# AHA Hands-Only CPR



## VentMedic (Mar 31, 2008)

It's now official that the AHA has approved the Hands-Only CPR for bystanders. 

*AHA Hands-Only website *with information for the public:
http://handsonlycpr.eisenberginc.com/


*AHA Says Hands-Only CPR OK*

http://www.emsresponder.com/article/article.jsp?siteSection=1&id=7297

By STEPHANIE NANO
Associated Press Writer



> You can skip the mouth-to-mouth breathing and just press on the chest to save a life.
> 
> In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.
> 
> Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.




*Circulation Journal:* (Free Full Article)
*Hands-Only (Compression-Only) Cardiopulmonary
Resuscitation: A Call to Action for Bystander Response
to Adults Who Experience Out-of-Hospital Sudden
Cardiac Arrest*
*A Science Advisory for the Public From the American Heart Association
Emergency Cardiovascular Care Committee*

published online Mar 31, 2008; Circulation
Roger D. White
Michael R. Sayre, Robert A. Berg, Diana M. Cave, Richard L. Page, Jerald Potts and

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189380v1

http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.107.189380v1


----------



## MMiz (Mar 31, 2008)

I just saw this on CNN.  I understand that we keep dumbing it down so that the majority can learn the skill, but 100% of my seventh grade students this year were able to learn and be certified in AHA Heartsaver CPR.  Is it really that hard?


----------



## JPINFV (Mar 31, 2008)

Well there are a few issues. First, people are going to be hesitant to provide ventilations if they lack either mechanical means (BVM) or a barrier device. It's possible that people would rather not provide any care in fear of harming the patient than doing compressions only.

As far as the 2005 guidelines go, if I remember correctly one of the problems was that lay providers were having trouble properly assessing for a pulse. Mind you, this is a skill that they might never actually need to check for a pulse prior to the event. Essentially expecting perfection would be like cutting an EMT (B or P) loose after their skill test. Thus, it's better to do compressions on a person only in respiratory arrest than not do compressions or delay compressions in a patient with in full arrest.


----------



## EMTryan (Mar 31, 2008)

I teach CPR and whenever I teach a class I always ask the students...let's assume that you have been doing CPR for several minutes and you are starting to get tired, do you think that you could teach someone else to do it? 

Almost everyone says yes...CPR is NOT hard at all. Place on hand on the center of the chest, place the other hand on top of it and lace your fingers together. Press down hard and fast on the chest allowing for full recoil of the chest with each compression. Alternate 30 compressions with 2 rescue breaths. The youngest person I have ever seen learn CPR was 6 years old. I tell students to go home and teach someone else how to do CPR. Teach your kids, teach your spouse, it will improve your confidence with the technique. All kids should know how and when to do CPR, it is not hard.

I think deemphasizing rescue breaths (just like deemphasizing the pulse check) is a good step because doing something is a lot better than nothing. Ultimately though CPR is NOT hard and I think this change just might help more people realize that CPR is NOT hard and they may be less hesistant to use it in a real emergency.


----------



## jms2185 (Mar 31, 2008)

I really don't understand why people find CPR so hard to learn.  I mean if you can walk and breathe at the same time you should be able to do perform CPR.   I just think everyone is afraid of getting sued for something.


----------



## skyemt (Mar 31, 2008)

jms2185 said:


> I really don't understand why people find CPR so hard to learn.  I mean if you can walk and breathe at the same time you should be able to do perform CPR.   I just think everyone is afraid of getting sued for something.



here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...

if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...

that does not even cover the ventilations... are you aware of the studies finding that health care providers are overventilating during CPR? that this overventilation is building up intrathoracic pressures to the point that it is inhibiting venous return? basically building up pressures that fight against the compressions you are doing... is that really taught in CPR class? it wasn't in mine, and apparently there is a large knowledge gap here, because the overventilation by "professionals" is a serious issue... if one had a true grasp of the concept of negative intrathoracic pressures and it's effect on venous return, they would not dream of overventilating... this theory is behind the development of the impedance threshold devices, designed to lower intrathoracic pressures, creating a vacuum effect.. how many are well versed in this?

so, back to my earlier point... learning CPR is easy... learning to do it really well without mistakes is another story.


----------



## JPINFV (Mar 31, 2008)

jms2185 said:


> I really don't understand why people find CPR so hard to learn.  I mean if you can walk and breathe at the same time you should be able to do perform CPR.   I just think everyone is afraid of getting sued for something.



