When confronted with an unusual circumstance, or an emergency situation, the nature of most persons is to stand and watch and do nothing, perhaps that is better than doing the wrong or harmful thing, but when the problem is a cardiac arrest, looking concerned but remaining inert does nothing for the person lying unconscious on the ground as a result of his coronary artery obstruction.
Some onlookers will have been subjected, willingly or unwillingly to Basic Life Support (BLS) training, perhaps in classes at school or at work. They were taught the easy to remember ABC routine – Airway, Breathing, Chest compression -- and that might be why they stand there doing nothing. Inertia is not out of ignorance for such a person, it’s out of fear. They ask themselves, “Do I really want to give the kiss of life to this unshaven evil smelling person? Who knows what I might catch? Maybe he’s got AIDS. Don’t I owe more to the wife and kids than I do to him? And any way, the paramedics will be along soon and they have all the right tools for the job, don’t they?” And he walks off, unhappy with himself, angry at the predicament he found himself in, but sure he’s made the right decision for his family.
The field of Life Support remains under continuous review by expert committees who examine the evidence derived from real experiences, the reports of attempts to save life in emergencies as described, the more complicated reports of laboratory experiments, and they recommend improvements in techniques for the “first rescuer,” the person on whom too often rests the fate of the victim of the heart attack. Will this non-medically trained person do what is needed? Will he do it when it is needed? Will he do it in the most effective way?
The relevant committees of the American Heart Association and the Canadian Heart and Stroke Foundation have taken note of the twin problems of natural inertia, and equally natural dislike of putting your mouth to the mouth of an unknown person, and hoping maybe some other bystander will choose to do it, or maybe someone has the right gadget in their purse or has a clean handkerchief they’d like to use.
Today, ABC is out and CAB has taken its place.
It has been recognised that the previously advocated, “Look – Listen – Feel for breathing” caused delays in getting to what really mattered, which is restoring oxygen to the brain. So look, listen and feel have been removed from the protocol. At most 10 seconds should be spent searching for a pulse in the neck, but when all is said and done, what’s the point in that? It isn’t easy for the inexperienced to find the carotid artery in the neck in a person lying on the ground who might well be obese (try it!!).
The “C” that comes ahead of “A & B” stands for Compression which is the essential and prime requisite. All the cells in the tissues of the body need oxygen, none are more in need of oxygen than the neurons in the brain, and oxygen is carried there in the blood stream which is pumped there by the heart. In a heart attack the heart muscle is often still contracting, but in an irregular and ineffective manner such that its action as a pump is virtually non-existent. The rescuer must become the heart, it is his job to get the blood circulating to the brain, and that is effected by external compression of the heart.
In the new “Hands Only” protocol in which Compression comes first, the instruction is for at least 100 compressions per minute, causing a depression of the center chest (sternum) of 2 inches (5cms), and allowing complete recoil of the chest with each compression. The person doing the compressions, the “rescuer,” must position himself and the “person to be rescued” for best effect. A hard substance behind the back of the unconscious person facilitates the effectiveness of the compression, if the subject is on a soft mattress it will be much less useful.
The rescuer will find his work easier if his shoulders are over the subject’s chest, either by standing on a stool at the side of the hospital stretcher, or straddling the subject if he is large and the rescuer small – whatever it takes to get the most use out of the rescuer’s body weight behind the compressions. It’s hard and tiring, especially when you’re not used to doing it (and may you never get used to it!) and is best performed in relays, minimizing the time of no compressions, certainly not more than 10 seconds, as rescuers change places.
The use of an Automated External Defibrillator (AED)
You will hope one is available. Which do you do first? Defibrillate or compress?
The answer to that question is in no doubt. Waste no time before starting compressions. Compressions keep the brain alive. Getting that defibrillator of the wall, opening it, taking out the paddles, trying to remember how to use it is going to take up precious time.
Hands On Compression comes first!
It is not always easy to find a normal pulse in an adult, it is even more difficult in the child or infant. Don’t waste time searching for it in the unresponsive child.
Hands On Compression should be started immediately in the child, and after 30 compressions 2 breaths should be given – most persons will find it less difficult to give a breath to a child. If 2 persons are present to work as a team, 15 compressions to 2 breaths is the routine.
The depth of compression is recommended as one third of the antero-posterior diameter of the chest, or in most infants 1½ inches (4 cms) or older children 2 inches (5 cms).
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