The 911

Did you catch the startling announcement in the news today? What announcement you ask? Well, this afternoon the American Heart Association issued a press release promoting hands-only CPR also referred to as compression-only CPR. The timing of this announcement was somewhat unusual (at least by AHA standards), since the next scheduled release of updated (and peer reviewed) ECC standards was not schedule until International Liaison Committee’s October 2010 Consensus Conference. With that in mind, I guess that is why the AHA is calling this a “clarification” of their 2005 ECC guidelines rather than a guideline change.

So, is Hand-only CPR taking the place of traditional CPR? . Not at all. Keep in mind that hands-only CPR does NOT replace the need for traditional CPR in some situations. However, it being promoted as a viable option, even a preferred option, in certain situations.

When would hands-only CPR be preferable over traditional CPR (with both ventilations and compressions)? Under the following circumstances:

• Event occurs out-of-hospital
• Patient is an adult
• When a sudden collapse is WITNESSED (most likely cardiac arrest)

If all of the above conditions are met then it would be advisable to do compression-only CPR without the ventilations. You would do continuous compressions, on the center of the chest, at a rate of 100 per minute. You would continue with compressions until the patient responds, an AED arrives, or until EMS arrives.

When would traditional CPR be preferable over Hands-only CPR?

• Patient is a child or infant (event is more likely respiratory in nature)
• Collapse is NOT witnessed
• Event occurs in-hospital or in your dental practice
• Cardiac arrest due to noncardiac origins (e.g. drowning, drug overdose, etc)

Of course as always, if a rescuer questions there ability to do traditional CPR or is unwilling to provide ventilations due to circumstances (e.g. no breathing barrier available) then it is better to Hands-only CPR rather than nothing at all.

Why does the American Heart Association feel will be the benefits of this clarification?

Well, studies show that in most US cities the prevalence of bystander CPR remain relatively low at around 27%-33%. Why is there reluctance to perform CPR on the part of between 67%-73% of bystanders (many of whom have had training in CPR)? Studies reveal that the reason most cited are panic and fear of causing harm to the person. In a nutshell, many question their ability to perform CPR correctly. Another factor, although far less frequently mentioned, is the fear of disease transmission.

It is the hope of American Heart Association that the clarification of when Hands-only CPR is to be performed will increase the prevalence of effective bystander CPR. Of course, time will only tell if it has the desired effect.

If you want more information, check out the American Heart Association Hands-only CPR website.

We are happy to announce that MyCPRPros has two new instructors, Christine and Leticia. Christine is both a firefighter and EMT and will be teaching our ACLS and PALS classes, along with other advanced courses. Leticia is a former Red Cross instructor who has been away from the training world for a little while, but who is now ready to jump back in. We are excited to have the both of them aboard. You can get to know them a little better by visiting the instructors page on our company website.

Well, answer these questions for me: Are you tired of spending 3-5 hours on a weekday evening or Saturday learning CPR & First Aid when you have been through the same class for the last 10 years? Do you have internet access? Would you rather spend a few hours at home, in your comfy PJs, reviewing the content portion of the course and then schedule a short 30-60 minutes classroom session for skills evaluation? Then, online CPR training IS for you! Or, more accurately, “blended training” is for you!

What is the difference between “online training” and “blended training”? Simply put, “online training” usually refers to CPR training that’s 100% online based. If you type ”online cpr training” in a Google search you will see a few companies offering this at the top of the listings. Before you purchase their course, be sure to read their requirements for receiving a certification card. If they do not require you to complete an in-person skills test, then stay away! (Or keep looking down the list until you see the link for www.mycprpros.com. ;-)) Why? Because many employers and regulatory agencies (including the NC Dept. of Child Development) will not recognize certifications offered through 100% online courses that do not require in-person skills testing with a CPR instructor. This is a fact that many of these companies that offer CPR training online recognize. For example, here are actual samples of the “small print” on some of the top listed sites:

Sample #1

“This Site nor any party involved in creating, producing, or delivering this Site or its content, is associated or affiliated with, nor endorsed by American Red Cross or The American Heart Association. Our course is not designed to serve as a substitute for an inperson hands-on class conducted and/or supervised by a qualified instructor.”

