of method is not new.
Side question:: when one of my colleagues went to get the official First Aid helper for the workplace cert. and course, he had learned about the Defis or AED (Automatic External Defibrillators). They’re little boxes that talk to you: you open the box, find two large patches with wires and a nice schematic on the protective covering that one goes over the heart and the other on the side, the flank, peel of the cover and slap them on. Then the machine says “Please wait, measuring” and then either says “shock recommend, please step back and then press red button” or says “shock not recommended please do chest compressions for 3 minutes” (okay, it talks German). These boxes are for sudden heart attacks specifically (as opposed to the many other reasons why people in severe accidents suddenly their heart stops beating), and are mounted in many subway stations* and bigger public buildings. **
Apparently, they have quite a good success rate, saving about a dozen people’s lifes in the several years they have been being installed around the city. Obviously, treating only a narrow case - the heart is fibrillating - gives much better chances.
What I’d like to know: is this a trend common in the US (and copied from there) to put these automatic boxes in big buildings and offices - or have you never seen them, because of being sued if used wrong?
German subways are clean, well-lit, patroled by security, have cameras and emergency buttons to link via radio to a central service center. They release the lock on the box remotly, to prevent theft, and can give additional advice while calling EMTs.
** This is being financed partly by a private charity, the Foundation against sudden heart death.
Yes, the AEDs are showing up in lots of places in America too. There’s one on every floor of the building where I work, one in the supermarket where I shop, and even one in my shooting club.
WhyNot, I’m trying to get some more info/confirmation on the MA Nurse duty to stop. I’m getting a feeling it’s one of those “everyone knows” things that just might not be true. I’ll see if my wife is willing to talk to HR/legal at her hospital to see what they think. I do know that 9.03(47) from your link:
has been used as a bit of a catchall - including one attempt to use it to discipline unionized nurses for going on strike.
In Indiana (where I’m an EMT), the law is that, if you can be identified as rescue personnel, you must render aid. That means that, if I’m out as a private citizen, but wearing a jacket, shirt, or other apparel that signifies my profession, I am obligated to assist. Likewise, if i’m in my personal vehicle, and I come across an accident, I have to at least check on everyone. If anyone is injured, I have to render aid (FWIW, my personal vehicle has an EMT license plate in front, and a few EMT window stickers, so I can be identified as rescue personnel when I’m in it) until other rescue workers arrive.
Yes, AEDs are becoming more and more common here. I’ve seen them in courthouses, at travel oases (places on the highway with toilets and vending machines, and sometimes gas and restaurants), shopping malls, supermarkets and of course in medical clinics. The CPR class I took most recently emphasized that, ideally, you should check for responsiveness and then send someone to find an AED if you were in a place likely to have one. In today’s world, they can be calling 911 on their cellphone while running down the hall for an AED.
I believe many (all?) AEDs are also hardwired into an emergency telephone line, so if you remove them from the wall, Emergency Services will be notified and they’ll send out an ambulance.
I would think, though, that “difficulty finding a pulse” wouldn’t be a good reason to skip that step. If that were the only problem, then it seems to me it’d make more sense to check, and if you didn’t find one, then to move on to the compressions. If you do succeed in finding one, well and good, and if you don’t (whether because it’s not there, or just because it’s hard to find) then you proceed the same way you would under the new guidelines. It’d only make sense to me if either a lot of folks were detecting a pulse (presumably their own) when there wasn’t actually one, or if people were spending an inordinately long time on trying to find it.
A major change in the guidelines is the recommended process from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compression, Airway, Breathing), based on the delay caused by A-B before compressions begin.
From how I understood what the doctor explained, it was both: people feeling their own pulse instead of the victim - easy to do, since the helper is excited and the victim will have either no or a weak pulse; and people spending a long time looking for one.
Additionally, he said that research findings showed that the pulse generally is very hard to find both at the neck and the wrist; and, that if you have no breath, you most likely won’t have a pulse either. He didn’t give further explanations - maybe one of our doctor dopers can dig up the background of the new AHA guidelines, where it says “our findings and animal experiments showed that x% of beings who weren’t breathing also had no beating heart” with x being above 80 or so (WAG), so the remaining victims have to take their chance.
As an example, in the early first aid courses (end of 80s, 90s) I took, they were la-la about taking off motorcycle helmets after an accident - it requires two people to do it correctly to keep the spine stretched in case of spinal breakage.
Then in the early 2000s, they told me “if the motorcyclist is not concsious, off with his helmet!” Their studies from actual accidents had shown that in the vast majority of motorcycle accidents, while the helmet protects the head, the brain inside still decelerates and hits itself against the skull, causing concussion. Concussion means the brain swells, which cuts off breathing, which means you need to rescuciate, which means take the helmet off. Even if he keeps breathing, concussion can lead to vomiting, so you need to turn him into the stable side position, again necessary to take the helmet off.
Or another example: Because in Hollywood, cars explode with every accident, people have often hesitated to help once the car started burning, believing an explosion was imminent, and dragged people out of the car afraid it would start flaming and blowing up. Now they tell people to not move a victim unless there’s immediate danger or you need to administer aid, because of possible spinal injuries (and several popular science shows have demonstrated how hard it is for modern cars to explode without special effects help). So again, feedback from the field changed the priorities about what beneftis most victims, even if that is counterproductive in a few other cases.
Chronos, I wanted to add my general impression from taking several different first aid courses and talking to volunteer EMTs, who both teach and try to recruit volunteers, and from watching documentaries on the the psychology behind not-helping:
the biggest hurdle for lay-people is the psychological. That’s why we require people to be trained for the drivers license, and to help regardless of their level of training, and why our laws protect helpers from both property damage and being sued.
It’s a mixture of different psychological mechanisms: the bystander effect, where responsiblity gets passes around; fear of doing wrong (what if I make a mistake and make things worse for the victim?); the ick-factor (blood and gore, and death - I think I’ll pass).
Therefore, in every course, the teacher emphasized: “helping is better than doing nothing; there are very few rare cases where wrong help makes things worse”. In each course, they told us how little was necessary to save a life:
somebody is unconscious on his back = can suffocate on his own tongue or vomit > overstretching his head and putting him in a stable position takes a few seconds and saves his life
somebody has a cut on an artery or major vein = can bleed out in minutes > applying pressure at the point and putting on a pressure bandage can save his life
somebody’s heart has stopped = he will die > chest compressions keep the blood flowing to keep the brain from damage until EMTs arrive.
They never ever mentioned the low actual rates Cecil gave in his column. They said “if mouth-to-mouth squicks you out, skip it”. They want to put the entrance barrier to helping as low as possible by making it as easy as possible to remember, and for helpers to feel confident. If you are unsure, you might try to find a pulse so you can avoid chest compressions. If you know you could do damage if the victim still has a pulse, you might spend too long trying to decide whether he really has a very very weak and slow or no pulse at all. So they tell everybody to go ahead, because a low percentage of harmful cases where it’s not the correct response is apparently better in the bigger picture than helpers shying away from the other cases.
Difficult decisions for different cases are for the trained experts, the nurses and EMTs, which have not only a far better training than 14 hours, but also a very different motivation.
Y’know, that’s probably a very good point. It might not be all that relevant for CPR (where even professionals on the spot have only an iffy success rate), but for something like severe bleeding, the proper treatment is pretty intuitive even to folks without any training, and really can make a big difference… If the person gets over their fear and bystander-ness to actually do something. And encouraging people to do as much as they can in all situations probably does help the outcomes in the subset of cases where lay help is likely to be effective.