Bystander CPR: The biggest links in the chain of survival
The release of the American Heart Association 2010 Emergency Cardiac Care Guidelines marks the 50th anniversary of CPR. It is perhaps with some irony that some of the biggest changes in the resuscitation guidelines have occurred at the most basic level of care – public participation in managing sudden cardiac arrest (SCA). It may be that the greatest opportunity for EMS providers to improve patient survival from SCA is in the encouragement and support of the lay person to recognize cardiac arrest, activate the emergency response system, and perform effective chest compressions and defibrillation.
Scope of the problem
Professional resuscitation comes of age
This evolution is reflected in the 2010 Advanced Cardiac Life Support Guidelines; there have been relatively few changes in the recommended care provided by the advanced healthcare provider. The AHA has clearly organized its resuscitation guidelines around the delivery of high quality chest compressions to increase perfusion through the coronary arteries and the need to defibrillate early in cases of ventricular fibrillation. This makes sense – there is no reason to believe that the ALS "house" would stand if the BLS "foundation" is weak.
The effect of bystander participation
Where EMS plays a role
While providing certification courses in CPR, AED and First Aid is helpful, there are additional ways to increase public knowledge of CPR. The AHA has endorsed the concept of "hands only" CPR, where recognition of cardiac arrest, activation of the emergency response system, and high quality chest compressions are the key knowledge points.
A casebook example of public participation would be the San Francisco Paramedic Association sponsorship of "sidewalk CPR," which began two years ago. During National CPR & AED Awareness week, volunteer instructors coaxed and cajoled people passing by the SFPA’s building during rush hour, and encouraged them to spend less than 5 minutes practicing hands only CPR on manikins that were laid out on the sidewalk.
Music such as the Bee Gee’s "Staying Alive," "Quit Playing Games with my Heart" by the Back Street Boys, and "Rock It" by Master P provided a soundtrack that allowed participants to practice a rate of about 100 beats per minute. Over the course of two hours, more than 50 individuals stopped and practiced CPR. The cost was low, and the fun factor was high. Last year the event expanded to San Francisco City Hall, where more than one hundred individuals trained during a short period.
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Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at Art.Hsieh@ems1.com and connect with him on Facebook or Twitter.
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