Simple Skills Save Lives!

Cardiopulmonary resuscitation (CPR)

Every year in the UK there are more than 30,000 out-of-hospital cardiac arrests. The survival rate from these in the UK is around 1 in every 10. In parts of the United States, Seattle in particular, the survival rates are far greater.

This means that only around 3000 people will survive an out-of-hospital cardiac arrest each year in the UK. In parts of the US that figure is closer to, and sometimes in excess of 15,000 per 30,000 arrests. So why are survival rates in the US so much higher?

Part of the reason is high quality bystander CPR, and the availability of public access defibrillators. This is backed up by high quality public education programmes, teaching people how to carry out CPR and use defibrillators.

Public Access Defibrillator

On Saturday the 17th of March 2012, during an FA Cup game against Tottenham Hotspur, 23-year-old Fabrice Muamba of Bolton Wanderers suffered a sudden cardiac arrest and collapsed on the pitch.

Medics were quickly on the scene, and CPR was administered. Fabrice survived, and went on to become an ambassador for CPR education, and the placing of defibrillators in public places.

Last weekend we were given a stark reminder of the fact that a cardiac arrest can strike down anyone at any time, and without warning, when Danish footballer Christian Eriksen collapsed on the pitch during a European Championship game against Finland.

Again, medics were quickly on the scene, and Christian received CPR and defibrillation. Thanks to the quick actions of many, including the referee, and Christian’s teammates, he was conscious when he left the field.

Thankfully he is now on the road to recovery, but this was yet another reminder of the importance of simple interventions.

CPR and the use of public access defibrillators are simple skills that are easy to learn, and it is the simple skills that save lives.

As a bystander giving CPR, you are giving someone a chance of survival that they may not get without it. I have taught CPR to all age groups for many years, and I believe that everybody should learn.

You can learn the basics by taking our free online course. This course will give you the information and confidence you need to learn how to save a life.

Simple Skills Save Lives! Lesson 2 – Defibrillators and the Recovery Position

Before reading this lesson you should have already worked through lesson 1

Public Access Defibrillators are popping up everywhere. You can find them on the side of public buildings such as restaurants, cinemas, and public houses; most town centres will now have one somewhere. The thing that puts people off using one or stopping to help is the misconception that they are difficult to use, or you must be trained to use one.

Public Access Defibrilator

Automatic, or semi-automatic external defibrillators are extremely simple to use and designed in such a way that they cannot deliver a shock to someone who doesn’t need one. You simply open the lid and stick the pads to the casualties bare chest; the device evens shows and tells you where to put them.

Most ambulance service trusts will have a register of these defibrillators, including the location and access code. When you phone 999 and explain that someone has collapsed and is not breathing they will give you the location of the nearest unit and the access code to get into the cabinet. If someone else is available then send them for it, otherwise you will need to get it yourself.

Defibrillator Pads Placement

As soon as a defibrillator is available you should attach it to the patient.

  1. Open the lid and listen carefully to the audio information;
  2. Locate the pads and attach one to the upper right hand side of the patient’s chest;
  3. Take the second pad and place it on the lower left hand side of the chest, underneath the armpit;
  4. The unit should detect that the pads have been applied and carry out an assessment of the patient’s heart;
  5. It will either advise a shock and tell you to stay clear of the patient and push a flashing button, you, or ask you to continue CPR.  

If the patient’s chest is excessively hairy then the pads will not stick properly. You will need to shave the area where the pads are to be applied. The Defibrillator should come with a safety razor for this purpose. There should also be a pair of tough cut scissors and a cloth for wiping away excessive perspiration.

Every couple of cycles of CPR or at a pre-set interval the device will assess the heart rhythm. It is important that while this is happening everybody remains still and does not touch the patient. Movement may cause a false reading within the device and it will have to start the assessment again, wasting valuable minutes.

Important Excessive chest hair will need to be shaved before applying the pads to the patient’s chest.Excessive perspiration will need to be wiped from the patient’s chest before attaching the electrodes. Defibrillators should not be used in pools of standing water, or flammable atmospheres. Before administering a shock make sure that nobody is touching the patient.  

The Recovery Position

Should the patient recover, the device will ask you to check for a pulse. You should do this, and check to see if they are breathing normally.

If they are breathing again we need to put the patient in the recovery position and LEAVE THE PADS ON just in case they go back into cardiac arrest.

The Recovery Position

To place someone in the recovery position:

  1. Kneel down next to the patient;
  2. Move the arm nearest to you so that it is pointing towards you, at a right angle to the body;
  3. Take the arm that is furthest away from you and fold it over the casualty so that the back of their hand is resting against the cheek closest to you;
  4. Lift the knee furthest away from you and use the patient’s leg as a lever to roll them over towards you;

The patient should now be lying on their side facing towards you. Continue to monitor the patients breathing

Simple Skills Save Lives! – Cardiac Arrest and CPR

Welcome to lesson one in our saving lives series. In this session you will learn what a cardiac arrest is; how to identify when someone has suffered from a cardiac arrest, and what to do.