Sample #2

“The certificate does not represent, warrant or guaranty that the purchaser is properly prepared or equipped to perform CPR, First Aid, or AED assistance. [Company’s name] role is to provide education to the student using generally accepted scientific guidelines. [Company’s name] does not represent, warrant or guaranty, either explicitly or implicitly, that its certification will comply with the user’s or any third party’s requirements or standards.“

Now, to be fair, most of these companies do offer a refund if you find that their certification is not accepted by your employer or regulatory agency. However, doesn’t having to contact this company, request and wait for a refund, and in the meantime schedule yourself for another CPR course, sort of defeat the purpose of taking online training in the first place - convenience? So, what does all of this mean? Are you back to wasting another weekday evening or Saturday? Absolutely not! Online CPR training is not something to be avoided; online training is something that should be purchased carefully. Make sure you choose a course that provides both online training AND and in-person skills evaluation, also called “blended training”. In part 2 of this series I will discuss the differences and benefits of “blended training”, which is the type of online CPR training MyCPRPros offers.

I read an interesting article today on the JEM website about the use of wireless phones in calling 911 in an emergency. In the nutshell, the “less” in “wireless” stands for less effective.

The 911 emergency dispatch system has not kept up with the latest technologies. The explosion in the use of wireless and VOIP system (like Vonage) has left the emergency dispatch system scrambling. The current 911 system in place to incorporate these two growing communication systems is at best a patchwork. I want to first of all address the issues related to wireless phone technologies. In a future post I will address VOIP.

According to the JEM article I mentioned above there are currently two systems for wireless 911 access: network-based and GPS. Network-based systems (like used by AT&T Cingular) use multiple cell phone towers to triangulate your current location. GPS systems use low-orbiting satellites that communicate with the GPS chip in your phone (like used by Verizon Wireless) to determine your location.

Overall network-based systems tend to work better in urban areas that have plentiful cell towers and GPS systems in rural areas. However, both systems have serious weaknesses.

GPS-based Systems
If you are calling indoors with a wireless phone that uses GPS it may be difficult for the satellites to pick up your position. That is why it is best to get close to a window or to step outside when calling 911 on phone using this system. Also, in urban areas the satellite signals can be blocked by buildings and other structures.

Network-based Systems
Network-based systems run into issues in less populated areas that do not have as many cell towers. These systems require a minimum of three towers in order to triangulate your position.

My company offers First Aid & CPR training in North Carolina and surrounding states. I recently conducted some CPR classes in Virginia. My visit there highlighted a huge issue with using cellphones to call 911. What was that you ask? You have to have a signal. At the site where I was, I was dead in the  water.  Many of  the miners that  I taught mentioned that this  is a big issue there in the mountains. Now, let’s say that you do have a signal, you  are still not in the clear. I have had numerous students of ours tell us that they were routed to a 911 dispatch center in a different state when they used their cellphone to call for help. These calls then have to be rerouted and that delay can be critical in an emergency. One of the miners in my recent class did something that I thought was an excellent idea. He programmed in the direct phone number to the local EMS system. So, instead of calling 911 in an emergency he calls EMS directly. I don’t recommend this in general, but in his situation (deep in the mountains) it was probably a smart move.

So, for the foreseeable future, if possible call 911 from a landline phone. If that is not possible, be prepared to give the dispatcher your exact location.  Hopefully, future technologies will address these glaring weaknesses in the system.

Here is an interesting news story I found this morning on CNN.com. It is reported that a dog named Toby saved his owner’s life when she was choking. The owner, Debbie Parkhurst, of Calvery, Maryland says that she was choking on an apple when her furry rescuer pulled her to the ground and began jumping on her chest. And with a few thrusts of the paws the obstructing apple bit was launched skyward.

