A work colleague approaches you clutching their chest, looking pale, sweaty and complaining of discomfort in the chest and left arm. Immediately you suspect they may be having an issue with their heart. They reports feeling dizzy, lightheaded and not well. You ask them about the pain and they report it is more discomfort than pain. At this moment you recall from your first aid training that pain may not be specific nor localised to one area. You seat your colleague and then make the call to 000.
With the Ambulance on its way, reality kicks in and you recognise that “you’re it” until help arrives. You call for the first aid kit, AED (Automatic Electronic Defibrillator), oxygen kit and ask the casualty to lay down to make them more comfortable. The next couple of minutes pass and remain uneventful but then the worst happens.
Your colleague stops talking and responding to your voice. Pinching their shoulder provides no response so immediately you check for breathing and airways. Their regular breathing has deteriorated to a gasp, like a fish gasping for oxygen. Immediately you realise things have just gotten a lot worse. Your first aid training taught you that an unconscious casualty without breathing equals cardiac arrest.
The mind starts to rush. Do you start CPR if their breathing is irregular? Will you correctly apply compressions and breaths? Will it hurt them? Should you start immediately? What are your priorities? Do you get oxygen on first, or apply the pads?
Stop and remember “ANY ATTEMPT AT RESUSCITATION IS BETTER THAN NO ATTEMPT” from the Australian Resuscitation Council’s (ARC) website.
In my experience as an Intensive Care Paramedic, the primary reasons for first responders' reluctance to commence resuscitation is the fear of getting it wrong or causing further harm to the casualty. Remember even if your compressions aren’t perfect, or you don’t have an AED available, you are still helping the casualty by doing something rather than nothing.
Approximately 30,000 people suffer Cardiac Arrest in Australia each year with only about 10% surviving. When a heart stops, it’s serious! It’s going to take a fair effort from the entire health system and a little luck to revive the casualty and that’s where your actions matter. Do nothing and they have no chance. Do something and the odds improve.
Statistics show survival rates significantly increase when an AED is used on time. The ARC guidelines suggest that the survival rate however drops as much as 10% for every minute which passes without AED support during ventricular fibrillation, a shockable rhythm.
Follow your DRSABCD, begin CPR immediately and get those pads on as quick as possible to increase the chance of survival.
Some studies show that survival rates increase by up to five times if an AED is available and used as soon as possible.
Injury from chest compressions is often a topic for concern of the inexperienced however considering the alternative, being death, the risk of fracturing a rib becomes a lesser issue.
The ARC website states that “compression depth of even 6cm is acceptable but below 5cm, the outcomes become poor”. Remember, too deep is preferable to not deep enough. As a guide, compressions should be 1/3 of the depth of the chest typically, unless the casualty is elderly or an infant.
Compression rates should range between 100-120 per minute and always be mindful the most important person in the room (other than the casualty) is the responder doing compressions. The quality of compressions, rate, depth, and continuity play a major part in the survival rate. So, get on that chest and focus. As soon as you are tired, change out with another responder. The recommended time on the chest is no more than two minutes, per responder, per rotation.
If you have no support, do what you can and always remain focused. Focus is so important. Many times I have witnessed, whilst in training exercises and live situations, compression efficiency drop due to fatigue or the responder being distracted by others on scene.
The importance of early defibrillation and compressions has now been recognised and accepted nationally and internationally improving cardiac arrest outcomes.
Throughout Europe, school students are trained in CPR. In Seattle, the survival rate of cardiac arrest is an astonishing 56%. This is due to EMS staff spending more time training, readily available AEDs in the community and most importantly community awareness, training and their ability to commence resuscitation early.
Australia has a long way to go pursuing these numbers but I am certain through training and awareness programs including the availability and use of AED’s, that we can certainly improve.
My experience is that patient revival from cardiac arrest is unfortunately low, especially when immediate medical help is not available. This however doesn’t deter us as paramedics arriving on scene. We always give it our best, regardless of the odds and that's where YOU fit in.