5 tips for treating cardiac arrest in EMS

I may not be a practicing paramedic anymore, but my passion remains for that field. It is amazing the things that people in EMS are now able to do. This field has come a long ways from the days of old where the patient was thrown into the back of a hearse to be taken either to the emergency room…or the funeral home. There was no such thing as pre-hospital care.

While the list of illnesses and injuries that an ambulance crew can handle in the field is extensive, one of the things that we often focus on and measure success against is cardiac arrest. This is also one of the most frightening for family members and bystanders who are witnessing the event. To get a detailed explanation about cardiac arrest, visit my post about the difference between heart attacks and cardiac arrest here. To quickly refresh your memory, cardiac arrest is where someone no longer has a pulse and has stopped breathing. They are dead.

Because of this, and because of how frightening this is to family and bystanders, often times as a practicioner, I would be asked repeatedly by the non-coworkers around me why we aren’t going to the hospital…”because the hospital can help them”. (That last bit always irritated me to no end.)

I mean, we (and I still consider myself “one of them”) can do so much for your loved one at home while they are in cardiac arrest. Not every system is as aggressive as the system I was privileged to call myself part of. But if there is a paramedic on the truck, we have the skill set to treat them — the trick is to have the permission from the medical director of the system and the necessary supplies.

So, for you the bystander, these 5 tips for treating cardiac arrest are just as pertinent for you as to the provider. Hopefully, you will understand why we “stay and play”, as we sometimes call it, instead of “scooping and running” like we did many years ago. Let’s get started:

  1. Time is your enemy — Survival is extremely time-dependent. Each minute that goes by reduces the survival rate by 7-10 percent. :: We don’t want to mess around. Success, for us, is measured by survival rates and the level of function they have after they leave the hospital. Imagine that after 5 minutes without CPR, the survival rate will have dropped 35 percent…at the best. At worst, you have a 50/50 shot of living only based upon getting the CPR. This doesn’t take into account the reason for the cardiac arrest of other health problems.
  2. Don’t move the patient — If the scene is safe, there’s no rush to get to the hospital or even into the ambulance. All resuscitation skills are more difficult and more dangerous in a moving ambulance, and moving the patient — often accomplished by monitors, shocks, pulse checks and airway management — takes the focus away from the chest. :: Have you seen the back of the ambulance? It’s t-i-n-y. I have, out of necessity, worked several cardiac arrests in the back of my truck and it is tough. It is impossible to do effective CPR while moving a patient. We come up with unique ways of trying to do it, and do it safely on our part. But even if we move them to the truck, and do effective CPR all the way there, once that truck starts rolling to the hospital, the situation gets more dangerous as we are standing up as are rocking and swaying with the starting, stopping, turns and bumps of the trucks.  Talk about ineffective CPR.
  3. Breathing is overrated — Focus on the chest. Maximize outcomes by using compression-only CPR. Each chest compression increases the difference in pressure between the sides of the heart, but every time you give a break in CPR, the pressure difference decreases. The greater the pressure difference, the better chance the heart will begin beating again on its own. :: When CPR is done (and I’ll put the caveot on this: effective CPR), the pressure change in the chest cavity will draw air in and send it out. It’s not as much as if you were providing manual ventilations, but it works very well. (And it works even better if you think to throw in an NPA or OPA and a non-rebreather, though it’s not required in the short-term until you get more help.)
  4. CPR, CPR, CPR! — Whether it comes from the bystander’s existing knowledge, the dispatcher’s guidance or your own hands, hands-only CPR is the most critical and effective tool for resuscitating cardiac arrest victims. :: Does the need an explanation? This is the single most important thing that can be done during a cardiac arrest. Do it, do it uniterrupted and do it like you mean it.
  5. There is no magic at the hospital — All the patient needs for full recovery is what you bring to the scene — yourself (safely!), your hands, and, sometimes, an AED. :: Let us do our job. And let us do it right where we are. Unless we invite you to the party, please back away and let us work. We move around a lot, and if you are too close, you will hinder our efforts to help the patient. Please don’t sit over our shoulder and constantly say anything to the effect of “you’ve got to help him/her”. If there is anything to be done, we’ll give it our best effort. And please answer our questions completely and honestly. If you know the patient did drugs an hour ago, be honest and tell us! It might save their life. And, again, when we ask you to back up, do it…even if you are a healthcare provider, or we’re in your facility. You called us. If you wanted to handle the situation, you shouldn’t have called.

Please remember that everything we do is to help our patient. If, for any reason, we think that the patient would benefit from getting to the hospital immediately while they are still in cardiac arrest, we would go. But, remember if the reason they went into cardiac arrest was because of a heart attack, we still have to get a pulse back before they will go to the cath lab. I don’t know of any cardiologist that would take a patient to the cath lab that is still in cardiac arrest.

 

Article and excerpts from EMS1.com