I am not making this up, check ou the video news story on CNN.com

Oh, I fortgot to mention that we were unable to independently verify this story, since, well…Toby ate the apple projectile. Additionally, our calls to identify the offending apple variety were not returned.

The National Institute of Child Health & Human Development (NICHD) just released the findings of its Study of Early Child Care and Youth Development (SECCYD). The full study results are published in the March/April issue of Child Development.

Research for this study started in 1991, when parents of 1,364 children in 10 locations around the US were asked to participate. Each of these children were cared for by someone other than their mother for at least 10 hours per week. This included care by fathers, grandparents and other relatives. The study evaluated these children’s academic achievement, and intellectual functioning from kindergarten through fifth grade as well as their social development through sixth grade.

Here is an quick overview of the findings:

• Children with a higher level of child care showed better than average volcabulary skills than other children.
• Children would spent more time in child care centers showed more of a pattern of “problem behavior” through the sixth grade than did children cared for my their mothers. This included aggressive and disobedient behavior.

To be completely fair, the researchers also found that the level of problematic behavior in children cared for in child care centers was hardly discernable, yet was present. More study will no doubt be conducted on this and we will keep you updated on the findings.

What are your thoughts on this study? Share your comments with us.

If you were following the news last week you no doubt saw or read a story about a study in Japan that showed that permanent brain damage was less likely when victims of cardiac arrest were give compression only CPR (also called cardio-cerebral resuscitation or CCR) as opposed to those receiving traditional CPR (compressions and ventilations). This study was published in a recent issue of the medical journal The Lancet. In the study, researchers examined the post event neurological function of 4,068 patients who had been victims of witnessed cardiac arrest. The results showed healthy neurological function in 22% of those receiving compression only CPR compared with 10% of those receiving compressions along with ventilations.

This finding is in no way breaking news. In fact, the current study, and the media attention surrounding it are just a recent splash of lighter fluid on a decade old pile of glowing scientific embers. I haven’t had the time (nor interest to be honest) to find out when this debate began, however, I am aware that even as far back as October 1993 the magazine Circulation published studies on this topic. So, the debate rages on.

Which CPR method should be advocated? That is not a simple answer. In actuality, it depends on the person performing CPR, and the person it’s being performed on. Let me illustrate. If a fuel pump stops functioning properly in your car it needs to be replaced in order for a continued supply of fuel to be delivered to the the engine. However, if there is no fuel in the gas tank, replacing the pump in itself will be of no benefit. Likewise, when the human heart is out of normal rhythm its function must be replaced, in this case by manual contraction of the heart by means of chest compressions. Manual compression provided as quickly as possible will insure the best possible distribution of fuel, in this case oxygen carried in the blood, to the engine, the heart and brain. However, if there is no fuel (oxygen) in the system, replacing the pump (manual contractions of the heart) will be of little to no benefit.

So, in cases where there is still an adequate supply of oxygen in the blood, as in the case of a witnessed collapse from cardiac arrest, some recent reports have shown that compression only CPR results in significantly better survival rates. An additional time when compression only CPR can be beneficial is when a rescuer is hesitant to provide traditional CPR, either due to lack of knowledge, or due to concerns about communicable diseases. However, in the case where there is the potential for a significantly diminished levels of oxygen in the blood, as in the case of unwitnessed cardiac arrest, and cardiac arrest caused by chocking, drowning, or respiratory issues (as is often the case with infants and children) traditional CPR will most likely provided the greatest benefit to the patient. So then, there really is no one-size-fits-all resolution to this debate. It will be interesting see what evidence future studies bring to the table and how CPR training guidelines are affected by these. We will just have to wait and see.

You may find the following links related to this topic to be of interest:

American Heart Association Compression Only CPR Worksheet

PubMed Directory Listing of Compression Only CPR Articles