Cardiac Arrest – Different Heart Rhythms

Have you ever wondered what you would do if you came across a person who has collapsed in the street? One of the most common responses I hear to that question is that “I wouldn’t be much help” or “I couldn’t do anything to help.” The thing is that helping may be easier than you think, and with a few simple skills you could save a life.

According to the British Heart foundation there are more than 30,000 out of hospital cardiac arrests in the UK each year, with a survival rate of just 1 in 10, but what exactly is a cardiac arrest?

Often confused with a heart attack, a cardiac arrest is an electrical problem affecting the way that the heart beats, as opposed to a heart attack, which is a plumbing problem in which one of the arteries supplying blood to the heart becomes blocked.

In a cardiac arrest the electrical impulses which cause the heart to contract and pump blood around the body become scrambled, causing random contractions of the heart muscle. When this occurs the heart can no longer pump blood effectively, and the organs of the body become starved of the vital oxygen and nutrients required to survive. Without intervention, this scrambled heart rhythm will continue to get worse until the heart eventually stops beating altogether.

When somebody suffers from a cardiac arrest, time is vital. The longer they are left untreated, the smaller their chance of survival becomes. The first step is to identify that a cardiac arrest has occurred, and we do this by following a simple process known as DR ABC.

DANGER – First and foremost we need to make sure that it is safe to approach them. Rushing into a situation without knowing the circumstances is a risky strategy that may lead to you yourself becoming another casualty, making the situation twice as bad as it was in the first place. You can’t help them if you need help yourself.

RESPONSE – Call out to them; ask them to open their eyes if they can hear you. If they respond to this by opening their eyes then we can rule out a cardiac arrest for the time being. If you get no response then we move onto the next part.

KEY POINT: Call for help. It is all too easy to start helping the casualty and forget to call for an ambulance. You should do this as soon as possible.

AIRWAY – We now need to open the casualty’s airway to find out if they are breathing. We do this by placing our fingers under the bony part of the chin and the other hand on their forehead. Gently tilt back the head and place your cheek next to their mouth.

Opening the Airway – head tilt chin lift

BREATHING – We will now look, listen, and feel to see if they are breathing.

Look at their chest to see if it is rising and falling; Feel for their breath on your cheek and Listen to see if you can hear them breathing.

Do this for 10 seconds. You need to identify at least two breaths in ten seconds. If they only breathe once, or they are just gasping occasionally then they are not breathing effectively.

CALL FOR HELP/CPR – If you have not already called 999 then you should do so immediately, stating your location clearly, and that the casualty is not breathing. The call handler will stay on the line and talk you through the next steps. It may be easier where possible to put them on speaker phone so that you have both hands free for CPR.

How do I carry out CPR?

In order to carry out CPR the casualty needs to be lying on their back on a solid surface. Soft surfaces such as beds of sofas will flex when you are compressing the chest, reducing the effectiveness of the compressions.

We start with thirty chest compressions. To carry out chest compressions kneel beside the casualty and place the palm of one of your hands on the centre of the chest on the breastbone (Sternum). Place your other hand on top and interlock your fingers.  

CPR – Hand Position

Lock your elbows and position yourself so that your shoulders are directly above your hands and your arms are straight. Using your body weight compress the chest by between 5 and 6 centimetres, and then release again, ensuring that you fully release. That is one chest compression, and you need to repeat this 30 times at a rate of between 100 and 120 per minute, that’s around two per second. To get the rate right it can help to sing nelly the elephant or stayin’ alive by the Bee Gees (preferably in your head of course).  

Following 30 compressions we then attempt to carry out 2 rescue breaths. To do this we need to open their airway, just as we did before checking for breathing, pinch the casualty’s nose to close the nostrils and cover their mouth with ours. Breathe into their mouth as if you are breathing out normally. You are not trying to blow up a balloon, and if you blow too hard then you will probably end up filling the stomach with air, which may in turn cause the casualty to vomit. If the casualty does vomit simply roll them onto their side and allow this to drain from their mouth before continuing.

Rescue Breaths

If the two breaths are not effective, don’t waste time trying two more. It is vitally important that we get straight back on the chest and carry out the next set of chest compressions. You should only stop CPR if someone else arrives to take over; a medical professional arrives and either takes over or asks you to stop; you become too exhausted to carry on, or the casualty recovers, which is extremely rare when carrying out CPR alone.

In lesson two we will look at the recovery position, and how to use a defibrillator…