Well, it doesn't help that last time I did my recert (it might be expired now, actually), the people running it thought I was doing it too hard. They weren't amused when I replied, "Well, err, the patient's currently dead anyways." It didn't help that Annie was so worn out that it didn't take much effort to actually do compressions.


----------



## jms2185 (Apr 1, 2008)

> here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...
> 
> if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...
> 
> ...



  Wow, you know a lot about CPR you should be an EMT or something.  To answer your previous questions no I am not a CPR instructor and have never claimed to be one.  So since it appears that you are the definitive source in CPR, what exactly constitutes "quality CPR"?  What separates "quality CPR" from a     "waste of time"?  Douse this mean that the new guidelines from AMA are a "waste of time" because they don't explain the anatomy or physiology as in depth as you?  So intern would that mean all CPR is a waste of time?  Have you considered giving seminars or speaking at University's to share your wealth of knowledge on this subject?  

  Oh my God!!!  Study s suggests that Health Care providers are over ventilating patients?  More importantly you had to read study s to find this out?  As I recall I didn't say anything about Health Care providers lacking the abilities to learn CPR, (but fell free to correct me as you are all knowing).  Do you think that AMA changed its guide lines because of health care providers over ventilating patients? Do you regularly bash other fellow health care providers?   Did you read the article on AMA's website or watch it on T.V?  Did you know that this was aimed at "laypersons" or bystanders that are unwilling to give mouth to mouth?  I look forward to your answers.


----------



## skyemt (Apr 1, 2008)

you know, if CPR was so easy, then why is it going wrong in the field?

i never claimed to be a university instructor, or a proclaimed expert.

there are issues in CPR, and i raised them, and offered my opinion as to why it may not be as easy as it seems.

why so defensive?

if you do not find any value in my posts, please, feel free to ignore and move along. i am not going to get into a 'personal' attack situation, so it better i don't really reply to you questions.

if i hit a nerve, perhaps one should ask why.

if i did not, then just ignore me as someone who doesn't know what he's talking about, and move along.

your choice.


----------



## Ridryder911 (Apr 1, 2008)

jms2185 said:


> Wow, you know a lot about CPR you should be an EMT or something.  To answer your previous questions no I am not a CPR instructor and have never claimed to be one.  So since it appears that you are the definitive source in CPR, what exactly constitutes "quality CPR"?  What separates "quality CPR" from a     "waste of time"?  Douse this mean that the new guidelines from AMA are a "waste of time" because they don't explain the anatomy or physiology as in depth as you?  So intern would that mean all CPR is a waste of time?  Have you considered giving seminars or speaking at University's to share your wealth of knowledge on this subject?
> 
> Oh my God!!!  Study s suggests that Health Care providers are over ventilating patients?  More importantly you had to read study s to find this out?  As I recall I didn't say anything about Health Care providers lacking the abilities to learn CPR, (but fell free to correct me as you are all knowing).  Do you think that AMA changed its guide lines because of health care providers over ventilating patients? Do you regularly bash other fellow health care providers?   Did you read the article on AMA's website or watch it on T.V?  Did you know that this was aimed at "laypersons" or bystanders that are unwilling to give mouth to mouth?  I look forward to your answers.



Okay, I will answer some of your questions and as well as some of your poor thought dribble. 

I am a university professor, as well as an AHA instructor (all levels, pick a vowel) probably longer than you have been alive. So as one that not only reads and but also participates in those studies. If you have read the studies over the past ten years, you would had not even mentioned "law suits" as one of the reasons for change. Also it appears you lack knowledge in the methodolgies of educational standards of emergency cardiac care.* AMA does NOT set standards nor have they ever*, it is the Emergency Cardiac Committee (ECC) that develops those standards and they set such recommended standards to organizations such as AHA, ARC, etc. Those standards are published in the _AMA Journal_ for review. Again, if properly educated as in CPR courses following the ECC & AHA recommended course outline, this subject should had been covered and discussed to make participants feel at ease, and eliminate worries of potential litigation. 

In actuality, what the studies have demonstrated was broke down in major items. I will not go into detail, as they are lengthy and really dull , as well most on this site would not understand them; as well could care less. One of the reasons were, most students (of non-medical background) demonstrated poor retention of CPR methodology (about 4-6 months). As mentioned many were hesistant upon performing ventilations, which is common. 

The issue addresses, ventilation is being found not to be as essential in the first few minutes as comparrision of build of ATP per compressions. 

