Chain of Survival

The term Chain of Survival provides a useful metaphor for the elements of the ECC systems concept.

The 5 links in the adult Chain of Survival are

• Immediate recognition of cardiac arrest and activation of the emergency response system

• Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions

• Rapid defibrillation

• Effective advanced life support

• Integrated post-cardiac arrest care

A strong Chain of Survival can improve chances of survival and recovery for victims of heart attack, stroke and other emergencies.

Highlights of the History of Cardiopulmonary Resuscitation (CPR)

1740 The Paris Academy of Sciences officially recommended mouth-to-mouth resuscitation for drowning victims.

1767 The Society for the Recovery of Drowned Persons became the first organized effort to deal with sudden and unexpected death.

1891 Dr. Friedrich Maass performed the first equivocally documented chest compression in humans.

1900

1903 Dr. George Crile reported the first successful use of external chest compressions in human resuscitation.

1904 The first American case of closed-chest cardiac massage was performed by Dr. George Crile.

1954 James Elam was the first to prove that expired air was sufficient to maintain adequate oxygenation.

1956 Peter Safar and James Elam invented mouth-to-mouth resuscitation.

1957 The United States military adopted the mouth-to-mouth resuscitation method to revive unresponsive victims.

1960 Cardiopulmonary resuscitation (CPR) was developed. The American Heart Association started a program to acquaint physicians with close-chest cardiac resuscitation and became the forerunner of CPR training for the general public.

1963 Cardiologist Leonard Scherlis started the American Heart Association's CPR Committee, and the same year, the American Heart Association formally endorsed CPR.

1966 The National Research Council of the National Academy of Sciences convened an ad hoc conference on cardiopulmonary resuscitation. The conference was the direct result of requests from the American National Red Cross and other agencies to establish standardized training and performance standards for CPR.1972 Leonard Cobb held the world's first mass citizen training in CPR in Seattle, Washington called Medic 2. He helped train over 100,000 people the first two years of the programs.

 

1973 Second National Conference on CPR and ECC.

1979 Advanced Cardiovascular Life Support (ACLS) is developed after discussions held at the Third National Conference on CPR.

1981 A program to provide telephone instructions in CPR began in King County, Washington. The program used emergency dispatchers to give instant directions while the fire department and EMT personnel were en route to the scene. Dispatcher-assisted CPR is now standard care for dispatcher centers throughout the United States.

1983 AHA convened a national conference on pediatric resuscitation to develop CPR and ECC Guidelines for pediatric and neonatal patients.

1985 Fourth National Conference on CPR and ECC.

1988 AHA introduces first pediatric courses, pediatric BLS, pediatric ALS and neonatal resuscitation, cosponsored with The American Academy of Pediatrics (AAP).

1990s Early Public Access Defibrillation (PAD) programs are developed with the goal in mind to provide training and resources to the public so they are able to aid in the successful resuscitation of sudden cardiac arrest victims.

 

Feb 1992 Fifth National Conference on CPR and ECC.

1992 International Committee on Resuscitation (ILCOR) founded

1999 First task force on first aid was appointed

First International Conference on Guidelines for CPR and ECC

2000

2004 AHA and ILCOR releases a statement regarding the use of AEDs on children. It is determined that an AED may be used for children 1 to 8 years of age who have no signs of circulation.

2005 AHA developed the Family & Friends® CPR Anytime® kit, a revolutionary product that allows anyone to learn the core skills of CPR in just 20 minutes. The kit contains everything needed to learn basic CPR, AED skills and choking relief anywhere, from the comfort of your home to a large group setting

2005 The 2005 International Consensus on ECC and CPR Science with Treatment Recommendations (CoSTR) Conference produces the 2005 American Heart Association Guidelines for CPR & ECC. These Guidelines reveal a new compression: ventilation ratio as well as changes to AED usage.

Hands-Only CPR Saves More Lives

Action Points

This is a nationwide, prospective, population-based observational study covering the whole population of Japan and involving consecutive out-of-hospital cardiac arrest patients with resuscitation attempts.

Point out that in this study, compression-only CPR was more effective than conventional CPR for patients in whom out-of-hospital cardiac arrest is witnessed and shocked with public-access defibrillation.

