Author Topic: CPR Debate  (Read 4654 times)

adi

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CPR Debate
« on: September 28, 2013, 06:07:47 PM »
I have posted what the H&S regs say, which are the work place regulations,  St John's/St Andrew's/Red Cross have to follow them, after all they are first aid faculties like the two faculties I am a member of.

The resuscitation protocols are set by the Resuscitation council (UK) from guidance from International Liaison Committee on Resuscitation (ILCOR) who are responsible for overseeing a set guidance across member counties. The guidelines protocols are there to be followed. If you are a first aider, paramedic, nurse of doctor you are best to follow them.

« Last Edit: September 28, 2013, 07:38:53 PM by adi »
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

captain paranoia

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Re: CPR Debate
« Reply #1 on: September 30, 2013, 12:43:16 PM »
Thanks Adi.

Links to the two threads:

First Aid Kits
BLS Resuscitation Guidelines Guidelines 2010

My guess is that the BHF campaign is intended to get bystanders to do something, rather than stand by and watch someone die.  Of course, CPR resus rates are rather low away from immediate hospital care, so the chances are the patient will die anyway, but at least try to do something that might keep them going until a paramedic with AED arrives, in which case the survival rate will jump considerably.

Lost Soul

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Re: CPR Debate
« Reply #2 on: September 30, 2013, 06:39:38 PM »
Re CPs post above. < - - - but at least try to do something that might keep them going until a paramedic with AED arrives, in which case the survival rate will jump considerably.>

A guy I used to work with many years ago was and probably is still proficient in CPR.  One day (10 years or so ago) his wife collapsed in their kitchen.  He applied CPR.  To the best of my knowledge she is alive and well to-day. 

Then blow us all down a few months latter one of the guys in the office collapsed.  Once again our CPR proficient colleague stepped up to the mark and saved yet another life.  Unfortunately second saved sole had a lot of heart disease and died about 3 years ago.  But had not CPR been given to him there and then he would have died 9 years ago - so he survived for 6 years.

As you can see from my limited experience I would say CP's advice is spot on.
« Last Edit: October 01, 2013, 10:43:23 AM by Lost Soul »

captain paranoia

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Re: CPR Debate
« Reply #3 on: September 30, 2013, 06:55:15 PM »
Just goes to show how statistics and probability work...  I think the average survival rate is about 5%, and I know paramedics who have attended a number of incidents, and never had one survive...

I know that if someone close to me had a heart attack, I'd want to do the best I could to keep them alive, and, to me, that would mean breathing for them, regardless of the statistics or the BHF advice.  And I think I'd want to try my best for anyone I encountered.

adi

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Re: CPR Debate
« Reply #4 on: September 30, 2013, 11:23:01 PM »
I have done CPR 22 times 9 are alive today. 4 died within days the rest died on seen. Survival rates in this country at dismal. The last time i did CPR was on a 15 year old girl in a doctors surgery earlier this year. I saw her in town on Saturday, she is doing really well. Luckily the paramedic got to us quick enough to defib her other wise I think I would have lost her.
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Skills4Survival

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Re: CPR Debate
« Reply #5 on: October 02, 2013, 10:45:21 PM »
Adi, that is impressive, must be quite something to experience these things and live with that. Thanks for sharing.
Ivo

adi

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Re: CPR Debate
« Reply #6 on: October 03, 2013, 03:47:31 PM »
Adi, that is impressive, must be quite something to experience these things and live with that. Thanks for sharing.

Thanks Ivo. From my experience the higher risk environments you go into the greater the need for first aid and the more likely you are to need it.  I remember as a teenager watching someone die and seeing other stand around and watch. Being young I did not have the confidence to step forward and do something. From that day on I will get involved. It has lead to some very rewarding experiences and some great friendships. The highlight was delivering a baby in the back of my ambulance and assisting a doctor opening a young mans chest  in the street  after being stabbed. Both of those incidents where during the national ambulance strike of 1989.
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

captain paranoia

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Re: CPR Debate
« Reply #7 on: October 03, 2013, 06:50:37 PM »
> I have done CPR 22 times 9 are alive today.

That's a very impressive record, Adi, and, I think, way above the average.  It felt good to fix the washing machine recently, so I can't imagine how I'd feel if I saved someone's life...