Yes, the CPR training has been extremely watered down. Will this help? Doubtful. It is not litigation they fear rather most people prefer not to get involved period. This is demonstrated as per the Seattle Medic One CPR project over 25+ years ago, when 1:4 citizens knew and could perform CPR (may, I say the technique was much harder as well). Demonstrating, it is not so much the method, rather the interest or lack of apathy.

CPR is the only choice we currently have. If there were another procedure available, we would abolish it because of the very poor sucess rates both prehospital and even in-hospital (which is less). 

If you would like I can link you to about six AHA and American Cardiology journals and citations backing my claims, as well some current studies just addressed this past weekend. 

Before bosting and attacking posts, let's be sure we have our own ducks in a row. 

R/r 911


----------



## skyemt (Apr 1, 2008)

i do have to say, i feel like the posts on this site are getting a bit personal, and rude...

we all have a lot to say, and have strong opinions...

i tend to to post it like i see it... i have been right, i have been wrong, and i have changed some views through healthy debate...

that is what this site is supposed to be about... i don't mind flared tempers, i don't mind fierce debates... as long as it is about the knowledge and information... if i'm right, great. if i'm wrong, i'm wrong and i've admitted as much... and it means i've learned something... 

but i have to say, lately, differences of opinions are leading to personal attacks, and i don't think it's called for at all.


----------



## VentMedic (Apr 1, 2008)

skyemt said:


> here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...



This is also what I see as the problem being for lay person CPR.  How many people are going to do effective depth and rate to be successful at maintaining the intrathoracic pressure demonstrated in the studies for compressions only CPR?   Most are going to imitate what they have seen on TV which doesn't break a sweat.   

Although, any effort is probably better than no effort at all. 

I have seen a lot of changes in CPR over the past 30 years. The compression rate and depth has for effective CPR has gotten challenging even for the experienced and physically in shape professional provider.   The old one-one thousand........five-one-thousand...breathe, rest...was easy to do but complicated  to remember with all the variations and numbers to remember.  And, yes, we did save a few people with that method of CPR or maybe it was just not their time to go. Who knows?  I actually think there was more enthusiasm for CPR amongst both the lay persons and professionals back in the 1970s and 80s.


----------



## LucidResq (Apr 1, 2008)

skyemt said:


> i do have to say, i feel like the posts on this site are getting a bit personal, and rude...
> 
> we all have a lot to say, and have strong opinions...
> 
> ...



I agree that personal attacks are not okay, but you do occasionally give off a pretty condescending vibe which I believe makes people feel insulted. It's just something you might want to be aware of, because I think it has led to some of these personal attacks. You may not realize it but you may be making some people feel like you attacked them first.


----------



## skyemt (Apr 1, 2008)

LucidResq said:


> I agree that personal attacks are not okay, but you do occasionally give off a pretty condescending vibe which I believe makes people feel insulted. It's just something you might want to be aware of, because I think it has led to some of these personal attacks. You may not realize it but you may be making some people feel like you attacked them first.



ok... so you feel the right thing to do is to come back and make things personal again??

so, you presume a lot about me, that you really don't know....

if you have an opinion like that, perhaps a PM is more appropriate?

would you care for others to post their personal opinions about you on this thread, Lucid?

i rather think you probably wouldn't want that...

so, if you have something of a personal criticism, do me a favor and tell me in private... 

it's the same courtesy you'd expect from others.


----------



## ffemt8978 (Apr 1, 2008)

Get back on topic, people.


----------



## LucidResq (Apr 1, 2008)

skyemt said:


> ok... so you feel the right thing to do is to come back and make things personal again??
> 
> so, you presume a lot about me, that you really don't know....
> 
> ...



I don't think it's appropriate to come back and make things personal and you're right... that comment would have been better made over private message. I apologize.


----------



## jms2185 (Apr 1, 2008)

I posted this reply earlier but it was taking down due to reasons I won’t go into.  
Skyemt, I found your response to be very informative and insightful, but I did feel as if you were singling me out and telling me my opinion was wrong and trying to in a way to belittle me, which is why I got so defensive.  If you did not intend this then I apologize to you for my previous post.

  I do not know every thing and never have claimed too.  I will not be making a distasteful comment to Ridryder911, rather I will ask him if he will stop referring to my thoughts as " poor thought dribble" I did nothing to him to deserve this type of comment directed toward me (even though I must admit I thought it was funny).  So with that said we are all professionals so there is no reason that we can’t get along and have conversations over the internet that is civilized.  I find this subject vey interesting and think it will be interesting to see everyones opinion on this website about the new guidelines AMA has realeased.