The chances of surviving cardiac arrest with good brain function are better when bystanders focus CPR efforts on chest compression without mouth-to-mouth rescue breathing, a nationwide Japanese study affirmed.

When bystanders performed chest compression-only CPR and used a public-access defibrillator, 40.7% of out-of-hospital cases survived at least a month without needing assistance in daily living, Taku Iwami, MD, PhD, of the Kyoto University Health Service in Kyoto, Japan, and colleagues found.

That rate was a third higher than with conventional CPR group and a defibrillator shock, at 32.9%, the group reported online in Circulation: Journal of the American Heart Association.

"This is one of the highest survival rates with neurologically-favorable outcomes reported and should be the target survival after out-of-hospital cardiac arrest," they noted.

Chest compressions alternating with rescue breathing remains the standard for trained rescuers, but recommendations for untrained bystanders switched in 2010 to only chest compressions regardless of emergency dispatch assistance.

The reason is that "rescue breathing is so difficult to perform that it can interrupt chest compressions," which animal and clinical studies have linked to survival, Iwami's group explained.

The hands-only technique may be more effective than conventional CPR in the early phase of sudden cardiac arrest, which may be all that is needed if an automated external defibrillator (AED) is available nearby, they added.

These findings would likely generalize to other countries, like the U.S., where AEDs are widespread, according to a statement from the American Heart Association.

"Across the U.S., too many people are dying from sudden cardiac arrest because family members and friends of the victim are unsure how to help. This study confirms that hands-only CPR is highly effective. Plus it's easy to do," Michael Sayre, MD, of the University of Washington in Seattle, said in the release as a spokesperson for the AHA.

The study analyzed all consecutive out-of-hospital cardiac arrests of presumed cardiac origin that were witnessed and received CPR and AED shocks as recorded prospectively in the All-Japan Utstein Registry of the Fire and Disaster Management Agency.

The population-based registry included 1,376 such cases among the total 547,153 confirmed out-of-hospital cardiac arrests that occurred in Japan over a 5-year period, basing CPR characteristics on bystander interviews with emergency responders on the scene.

In this country where 1.6 million individuals each year get conventional CPR training offered by fire departments and the emergency dispatch gives conventional CPR instructions, chest compression-only CPR accounted for just 34% of cases in the analysis.

That proportion rose over time from just 5% of eligible patients in 2005 when the registry started to 44% in 2009 (P<0.001 for trend).

But outcomes were better after chest compression-only CPR than when it involved rescue breathing for several key endpoints:

Prehospital return of spontaneous circulation (50% versus 40%, P<0.001)

 One-month survival, based on follow-up by emergency responders (46% versus 40%, P=0.018)

 Survival to at least 1 month with no more than moderate cerebral disability (41% versus 33%, P=0.003)

 

The odds of 1-month survival with favorable neurological outcomes remained 33% more likely (95% CI 1.03 to 1.70) for the hands-only group after adjustment for age, sex, time from collapse to public-access AED shock or initiation of CPR by bystanders, and year.

The study couldn't determine the quality of bystander CPR or what biases might have led some to do chest compressions only, since only conventional CPR was taught in Japan at the time.

Nor could the results be extrapolated to the 97% of witnessed out-of-hospital cardiac arrests with CPR by bystanders that didn't get shocked by public-access AEDs.

Nevertheless, the superiority of hands-only CPR in the study "strongly suggests the need for implementation of public-access defibrillation programs with attempts to increase the number of lay rescuers who can at least perform chest compression CPR and use an AED," the researchers concluded.

Conventional CPR with rescue breathing is still recommended for children, since their cardiac arrests are less likely to be of cardiac origins, so a dual training program may be warranted.

Iwami's group proposed chest compression-only training as standard for most people and conventional CPR training as an option for medical professionals, lifeguards, school teachers, and families with children.

They pointed to a successful public campaign in Arizona that "has consistently and carefully advocated conventional CPR for suspected noncardiac and pediatric arrests and successfully demonstrated that most pediatric out-of-hospital cardiac arrest patients had received conventional CPR."