Here are a couple of links I pulled from a UKC thread, posted by an A&E consultant, after he was questioned on his comments that CPR in remote areas was pretty well pointless, whilst supporting the teaching and use of urban CPR:

http://www.chainofsurvival.com/cos/Timing_detail.asp
http://www.ncbi.nlm.nih.gov/pubmed/22490674

The Chain of Survival table shows just how vital it is to get defibrillation as soon as possible, and of the benefit of urban CPR.

adi

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Re: CPR Debate
« Reply #8 on: October 03, 2013, 08:26:17 PM »
Here are a couple of links I pulled from a UKC thread, posted by an A&E consultant, after he was questioned on his comments that CPR in remote areas was pretty well pointless, whilst supporting the teaching and use of urban CPR:

I completely disagree. However as an A&E consultant he is well aware of his abilities and reaction to death.  The reason I disagree is because you are in a remote location, which mean help could be hours or even days away in some parts of the world. You would need considerable experience of dealing with death to treat it in such disregard. Firstly there are conditions where cardiac arrest can be reversed. Ok sometimes there can still be sever damage and side effects. Secondly and a lot more importantly in remote locations you are probably going to be in a group, there is no way of shielding the group from the reality of a death. So by doing something however pointless it may seem is lessening the mental stress of the situation. It is a well documented fact that people who feel they have done nothing will suffer from greater guilt than those that did do something. This guilt terns into PTSD not nice for anyone to deal with. Secondly an active group working for a single cause is engaging everyone for that common cause, it goes a very long way to stopping people freezing or panicking. Someone who is panicking can do very rash things including ostracising themselves from the group or even being violent or trying to run off. Movement makes people breath, breathing introduces oxygen into the system burns off adrenalin which can cause fear. Thirdly once you get home you will be invited to a tribunal into the death where everyone in the group will be examined and cross examined. By acting makes you breath, oxygen is needed for brain function such as memory.  Could you give evidence saying you did not do everything possible for the deceased?  Don't forget others in the group might feel your actions contributed in the death and will say so, so you need to give a very good account of your actions. Lastly the loved ones will most likely want to meet you and the group to get information from the horses mouth for closure. Could you really say you did everything you could when you know you made the decision that it was pointless. If you thought it was pointless then you have to live with that thought for the rest of your life.

As a first aider in remote location for groups you are providing care for the whole group as a whole not just the casualty. You need to look like you are doing the up most at all times to gain respect and confidence from the group in your abilities. You might have to rely on their confidence in you to be able to do your job.   

The  A&E consultant comment shows me he has only ever worked in a hospital environment and has no experience in working in remote areas. 

Edit

I have just looked at your links and they have nothing to do with remote medicine. They are about out of hospital environment.  Secondly we are in the UK and not the US so please don't try to give US evidence to a UK forum. The information is similar however there are often quite considerable differences.  I have given details of sources of information for the UK.

« Last Edit: October 03, 2013, 08:43:29 PM by adi »
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

captain paranoia

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Re: CPR Debate
« Reply #9 on: October 04, 2013, 02:35:04 PM »
Adi,

You'll have to forgive me for sometimes being a very dispassionate engineer, used to dealing with statistics and probabilities, sometimes addressing very unpleasant issues such as injury & death.*

As it happens, I also disagree with the comments about remote CPR being pointless (I mentioned them only as a preamble to the pages showing survival statistics; that was the main point of my post), and said this on the UKC thread:

"Whilst I acknowledge [the] comments about the revised CPR instructions (I spend quite a lot of time in the CD section of BHF's second-hand shops, so I'm very familiar with Vinny...), again, I'd suggest that these are intended for an 'urban audience', on the assumption that an ambulance isn't far away. For remote CPR, I think breathing may still usefully be employed, even though I do note [the] observations on survival rates. If dealing with a mate, I'd like to think that I'd really tried my best."

Wanting to try my best addresses the emotional and blame issues you mention.  Nevertheless, I remain realistic about the limited chances of survival in a remote location.