----------



## el Murpharino (Apr 2, 2008)

skyemt said:


> here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...
> 
> if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...
> 
> ...



We learned the same thing in the "new" ACLS guidelines about overventilating the patients.  Instead of doing rescue breaths every 5 seconds (in adults), they're recommending ventilating your patients 8-10 times a minute during CPR.  This being said, proper ventilations must be provided, with an adequate seal with a mask...or with a secured advanced airway device.  Also what happens when you overventliate your patient is that the air that doesn't go into the lungs go into the stomach, increasing upward pressure on the diaphragm (and decreasing the amount of pressure in the thoracic cavity), and increasing the chance for vomiting and subsequent aspiration - not to mention the decreased venous return.  Ventilation should be provided just enough to see chest rise.  We should all know this...but as we all know, there are people out there who took CPR about 10 years ago, and think it's still the same now as it was then.

As far as the compressions during CPR...I've found it much easier to have 3 providers during CPR - two to manage the airway, one to do compressions.  Switch every 5 cycles of compressions, and you should be good to go.  Alot of providers don't give deep enough compressions.  It's startling how many EMT students I get doing compressions nowhere near deep enough.  Inadequate compressions don't help much...but I s'pose they're better than nothing.


----------



## enjoynz (Apr 2, 2008)

There was talk here when I did my last CPR course, of them changing the
adults bag on the BVM, for the child's bag, to stop EMT's (or whomever) from squeezing in too much air when ventilating.
It hasn't happened yet, but it seemed like a good idea to me. 
Especially for the newer EMT's at their first few cardiac arrests.
I'm not sure what size bags you use there, but as it was on topic, I thought I'd mention it.

Cheers Enjoynz


----------



## Ridryder911 (Apr 2, 2008)

jms2185 said:


> I find this subject vey interesting and think it will be interesting to see everyones opinion on this website about the new guidelines AMA has realeased.




Again it is *NOT* AMA... please, if you are going to cite, cite correctly. 

This is the information I recieved from the national today. 


...._Dear Training Network:

Last week, we asked you, our valued Training Network, to visit the ECC Web site the afternoon of March 31st to learn about an important "lifesaving initiative." If you've been to the Web site, you now know that lifesaving initiative is the American Heart Association's advisory statement on Hands-Only CPR, and you're probably wondering what it means to you as an instructor. 
First and foremost, through this advisory statement, ECC hopes to do two things:
Significantly increase the number of people who take action when they witness an adult sudden cardiac arrest. Despite training almost 12 million people in CPR and ECC each year, the national average for survival from sudden cardiac arrest remains less than 7 percent. 
Drive CPR training – ECC advocates that people take a CPR course to practice and learn the skills of CPR, including giving high-quality chest compressions.  People who have had CPR training are more likely to give high-quality chest compressions and are more confident about their skills than those who have not been trained. We know that CPR is a psychomotor skill that is best learned through hands-on practice.
Both of these goals mean more training opportunities for you as an instructor, and more people trained equals increased survival rates from sudden cardiac arrest. We can't emphasize enough the critical role you play as part of ECC's Training Network.

.......
What do you need to know?
This short Web Cast will provide you with guidance on how to incorporate Hands-Only CPR into the courses you teach. 
Everything else you will need (flyers, lesson maps, FAQ) can be found in the "What's Hot" section of the Instructor Network. Keep in mind that you will must be registered with the Network, confirmed as an instructor by your Training Center, and logged into the site to see the information. If you are not a member of the Network, please contact your Training Center Coordinator.
We hope that, by viewing the Web cast and the documents (http://americanheart.org/presenter.jhtml?identifier=3055324 ) on the Instructor Network, you will feel informed and prepared to talk about Hands-Only CPR. We thank you for your support in helping us get the word out about this lifesaving action and for promoting CPR training...._

This is the link to the new PEARS network for CPR. 
http://my.americanheart.org/eccportal/ecc/ecc

R/r 911


----------



## rayemtjax77 (Apr 2, 2008)

Well working in an ER and doing CPR often, we concentrate on making sure that you go "hard, Fast and deep" But you have to take into consideration the patients size as to how hard and deep you go.  So there is really no Cut and dry method to CPR.


----------



## skyemt (Apr 2, 2008)

let me ask this...

do we think the way CPR is taught to health care providers is adequate?

if not, what do we think is lacking in the way CPR is taught??