How to Treat a Heart Attack: 5 Steps

You find yourself going on a leisurely walk with your dad and out of nowhere he begins to complain of chest pain. Initial shock kicks in and you wonder if he may be suffering from a heart attack. Would you know what to do in this scenario? According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both men and women and an astounding one in every four deaths of Americans are from heart disease.

 

Have you ever wondered what causes a heart attack? On television and in movies it is always depicted as an overweight man exerting himself and boom, on comes the heart attack. In reality, the most common cause of a heart attack is coronary artery disease. Coronary artery disease is the hardening and narrowing of the coronary arteries caused by the buildup of plaque inside the walls of the arteries. Over time, the buildup of plaque can narrow the arteries so that less blood flows to the heart muscle, completely blocking the arteries and flow of blood or causing blood clots to form and blocking the arteries, according to NIH Senior Health.

 

Would you be able to tell if someone was experiencing a heart attack? Below you can find common symptoms a person may be experiencing if a heart attack is present.

 

Heart Attack Symptoms

 Chest pain or chest pressure

 Shortness of breath

 Cold sweat, nausea or vomiting

 Weakness or left arm pain

 Jaw, abdominal and back pain

 In diabetics and females, symptoms may be less obvious or atypical including lightheadedness, fainting or extreme fatigue

 

Now back to our scenario from earlier, what do you do if someone you are with is experiencing heart attack symptoms? According to Danielle Thomas, EMT-P, director of Pro EMS Center for MEDICS, below are instructions if this medical emergency happens to someone you may be around.

 

Instructions

 1.Stay safe and remain calm

 2.Call 911. “If anyone is experiencing a sudden or building onset of one or more of these heart attack symptoms, activate the emergency response system,” says Thomas

 3.Seat the patient. Stop all exertion.

 4.If no normal breathing and no signs of life are present, administer CPR(If you don’t know CPR, the 911 dispatcher can help walk you through it).

 5.(For CPR) Thomas advises, “Press hard and fast in the center or meaty part of the chest, 100 times a minute until help arrives. If you get tired, switch in someone else.”

 

 

 

Thomas adds, “If the patient has no allergies and no recent problems with bleeding, 81 mg. of low dose or baby aspirin can be given.” You must remember, the aspirin is not for pain, but rather to prevent blood from sticking to already forming clots and making those larger.  After taking the aspirin, the patient should immediately seek medical treatment.

 

If the situation above leaves you feeling nervous and underprepared, remember that the AHA has developed Hands-Only CPR. With two simple  yet monumental steps, you could save someone’s life. According to the AHA, people feel more confident performing Hands-Only CPR and are more likely to remember the correct rhythm when trained to the beat of the disco classic “Stayin’ Alive” (has more than 100 beats per minute, the push rate necessary for effective CPR). 

 

 

What To Do If Someone is Having a Seizure: Recognition and First Aid

Would you know what to do if someone you were with began to have a seizure?  According to the Epilepsy Foundation, “Epilepsy and seizures affect nearly 3 million Americans of all ages.” Seizures are what happen when the electrical system of the brain malfunctions, “Instead of discharging electrical energy in a controlled manner, the brain cells keep firing. The result may be a surge of energy through the brain, causing unconsciousness and contractions of the muscles.”

 

It’s important to note there are different types of seizures. The most common is called generalized seizure, also referred to as a tonic-clonic or grand mal seizure. According to Epilepsy.com, “Generalized seizures begin with a widespread electrical discharge that involves both sides of the brain at once”. Other types of seizures include petit mal seizures, partial (focial) seizures and alcohol withdrawal seizures. Epilipesy.com notes that partial seizures begin with an electrical discharge in one limited area of the brain. Many things cause partial seizures, for eample a head injury, brain infection, stroke, tumor or changes in the way an area of the brain was formed before birth. A person may have a single seizure or repetitive seizures.  In most cases, people with recurrent seizures or at-risk for recurrent seizures have epilepsy.

 

We spoke to Danielle Thomas, EMT-P, and director of pro EMS Center for MEDICS, to learn more about first aid treatment for people suffering from seizures. Thomas notes that typical seizure signs include movement or shaking and that large movement or jerks may occur. Atypical seizures could be less apparent notes Thomas, “The patient’s eyes may move side to side or up and down rapidly, or the patient may have a period of being awake but unresponsive to you.”

