CPR in the 21st century

I first had CPR training almost twenty-five years ago, when the company I worked for asked for volunteers to learn the technique. I remember little about it except having to say loudly “Lady, lady! Are you OK?” I rarely say anything very loudly, and I felt very awkward having to say it to the plastic mannequin lying on a table in the company lunchroom. (One thing I don’t remember is what we were supposed to say if the victim was male.)

I also remember that it was much harder to compress the mannequin’s chest than I had expected, and I wondered if I could do it effectively on a real person. They told us that sometimes the technique could result in broken bones. They also told us that while we didn’t have to perform CPR, once we started we were obligated to continue until medical personnel arrived.

I was very glad that I never found myself in a situation where CPR was needed. We did once have a man in the plant have a heart attack while at work, but I was in another part of the building, and only learned about it later in the day. No one trained in CPR was nearby when it happened, and people who witnessed it were very upset that no one had been able to help. Even hearing that the doctor had said that the heart attack was so massive that Roy was probably dead before he hit the floor, and that CPR would not have made a difference, didn’t make them feel much better.

A few years ago, I read somewhere that studies had shown that CPR was generally pretty ineffective. I don’t remember whether the article I read also said that people were no longer urged to perform CPR, but my overall impression was relief – if I found myself in a situation where someone was in cardiac arrest, I needn’t agonize over whether to try to do CPR or not if it wasn’t really going to make much difference.

Then a couple of weeks ago I was asked to join my department’s safety committee, to take the place of someone who had recently left for another job. I needed to check a certain area of the department to make sure everyone was out when the fire or severe weather warning sounded. Sure, no problem, I could do that. Having already agreed to that, I also agreed when I was told I needed to have current CPR certification.

So this week I got my training, which – to my surprise – included not only CPR training but also training in first aid, protection from blood-borne pathogens, and use of an AED (automated external defibrillator). Most of the information on first aid was familiar to me from attending sessions on first aid with my son in Cub Scouts (though this week’s session covered some additional topics, such as using an epi-pen on someone with a severe allergic reaction, and getting a diabetic with low blood sugar to drink something sugary).

But the AED was completely new to me, having previously been something I had only read about or seen hanging on a wall. (We have one at work; its significance to me up to now has been primarily as an object to point to, to identify where the door is out to the training room.) And while the basic technique of CPR isn’t much different from twenty-five years ago, some of the details have changed in significant ways.

One significant change is the current emphasis on protection for the person giving CPR. Back in 1987, we had heard of AIDS, but I don’t remember any use of gloves or other barriers to protect ourselves from diseases that could be transmitted by the victim we were trying to help. Now the very first thing we learned was to protect ourselves first. Taking the time to put on gloves and safety glasses won’t keep the victim waiting that much longer, and could make a huge difference to our own lives and those of our families.

The guidelines for chest compressions and rescue breaths (i.e. mouth-to-mouth resuscitation) have also changed. I couldn’t possibly have told you what the numbers were that I learned way back when, but apparently they were to complicated for people to remember easily. Now it’s simple: for children over 1 year and for adults, it’s cycles of thirty chest compressions and two breaths, or just do chest compressions and no breaths.

That last bit is the biggest change. When I mentioned it to my husband, he was very surprised that one could consider it cardiopulmonary resuscitation if the breathing part were left out. But studies have shown that “compressions-only CPR” is as effective as traditional CPR or more so (except with children, where causes of cardiac arrest are different and rescue breathing is still important). I could try to explain it as well as our instructor did, but instead I’ll point you to this article, which I think explains it pretty well.

One thing that certainly has not changed is the importance of calling for help. Once you’ve seen that someone is not breathing, the first thing to do (except with a child, where starting CPR immediately is most important) is to call 911 or send someone else to call 911. I don’t know why this is hard to remember. But when we all took our test at the end of the class, one of the things that most of us forgot, initially, was that step. (I had been rehearsing it mentally as I watched the others, as I knew it was the step I had trouble remember, and I still forgot.) I guess you’re focused so much how to do the CPR that you want to jump right in.

I also still have trouble with projecting an air of being in charge. (“You there, go call 911! You over there, get the AED!” and then later “Clear! Stand back!” when the AED is getting ready to deliver the shock.) But at least I no longer have to yell “Lady, lady!” at my hypothetical victim. In 2011, “Hey you!” seems to be perfectly acceptable. After all, if the person takes offense at that mode of address, that’s a good sign – it means he’s conscious, and therefore not in need of CPR.

One Response to CPR in the 21st century

  1. modestypress says:

    What a coincidence. Tomorrow morning, I am driving to the naval base at the north end of Whidbey Island to take a Red Cross cpr class. You expressed (as you usually do) the feelings of feeling insecure and not very competent in this regard.

    I have talked over the last year to three people who have performed CPR. One is a policeman who said that he was successful in saving the recipient’s life. The second was a woman in one of my classes who also reported a successful “save.”

    The third person was a volunteer fireman in our community. He said that the victim he used CPR on did not survive. I hope I never have to do it, but I hope that I am not feeling completely helpless if I have to.

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