----------



## rayemtjax77 (Apr 2, 2008)

Its adequate for the standards at the time.. but it changes so much.  First its hyperventilate.. then its hypoventilate.. Then its a slow chest compressions allowing time to recoil.. now its Hard fast and deep.  

As health care providers I feel that since we do CPR so much, we somewhat teach ourselves and those around us.

make sense?


----------



## skyemt (Apr 2, 2008)

rayemtjax77 said:


> Its adequate for the standards at the time.. but it changes so much.  First its hyperventilate.. then its hypoventilate.. Then its a slow chest compressions allowing time to recoil.. now its Hard fast and deep.
> 
> As health care providers I feel that since we do CPR so much, we somewhat teach ourselves and those around us.
> 
> make sense?



well, then it begs the question... if it is "adequate for the standards at the time", then why is it going wrong in the field?


----------



## rayemtjax77 (Apr 2, 2008)

what do U mean why is it going wrong in the field?


----------



## skyemt (Apr 2, 2008)

rayemtjax77 said:


> what do U mean why is it going wrong in the field?



well, studies are finding that professionals routinely overventilate, and do not provide deep enough compressions, or have interruptions in compressions that are too long..

again, this obviously is not a blanket statement, as many do good quality CPR... but there are issues out there... since you asked...

i am just asking if the issues are a function of the way CPR is taught, or if there are other factors at work...


----------



## BossyCow (Apr 2, 2008)

skyemt said:


> well, studies are finding that professionals routinely overventilate, and do not provide deep enough compressions, or have interruptions in compressions that are too long..
> 
> again, this obviously is not a blanket statement, as many do good quality CPR... but there are issues out there... since you asked...
> 
> i am just asking if the issues are a function of the way CPR is taught, or if there are other factors at work...



I am a CPR instructor and I have found over the years that many of my fellow instructors, I'm sure none of whom post on this site, are simply pencil whipping their instruction. One AHA instructor that I co-taught with would simply plug in a movie, then run the staff through the station with minimal observation of their skills. 

There is an attitude I have seen many times in EMS instruction that the 'real' education comes in the field, not the classroom and if you are providing the skills on a regular basis, you don't need instruction.

But, when standards change, so does the skill practice and those who are on their 12th recert sometimes need more training rather than less because they are going from habit. 

I have flunked people in CPR and refused to issue cards to those who do not perform the skills correctly. My goal is to be absolutely certain that if I, or someone I care about goes into Cardiac Arrest in front of this person.. they will be able to provide adequate CPR. I tell all my students that at the beginning of the class. 

I don't think this is so much a factor of AHA, ARC or any individual system of instruction, but rather a direction in business to be more invested in the ability to prove that the information was offered and document that offering, rather than any goal towards making sure the students actually learn.


----------



## skyemt (Apr 2, 2008)

BossyCow said:


> I am a CPR instructor and I have found over the years that many of my fellow instructors, I'm sure none of whom post on this site, are simply pencil whipping their instruction. One AHA instructor that I co-taught with would simply plug in a movie, then run the staff through the station with minimal observation of their skills.
> 
> There is an attitude I have seen many times in EMS instruction that the 'real' education comes in the field, not the classroom and if you are providing the skills on a regular basis, you don't need instruction.
> 
> ...



Bossy, thank you for your candor... 
i am aware myself of emt's who went through the AHA class, only to have no grasp on why they do what they do, and are more prone to make mistakes, or provide poor quality CPR.  then again, others with a different instructor come out very proficient in their skills...

from your perspective, what are possible solutions to the problem??


----------



## Jon (Apr 2, 2008)

Wow.

I know we've been moving in the direction that compressions are better than nothing.. but saying it is "just as good"?

One of the discussions at the bar last weekend (when we had of course consumed nothing but soda pop) was that the recent changes in CPR were mind-boggaling for the folks who'd been teaching it for eons. To go from "Airway... Airway.... Airway.... Breathe... Breathe.... Shock... Shock... Shock... then press on the chest for a bit and repeat" to "Harder is Better" Compressions, and don't get to obsessed with the airway and breathing bits has some of the instructors confused.

It is sad that we are only now doing the research to back up all the state of the art stuff we've been doing. MAST Pants, anyone?

Anyway... I'm _hopefully _taking a CPR instructor class (again) on Monday. Should be fun.

I'm NOT going to let the darn thing lapse this time!