 

The Center for Disease Control and Prevention offers first aid tips to help someone who is having a seizure:

 1.Stay calm. Stay safe.

 2.Prevent injury by clearing the area around the person of anything hard or sharp.

 3.Ease the person to the floor and put something soft and flat, like a folded jacket, under his head.

 4.Time the seizure with your watch (or if need be, by counting). If the seizure continues for longer than five minutes without signs of slowing down or if a person has trouble breathing afterwards, appears to be injured, in pain, or recovery is unusual in some way, call 911.

 5.Do not hold the person down or try to stop his movements.

 6.Turn the person gently onto one side. This will help keep the airway clear.

 7.Stay with the person until the seizure ends naturally and he is fully awake and offer to call a taxi, friend or relative to help the person get home if he or she seems confused or unable to get home without help.

 Push Here to Help!

If an adult suddenly collapses, is unresponsive and not breathing, by performing immediate continuous chest compressions, you can double or even triple a victim’s chance of survival.

Studies continue to show that compression only CPR is as effective for rescuing sudden cardiac arrest (SCA) victims as conventional CPR that includes compressions and rescue breathing.

What Is Sudden Cardiac Arrest?

Sudden Cardiac Arrest (SCA) is unpredictable, often striking people who have had no previous symptoms.  It can happen anytime, anywhere, to anyone.

•SCA is the leading cause of death in America, killing more than 330,000 people per year (1).

•SCA occurs when the electrical impulses that trigger the rhythmic beating of the heart are disrupted.  An abnormal, chaotic, quivering heart rhythm known as ventricular fibrillation results.  Ventricular fibrillation causes the heart’s contractions to become ineffective and the forward flow of oxygenated blood to the brain and lungs stops.

•During Sudden Cardiac Arrest, the patient will lose consciousness and stop breathing.  If a normal rhythm is not restored with a few minutes, death will certainly occur.

•Bystanders who recognize a cardiac arrest, contact Emergency Medical Services (911), provide compression only CPR, and use an Automated External Defibrillator (AED) if one is available, can significantly increase the chance of the patient’s survival.

Food Stamps ... For Pets?

When man falls on hard times, what's his best friend to do?

A new donation-based program called Pet Food Stamps aims to provide food stamps for pets of low-income families and for food stamp recipients who otherwise could not afford to feed their pets, reported ABC affiliate KVIA in Las Cruces, N.M.

Based in New York, the program is open to anyone in the United States. More than 45,000 pets have already been signed up in the past two weeks, according to the program's founder and executive director Marc Okon. Once need and income is verified, the families will receive pet food each month from pet food retailer Pet Food Direct for a six-month period.

"We're not looking for government funding at this point," Okon told ABCNews.com. "Should the government be willing to provide assistance further down the line, we will look into it."

The only way to apply for the program is through an online application, but Okon said applications would be accepted through mail once the program moved to its new office.

Okon said the program's nonprofit status was still pending.

There is currently no federal pet food stamp program in place, although the U.S. Department of Agriculture Animal and Plant Health Inspection Service tries to provide protection for animals in case of emergencies or natural disasters. The 1966 Animal Welfare Act also makes no mention of providing food for pets.

Okon's program isn't revolutionary. Other animal shelters and rescue leagues around the country, such as the Washington Animal Rescue League, have been providing pet food banks, in addition to discounted pet care, for years.

"One of our missions is to provide income-qualified families with discounted pet care, vaccinations, vaccine clinics, neutered clinics and vet care," said Washington Animal Rescue League spokesman Matt Williams. "We have a new medical center on site. … We also have a food bank run entirely on donations."

The new pet food stamp program comes at a when monthly food stamp assistance could be phased out. A temporary food stamp boost for low-income families was initiated in April 2009 to help offset the effects of the 2008 recession and is set to expire on Oct. 31, 2013, unless Congress passes legislation to extend the benefits.

Approximately 46.6 million people used the federal food stamp program in 2012, according to the U.S. Department of Agriculture.

