Changes to bystander Pre Arrival CPR Instructions coming....

[Guest alsfirefighter]

www.usatoday.com/news/health/2004-02-23-inside-ems_x.htm

This article is based on Seattle's findings that cardiac arrest victims whom receive immediate early bystander CPR fair better with just chest compressions then dispatchers giving mouth to mouth instructions. Citing several factors as to why bystander mouth to mouth is ineffective, including apprehension about exposure to stranger, poor skill technique and so on. There is mention of such technique in AHA's ECC 2000 guidelines as well as several other EMD curriculum's already but I'm willing to bet now that Seattle has given numbers it will probably become the norm.

[x635 4,066]

I've been reading about this topic for awhile, as it is now SOP for the latest version of NAEMD (I beleive). I can see how this can be effective, as it is extremly difficult and time consuming to instruct somebody to open and maintain a proper airway and deliver ventilations over the phone. I've read in some publications that if effective compressions are done, it also draws some air into the lungs for exchange, although I don't know how valid that it.

[Guest alsfirefighter]

Based on my A&P courses and clinical experience I would agree with you that its a significant valid point that air would be drawn in during just chest compressions, probably just not at anywhere's near a normal tidal volume. As time passes and blood circulates, there should be an exchange between CO2 and oxygen, the CO2 given off should create pressure in the lung space and as a compression occurs it forces the CO2 rich air out and on the upward movement air would be drawn into the space being its at a lower pressure then the outside atmosphere. Good thinking brother.

[x635 4,066]

Some state EMS medical directors favor chest compression CPR

by  

The man on the sidewalk is turning blue and you have minutes to save his life.  

You’re already trembling as you call 911.

Your heart is racing so fast that you have to ask the dispatcher to repeat her instructions.

Rescue breathing? Compress-ions?

Every minute without a pulse drops the man’s chance of survival by 10 percent.

A group of state emergency medical services medical directors are urging changes in the CPR protocol to increase the odds of people with cardiac arrest.

Rather than full cardiopulmonary resuscitation with mouth-to-mouth, some EMS directors are advocating that untrained bystanders use only chest compressions.

Explaining "rescue breathing" is too time-consuming when every second counts, the officials contend.

Twelve cities, including New York, Chicago, Los Angeles and Atlanta, have simplified 911 dispatcher instructions and two dozen more are interested, according to a report Tuesday in USA Today.

The ultimate solution is widespread training in CPR, including chest compression, rescue breathing and use of portable defibrillators, said Lisa Franco, senior regional communications director for the American Heart Association of Connecticut.

The AHA is a major source of CPR training for non-professionals.

Meanwhile, AHA guidelines established in 2000 already support compressions-only CPR in dispatcher assisted instruction, Franco said.

The AHA will issue new CPR guidelines in 2005.

"We have not made any changes. It’s a protocol that recommends that dispatchers talk callers through chest compression, not mouth-to-mouth and chest compression," Franco said.

Otherwise the current guidelines recommend both compression and rescue breathing for people assisting a cardiac arrest victim.

Donald MacMillan, emergency medical services coordinator at Yale-New Haven Hospital, said the move by other EMS directors is intended to minimize confusion and delays at the scene.

"The current protocol in most cities is to say ‘Do mouth-to-mouth, but if you can’t, do compressions,’ " MacMillan said.

Chest compression is simpler and easier to explain, he said.

Before mouth-to-mouth resuscitation is started the rescuer must clear the victim’s mouth and throat, make sure the person has not swallowed his tongue, and position the head so that the airway is open.

People often vomit during episodes culminating in cardiac arrest.

Emergency medical technicians and other health care workers carry masks that permit rescue breathing without touching the victim’s mouth.

MacMillan said the risk of infection is small, but most people are not eager to taste others’ vomit.

Franco said about 80 percent of cardiac arrests happen at home, meaning people will likely be treating relatives.

"There’s no way to know the percentage of people trained in CPR," Franco said.