----------



## BossyCow (Apr 2, 2008)

skyemt said:


> Bossy, thank you for your candor...
> i am aware myself of emt's who went through the AHA class, only to have no grasp on why they do what they do, and are more prone to make mistakes, or provide poor quality CPR.  then again, others with a different instructor come out very proficient in their skills...
> 
> from your perspective, what are possible solutions to the problem??



I think its a matter of personal work ethic. An instructor who doesn't care about the students is going to produce students who reflect that attitude. I don't think you can legislate this. 

On the business side, its a matter of dollars and cents. Do you have the time and money to pay for quality instruction and skills assessment of your employees? Or is it cheaper, faster and more efficient to pay for an online OTEP program and be able to show that the information was presented and that the presentation included all the key points required for certification of a skill? 

Like with all changes.. first you have to give a :censored:


----------



## Ridryder911 (Apr 2, 2008)

My personal opinion. I used to be a stickler that one should follow each letter of the standards. Then I grew up and wised up, only to read of how, why, and the B.S. of the standards are set. 

I have been on the National Faculty level onward, after spending time upon the development to move the standards outward, one learns most of it political in nature and not true methodology of care. 

So if the provider that does not check for the 5-10 seconds for a carotid pulse, but checked for 4 seconds, and has worked thousand of codes, I will not fail. Reason, he can detect a dead person, when he walks into the room, even without checking. It is the reason or intent, not so much the exact skill. 

Even AHA has now recognized common sense has to be weighed in. 

Good compressions is essential in situations that it will work. In reality, and for those that really work on a daily basis, realizes most of the "hard work" is foolish. Codes rarely if ever come back. More studies and finally the medical community is realizing this as well. Hopefully, soon they will  recognize in many cardiac arrest situations, the best treatment will be no treatment. Let nature take its course, and allow death to occur. Unless rapid arrival or effective CPR is being performed, death is eminent, just delaying or increasing costs to survivors. 

Very rarely, we are able to correct cardiac arrest. It really does take a lot to kill someone or for someone to die. The emphasis should be placed more upon the pre-cardiac arrest and preventative measures. Detecting cardiac problems, CT of vessels, antiplatelet medications, etc. 

Yes, we will continue to play or perform as directed of performing CPR, pushing medications that don't work, and not having any luck of increasing our success in saves. Hopefully, we realize to go with clinical based evidence and change resuscitation measures. 

R/r 911


----------



## LucidResq (Apr 3, 2008)

skyemt said:


> well, then it begs the question... if it is "adequate for the standards at the time", then why is it going wrong in the field?



I'll give you an example. A friend of mine took his EMT-B course through a different program than the one I'm in. He needed to take the BLS for Health care providers class prior, and the program he was in offered it right before the class.

The instructors could not get into the cabinets that the dummies were in, so they pretty much played the DVD and gave the test. 

That terrifies me.


----------



## Webster (Apr 3, 2008)

Our scout camp staff was going through CPR training (ARC Adult CPR) in one of our pre-camp training periods.  What amazed me was the total lack of effort put into the class by the instructor.  She didn't even give the test.  I'm just dumbfounded that such a carefree CPR class could be given.  Had I been certified in that class, I'd have thrown away my card (I had recertified in CPRO before that, thankfully).


----------



## paramedix (Apr 4, 2008)

Recently an article featured in one of our national news papers about the CPR technique. It is amazing to hear and see the public's response regarding this technique. 

It obviously made an impression on the people that read the article. Hopefully we'll have more bystander initiated CPR from now on.


----------



## daedalus (Apr 4, 2008)

skyemt said:


> here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...
> 
> if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...
> 
> ...


So you know better than the AHA itself on what should be taught in a CPR class? Maybe you need to replace their seasoned Cardiologists than...

CPR is CPR. Its better that someone try it than do nothing at all because its a "waste of time". Doing good CPR is a waste of time anyways in most cases.


----------



## skyemt (Apr 4, 2008)

daedalus said:


> So you know better than the AHA itself on what should be taught in a CPR class? Maybe you need to replace their seasoned Cardiologists than...
> 
> CPR is CPR. Its better that someone try it than do nothing at all because its a "waste of time". Doing good CPR is a waste of time anyways in most cases.



Yes, in fact, i know much better than the AHA... i also know much more than the top Cardiologists in the world... I am in the process of rewriting the CPR curriculum that will be accepted nation wide... and the inventor of CPR itself has asked to consult with me on my views.

HAPPY NOW?????