Innovation and Change: How CPR and AEDs Became a Part of Our Lives

Death, due to sudden cardiac arrest, or SCA, is a big problem. Typically related to heart disease, sudden cardiac arrest affects nearly 300,000 Americans each year. As its name suggests, these events occur quickly, and in most cases, without warning. They can occur at any time and in any place.

Most importantly, if one occurs in front of you, you are the only solution. There are only a few minutes between the time sudden cardiac arrest occurs and when treatment becomes useless. A bystander has the best, and maybe the only chance to help.

So how would you deal with a sudden cardiac arrest? Simple. You push. Push 911 on your cell phone. Push on the center of the chest. Push hard. Push fast. Push the shock button on the automated external defibrillator. Then, push again on the chest…

Some detail will help.

Your heart is a hollow muscle that squeezes down due to a repeating electrical impulse that goes through its tissue. The contraction forces the blood that fills the heart forward into the body. Moving blood picks up the oxygen you breathe in the lungs and continues on to the rest of the body.

This is how we get oxygen, which is required by the body to live, to individual body cells. The tissue most sensitive to a lack of oxygen is brain tissue. It can only survive a few minutes without oxygen. When there is a significant loss of brain tissue, a person cannot survive.

“Sudden” cardiac arrest occurs when the regular electrical impulses in the heart abruptly go haywire and turn the normal squeezing contraction of the heart into a quivering disorder. Technically this quivering is called ventricular fibrillation, and, when it occurs, the flow of blood from the heart stops. This in turn causes the affected person to suddenly lose consciousness and collapse.

The best way to approach this situation is to think about the underlying problem in two parts, mechanical and electrical. The immediate danger is the lack of oxygen to the brain because the regular blood-moving contractions of the heart have been lost. The way to manage that part of the problem is to somehow find another way to physically move blood through the body. This is accomplished by performing cardiopulmonary resuscitation, or CPR, using a combination of external chest compressions and rescue breaths.

Unfortunately, CPR can only deal with the mechanical part of the problem. CPR is not intended to solve the electrical chaos of ventricular fibrillation. It is also limited in its ability to maintain enough blood flow for an extended period of time. Without addressing the electrical part of the problem, CPR will be unable to effectively treat the problem on its own.

Defibrillation is the use of electricity to “shock” a quivering heart’s electrical activity back into a regular pattern that hopefully can stimulate normal contractions and return spontaneous blood flow. A defibrillator is a device that is designed to deliver defibrillation.

Without CPR, there is generally not enough time for a defibrillator to work. Without a defibrillator, CPR has a very low chance of success.

So let’s see if we can sum up the basic concept so far…

There are only a few minutes to react when a sudden cardiac arrest occurs before the ability to survive is lost. Immediate CPR can return some blood flow and delay the loss of brain tissue, but rapid defibrillation is required to solve the underlying cause of the problem. Seems simple enough…but we have to get better at it.

Historically, surviving sudden cardiac arrest has been nearly impossible. The current overall national survival rate for SCA in the United States is still pretty low, somewhere around 10-15%. Over the past century, a number of key events have occurred to bring us to our current approach to treatment. While there has been some improvement for society at large, remarkable improvements have mostly been seen only in local areas that focus on resuscitation fundamentals. Some local AED programs have survival rates as high as 40-50%!

We can understand these fundamental concepts better when we learn how they came about. Let’s highlight the key events in the history of resuscitation and see how a collection of strange treatments, random moments, and dedicated individuals have shaped how we deal with sudden cardiac arrest today.

Over time we were able to see the critical components and principles emerge about what we know today when dealing with sudden cardiac arrest:

•The outward appearance of death can occur, yet leave a heart still too good to die.

•How blowing air into someone’s mouth can provide them with oxygen

•How compressing a chest can create artificial blood flow

•The ability to “shock” a quivering heart back into normal function.

•The importance of CPR to create a better chance for a defibrillator to work.

•The importance of speed in the success of defibrillation.

•How easy, safe, and risk-free it is for you to operate an AED

Most importantly, history teaches you how to use simple concepts in your environment (like having those closest to you knowledgeable in CPR and having a ready-to-use AED nearby) to raise the chance of survival, should you, or someone close to you, go into sudden cardiac arrest.

We will see what lies ahead, as the history of resuscitation continues to unfold. There is still much to learn and improve. Be safe!