# Poorly trained UK lifeguard 'left girl to die'



## High Speed Chaser (Feb 25, 2010)

"A poorly trained British lifeguard stopped performing CPR on a dying  teenager because she thought she had saved her life, according to  reports."

Source

Sad that something likes this happened.

Just wandering what some people think, especially people from the UK who know the resuscitation guidelines.


----------



## rescue99 (Feb 25, 2010)

High Speed Chaser said:


> "A poorly trained British lifeguard stopped performing CPR on a dying  teenager because she thought she had saved her life, according to  reports."
> 
> Source
> 
> ...



Hmm, breathing certainly implies a pulse. Question is..rate/quality and for how long? Guess the LG forgot to check and recheck her victim. Sad


----------



## Markhk (Feb 26, 2010)

So, in the UK, pulse checks are no longer taught for BLS- even for the healthcare provider. Pt could have been having agonal respirations. 

http://www.resus.org.uk/pages/bls.pdf

I sympathize with the lifeguard. It can be tough to know what dead vs. alive is if  this is the first full arrest you've done and it's nothing like training. 

Personally when I teach, I try to avoid giving scenarios where CPR alone achieves ROSC. The science suggests CPR-only saves (i.e. no defib) is exceptionally small in verified cardiac arrest cases, which is a far cry to some scenarios I see instructors do. (i.e. two minutes of CPR, re-check pulse, wow the pulse is back! Sort of what we see in ER.)


----------



## Melclin (Feb 26, 2010)

We have a similar problem with the dispatching information/call taking. The call taker will ask if the pt is breathing and the caller, in a panic, says yes because they heard an agonal resp 30 seconds ago. 

I think also this highlights the need for emphasizing constant reassessment in CPR training. It seems like this poor girl has heard one breath, decided the pt was breathing and did what she had learned to do in that situation at which point she reached the end of the algorithm she had been taught in her 10 seconds of training and was probably confused as to where to go from there.


----------



## MrBrown (Feb 26, 2010)

Melclin said:


> We have a similar problem with the dispatching information/call taking. The call taker will ask if the pt is breathing and the caller, in a panic, says yes because they heard an agonal resp 30 seconds ago.



Could also highlight the need to put somebody with more than a couple weeks training and no medical knowledge whatsoever above a first aid certificate on the phone.

Oxygenation and ventilation are not the same thing.


----------



## mycrofft (Feb 26, 2010)

*CPR resinstates life in three scnarios:*

1. Very fresh electrocution.
2. Very fresh airway embarassment and it gets dislodged.
3. CPR wasn't necessary in the first place*.


(*A bystander screaming "He doesn't have a pulse!" fails to qualify as paitent assessment).


----------



## redcrossemt (Feb 26, 2010)

Melclin said:


> We have a similar problem with the dispatching information/call taking. The call taker will ask if the pt is breathing and the caller, in a panic, says yes because they heard an agonal resp 30 seconds ago.



The NAED "Medical Priority Dispatch System" asks callers to count the number of respirations in some amount of time, I think it's 30 seconds, to avoid this.


----------



## MrBrown (Feb 26, 2010)

redcrossemt said:


> The NAED "Medical Priority Dispatch System" asks callers to count the number of respirations in some amount of time, I think it's 30 seconds, to avoid this.



Are you sure? I do not think that was in the AMPDS book that I have read (black one, Principles of MPD or something simmilar from IAEMD) 

Our five key questions are

What is the exact address of the emergency?
What is the phone number you are calling from?
What is the problem, tell me exactly what happened?
Are they conscious? (can select yes/no/unknown)
Are they breathing? (can elect yes/no/uknown)


----------



## Melclin (Feb 26, 2010)

Yeah we use AMPDS and the questioning is along the lines of Brown mentions

What you mention, redcross, sounds like a tremendously good idea.


----------



## LondonMedic (Feb 27, 2010)

Markhk said:


> So, in the UK, pulse checks are no longer taught for BLS- even for the healthcare provider.


Resus Council guidelines removed the pulse check from the standard 'civvie' BLS algorithym because so many people ('healthcare providers' included) do it wrong and either find their own pulse on a deader or can't find a pulse on a faker.

To be fair to the general public, unless you do know what you're doing, have experience of checking pulses and aren't in a panic, finding a carotid pulse _isn't_ all that easy.


----------



## LondonMedic (Feb 27, 2010)

mycrofft said:


> 1. Very fresh electrocution.
> 2. Very fresh airway embarassment and it gets dislodged.
> 3. CPR wasn't necessary in the first place*.
> 
> ...


The public don't know that because that's not how it works on TV.


----------



## Melclin (Feb 27, 2010)

The removal of the pulse check makes good sense. We have the same thing here. I don't believe that is the issue. If the life guard had decided she was breathing, its perfectly reasonable to discontinue CPR. I don't think the issue is with resp guided CPR. The problem lies with the training. If a single agonal resp counts as breathing in the mind of a panicked rescuer, then they need to know that the resus game doesn't end there, and that is the responsibility of the trainers/guideline makers. This is what I'm getting at when I talk about reassessment. Reassessment and an understanding of what "breathing" constitutes - u don't need a four year degree in resp phys to understand that a single laboured 'breath' doesn't count as breathing when it comes to living (regardless of your knowledge of different resp patterns like agonal breathing - thats probably beyond the scope of a first aid course). It's not that hard to get. But I don't for a minute blame the poor life guard, its the training system that is to fault. 

Still, what exactly u do about that, I'm not sure.


----------



## redcrossemt (Feb 28, 2010)

Re dispatch,

Entry questions - "Is s/he breathing?" 

"Questionable/Ineffective/Agonal" breathing automatically makes any chief complaint an "Echo" level response, but you continue with the chief complaint card.

The cardiac/respiratory arrest card talks you through agonal respirations and having them count respirations, "You tell me every time they take a breath."

However, this doesn't work is the caller is confident that the patient is breathing. Most notice that they are breathing irregularly or making noises when breathing, and describe this when you ask the question on the entry card. There's also other mentions of effective breathing. One example is that the seizure card asks if the patient is breathing regularly.


----------