----------



## daedalus (Apr 4, 2008)

LucidResq said:


> I agree that personal attacks are not okay, but you do occasionally give off a pretty condescending vibe which I believe makes people feel insulted. It's just something you might want to be aware of, because I think it has led to some of these personal attacks. You may not realize it but you may be making some people feel like you attacked them first.



I would tend to agree here, skyemt. Your an EMT-Basic. Which means, no matter how much you educate yourself, your still going to be viewed by people who don't know you as the lowest common denominator (advanced first aid). Im not attacking you, but providing feedback to your question on why things tend to be getting personal. I think you are quite brilliant, and I commend you on wanting to educate yourself. But lets try and bring EMT out of the "advanced first aid" arena by supporting its education and not having an attitude with current providers for not knowing what you do.


----------



## skyemt (Apr 4, 2008)

daedalus said:


> I would tend to agree here, skyemt. Your an EMT-Basic. Which means, no matter how much you educate yourself, your still going to be viewed by people who don't know you as the lowest common denominator (advanced first aid). Im not attacking you, but providing feedback to your question on why things tend to be getting personal. I think you are quite brilliant, and I commend you on wanting to educate yourself. But lets try and bring EMT out of the "advanced first aid" arena by supporting its education and not having an attitude with current providers for not knowing what you do.



so, seriously.... what is the issue here? i brought up issues i have with CPR?
and you get your ***** all twisted up?

or is that a basic should not try to expand knowledge while getting certified for ALS?

you say that no matter how much i educate myself, i will still be viewed as the lowest common denominator... i tend to disagree... if someone has the opportunity to talk to me about EMS and protocols and treatments and everything else, i don't really think i will be viewed as the lowest common denominator... and no, i do not think i "know it all", quite the opposite, which is why i am continually educating myself... if you want to discount my views because i am currently a "basic", feel free, but you are then doing the exact same pigeon-holing that you are supposedly against.

i want to support education... i feel the way i can do that is by identifying what i think is lacking and trying to change it...

what is your problem with that? so, we should all just accept the current educational standards to "support ems", why not just stick our heads in the sand... 

if you think CPR is the best it can be, i am happy there are no issues for you...

but to criticize someone for having issues, and basically saying the only way to bring EMS out of "advanced first aid" is by "supporting it's education" in it's current form is quite frankly a ridiculous statement... in my most humble opinion...


----------



## ffemt8978 (Apr 4, 2008)

Thread reopened as long as everyone follows the rules.


----------



## bonedog (Apr 6, 2008)

I wonder why it took so long, especially with the length of time apnea testing has been around.


----------



## crash_cart (Apr 9, 2008)

Wow...great thread with a lot of great insight! 

I teach at a facility that requires CPR certification of the staff.  When you get into a situation where people DON'T want to be there and the evaluation is hanging over the instructor's head, I think the instructors do the whole video-practice light-heartedly-and move on routine.  CPR education tends to be rather poor because the instructors aren't assertive enough about what they are doing and why it's important.  Administration backs that feeling through evaluations.  Some people will mark someone down on an evaluation if they are told to readjust the head to deliver respirations.  Petty I know, but people do that kind of thing when they take it personal, which they shouldn't.:glare:  The administration also tends to undermine CPR ed. as limited class time is given to practice on skills.  Another huge component is the attitude of the people who have to take the mandatory training.  I have yet to see an environment permeated with a gung-ho, let's get to it enthusiasm.  I'm not certain why, but people get awfully quiet and just detest doing ANY physical skills.

If the new standards help more people to step in to situations, great.  I'm not certain that it can ever be made easy enough to please everybody.


----------



## LIFEGUARDAVIDAS (Apr 12, 2008)

*"Hands Only CPR" Not Appropiate For Drowning Treatment*

Just making some information available on CPR for "near-drowning" victims posted at the United States Lifesaving Association official website (www.usla.org) by USLA President:

"[

The American Heart Association has issued a release regarding hands-only CPR. Note that the release includes the following statements: 

"Hands-Only CPR is a potentially lifesaving option to be used by people not trained in conventional CPR or those who are unsure of their ability to give the combination of chest compressions and mouth-to-mouth breathing it requires." 

"Hands-Only CPR should not be used for infants or children, for adults whose cardiac arrest is from respiratory causes (like drug overdose or near-drowning), or for an unwitnessed cardiac arrest. In those cases, the victim would benefit most from the combination of chest compressions and breaths in conventional CPR." 