As for US studies not being applicable in the UK, well, the European Resuscitation Council find differently, it would seem.  In the 2010 ERC resuscitation guidelines, they compare the statistics of European and US cardiac rates:

"Summary data from 37 communities in Europe indicate that the annual incidence of EMS-treated out-of-hospital cardiopulmonary arrests (OHCAs) for all rhythms is 38 per 100,000 population.  Based on these data, the annual incidence of EMS treated ventricular fibrillation (VF) arrest is 17 per 100,000 and survival to hospital discharge is 10.7% for all-rhythm and 21.2% for VF cardiac arrest. Recent data from 10 North American sites are remarkably consistent with these figures: median rate of survival to hospital discharge was 8.4% after EMS-treated cardiac arrest from any rhythm and 22.0% after VF"

https://www.erc.edu/index.php/docLibrary/en/viewDoc/1195/3/

This document also discusses the use of compression-only CPR for non-trained rescuers, but that 30:2 compression/breath cycles should be performed by 'trained rescuers'.  The BHF discuss their compression-only campaign policy here:

http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr-faqs.aspx

"Without bystanders intervening by calling 999 or carrying out CPR there is a very small chance of someone surviving a cardiac arrest, so any CPR is better than no CPR. By simplifying the CPR message to hands only we hope to see more successful resuscitation attempts by bystanders."

Whilst there may be factors in a remote environment that actually increase survival rate over general 'out-of-hospital' survival rate (patients may be fitter, for instance), the massively increased time to get medical care (as opposed to first aid) must act against them.  Thus, taking the out-of-hospital figures is probably being generous in terms of the survival rates.  If you know of figures that deal exclusively with remote survival rates, then I'd love to see them.  Due to the low numbers involved, I suspect their statistical significance would be quite low.

> Secondly we are in the UK and not the US so please don't try to give US evidence to a UK forum.

We're not in the UK; we're on the internet.  Whilst the majority of forum members are UK-based, they come all around the globe; US, AU, NZ, IRL, BE, SP, PL, SA, FR, NL, etc.

* But I'm not a heartless git.  Reading the concluding paragraphs of the Paediatric Life Support section of the ERC guidelines brought tears to my eyes.  After all the dispassionate science, and statistics, and best practice guidance, we come to the human side of things, with the paragraphs "Parental presence" and "Family presence guidelines".  "Parental presence in the resuscitation room may help healthcare providers maintain their professional behaviour, whilst helping them to see the child as a human being and a family member."  A tacit acceptance that it is easy for healthcare professionals to become detached (and, in many ways, this detachment is essential for their psychological wellbeing, and, to some extent, to enable them to make rational decisions).

Lyle Brotherton

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Re: CPR Debate
« Reply #10 on: October 05, 2013, 09:30:02 AM »
personally I have never administered CPR, although train every three years to retain my First Aid Certificate.

At my last raining session the protocol had changed with the emphasis on breathing first, starting heart second - I will copy and paste the exact protocol.

MyMRT (Mountain Rescue Team) has a policy of NOT initiating CPR on the hill (a Scottish euphemism for mountain) if the Defibrillator is more than 20 minutes away and if the casualty cannot be evacuated within the same time frame. I am not sure if this is nationwide.
“Opinion is the medium between knowledge and ignorance” - Plato

Pete McK

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Re: CPR Debate
« Reply #11 on: October 06, 2013, 08:54:38 AM »
Following the near death experience of footballer Fabrice Muamba's, from SCA (sudden cardiac arrest), during an FA Cup match, the awareness of this life threatening event occurring to younger people was significantly raised throughout the school. As a response, in association with our feeder junior schools (we are a large State CoEd school) we extended our PE curriculum’s basic life-saving skills to include the ‘HeartStart Program’ which has been developed and is supported by the British Heart Foundation. 

We also had a Public Access automated external defibrillator, or AED, installed and kept in the Administration office, which we obtained with the help of the charity Community Heartbeat Trust. They provided us with compelling evidence which indicated that AED is almost 10 times more effective in saving lives than just CFR (Community First Responder) schemes alone and it is nothing to do with skills of the responders, but simply a factor of time to the patient.

An interesting footnote is the defibrillator has had to be used and I am pleased to with a good outcome, on a person visiting the school earlier this year.

Skills4Survival

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Re: CPR Debate
« Reply #12 on: October 06, 2013, 09:54:52 AM »
breathing first, starting heart second

same in netherlands
Ivo

captain paranoia

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Re: CPR Debate
« Reply #13 on: October 08, 2013, 07:01:38 PM »
Pete,

The school I help out with DofE have an AED (Automated External Defibrillator), so the first aid course covered AED use.

They also said that having an AED increased the amount they could charge for the school's facilities to outside organisations, as they all saw the presence of an AED as major plus!  This meant that the AED paid for itself...

Pete McK

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Re: CPR Debate
« Reply #14 on: November 03, 2013, 11:59:57 AM »
Thanks for this CP, something worth sharing as I know other schools in my district have not been able to obtain charity funding. I will now ping them this info :)