AHA Press Release 

Hands-Only CPR simplifies saving lives for bystanders 
New statement from the American Heart Association puts life-saving skills in your hands 

DALLAS, April 1 — Chest compressions alone, or Hands-Only Cardiopulmonary Resuscitation (CPR), can save lives and can be used to help an adult who suddenly collapses, according to a new American Heart Association scientific statement. 

The statement, from the association’s Emergency Cardiovascular Care (ECC) committee, is published in Circulation: Journal of the American Heart Association. 

Hands-Only CPR is a potentially lifesaving option to be used by people not trained in conventional CPR or those who are unsure of their ability to give the combination of chest compressions and mouth-to-mouth breathing it requires. 

“Bystanders who witness the sudden collapse of an adult should immediately call 9-1-1 and start what we call Hands-Only CPR. This involves providing high-quality chest compressions by pushing hard and fast in the middle of the victim’s chest, without stopping until emergency medical services (EMS) responders arrive,” said Michael Sayre, M.D., chair of the statement writing committee and associate professor in the Ohio State University Department of Emergency Medicine in Columbus. 

About 310,000 adults in the United States die each year from sudden cardiac arrest occurring outside the hospital setting or in the emergency department. Without immediate, effective CPR from a bystander, a person’s chance of surviving sudden cardiac arrest decreases 7 percent to 10 percent per minute. Unfortunately, on average, less than one-third of out-of-hospital cardiac arrest victims receive bystander CPR, which can double or triple a person’s chance of surviving cardiac arrest. 

By using Hands-Only CPR, bystanders can still act to improve the odds of survival, whether they are trained in conventional CPR or not, Sayre said. 

“Many times people nearby don’t help because they’re afraid that they will hurt the victim and aren’t confident in what they’re doing,” he said. “We want people to know that they can help many victims, just by calling 9-1-1 and doing chest compressions. Don’t be afraid to try it. We are sure many lives will be saved if the public does Hands-Only CPR for adult victims of sudden cardiac arrest.” 

The new recommendation for Hands-Only CPR for adults who suddenly collapse is an update to the 2005 American Heart Association Guidelines for CPR and ECC, which previously recommended that lay rescuers use compression-only CPR only if they were unable or unwilling to provide breaths. The update puts Hands-Only CPR on par with conventional CPR when used for an adult who has suddenly collapsed. This change was supported by evidence published from three separate large studies in 2007, each describing the outcomes of hundreds of instances of bystanders performing CPR on cardiac arrest victims. None of those studies demonstrated a negative impact on survival when ventilations were omitted from the bystanders’ actions. Hands-Only CPR is easier to remember and results in delivery of a greater number of chest compressions, with fewer interruptions, until more advanced care arrives on the scene. 

Conventional CPR is still an important skill to learn, and medical personnel should still perform conventional CPR in the course of their professional duties. The new recommendations apply only to bystanders who come to the aid of adult cardiac arrest victims outside the hospital setting. 

Hands-Only CPR should not be used for infants or children, for adults whose cardiac arrest is from respiratory causes (like drug overdose or near-drowning), or for an unwitnessed cardiac arrest. In those cases, the victim would benefit most from the combination of chest compressions and breaths in conventional CPR. 

The public is still encouraged to obtain conventional CPR training, where they will learn the skills needed to perform Hands-Only CPR, as well as the additional skills needed to care for a wide range of cardiovascular- and respiratory-related medical emergencies, especially for infants and children. 

The new statement is intended to increase how often bystander CPR is performed. It emphasizes the importance of “high-quality” chest compressions — deep compressions that allow for full chest recoil, at a rate of about 100 per minute — with minimal interruptions. 

More information on CPR training can be found at www.americanheart.org/handsonlycpr. 

Co-authors are: Robert A. Berg, M.D.; Diana M. Cave, R.N., M.S.N.; Richard Page, M.D.; Jerald Potts, Ph.D.; and Roger D. White, M.D. 

The Science Advisory is at: 

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189380

]"



Also on the USLA forum (www.usla.org > Guard to Guard bulletin / message board) there is a statement from the International Life Saving Federation on this issue. It would be great if those of you who are instructors distribute it widely. 

---------

I hope this "hands-only CPR" issue doesn't end up causing unnecessary (and on ocassions, deadly) confusion like the one caused by Dr. Heimlich statement on how his manouver should be used instead of CPR in drowning victims. 


Saludos from Patagonia,


Guri


----------

