Because you just happen to travel with a sandwich bag at all times? On topic, I work in healthcare and no way in hell am I ever doing mouth to mouth on somebody that I don't know (and I would even have to question doing it on some of the people that I do know). And they even taught us that in BLS and ACLS class. I am surprised this guy was advised (or even commanded) to do it.
I'd have just done chest compressions, it's better than nothing, and hands down better than getting a mouthful of disease ridden junkie puke. I probably would have told the dispatcher to fuck off regardless.
Like I said, CCC CPR is relatively new (I believe less than a year old, maybe two years old) and when I renewed my CPR cert a few months ago I was taught otherwise. CPR protocol changes every few years as research continually develops the field, so the info I am working with could be out of date in terms of the latest research. But, what I was saying is that even though the chest would re-inflate after every compression, there isn't enough volume exchange to result in adequate breathing. Compressing the chest a few inches isn't enough to expel adequate air from the lungs. Now, if the "micro-breaths" that tempest was citing above is going to be the new standard, then obviously I'll have to adjust my understanding of the issue. The primary role of CPR is to keep oxygenated blood circulating until an AED can shock the heart back, yes. The goal being, to keep the brain alive. Drowning is different because the chest compressions are actually designed to expel water out of the lungs, rather than circulate blood. Especially in children, sometimes clearing the lungs of water is enough to get people breathing again. CPR classes generally don't differentiate between these two issues because the technique for them is still the same (chest compression + rescue breaths) and the classes are designed to be as uniform and simple as possible, to avoid confusion. (And btw, CPR stands for cardiopulmonary resuscitation, in layman's terms it just means "restoring someone's pulse and breath," essentially.) (Note: I'm not a doctor.)
I think that it's going to be the new standard to non-medical people. In hospital and EMS, since they have ambu bags, will still be taught traditional CPR. Had a similar discussion with some co-workers last night and they've been told the same info. Officially, the AHA standards are still the same, so you never know if they'll change their minds before the next update. More on focus, I nearly did have to perform mouth to mouth on an old GI bleed last night. Someone asked me to pick him up from Nuke med, said he was stable, no monitor, no oxygen... Found him, he looked okay, got him to the wheelchair. Dude sits down, goes totally limp, eyes roll to the back of his head and becomes apnic. Awesome. I don't even know if this guy is a full code. I start sternal rubbing and feeling for a pulse. He's got one. The tech is scrambling to find an ambu bag, which they don't have in the suite. By the time she gets back the guy wakes up like nothing was wrong. He was about 30 seconds away from getting a stubbly kiss from yours truly. Focus: I find a heroin addict outside of the hospital setting? I'm just doing compressions. Oh, and a sandwich bag isn't going to do shit.
My understanding of one of the major reasons for dropping the breaths is that it takes too long in a situation where you don't have appropriate medical equipment. Even with two person CPR, the compressions have to stop to allowing the person giving the breaths to adjust the airway, deliver the breaths and release. That's now considered too much time without compressions being delivered. With proper equipment, it's only a very short interval to deliver air and resume compressions. As for why emergency services Victoria told the guy to perform mouth to mouth is probably because this country is still backwards and slow in adopting current medical procedures as standard outside of a hospital. A lot of trainers are still teaching outdated techniques that have been abandoned.
Question for the medical guys: How often does CPR actually work? One of my roommates was a paramedic, and he said that he could count on one hand the number of people who were actually saved by CPR. He admitted that most of the time, they were doing it on people who were completely fucked up as a "We're doing something cause we're medical people" activity, but he stood by his assertion that CPR, while the best thing you can do as a first responder, still doesn't do much. Does he know what he's talking about, or is he full of shit?
Last CPR course I took said that you can expect CPR to work only 2% of the time, which sounds about right. What you really need to save someone's life is a crash cart and a defibrillator (oh, and a good medical team). Ultimately, 2% is better than 0%, but it's still a pretty bleak figure.
2% is not an accurate figure. There's no static percentage because it depends greatly on the time between arrest and the start of CPR. I had a graph at one point that showed the survival rate based on response time and it declined rapidly after 3-5 minutes of non-respose (e.g. a non-witnessed arrest), too bad I don't have it anymore. In either case, I did a bit of googling and I got a lot of typical links like this one, where the survival rate is quite a bit higher in cities where people are quicker to get treatment (Las Vegas is apparently one of the highest because I guess so many more people are trained to respond to heart attacks, I'm assuming because they're more frequent there).
I guess it depends on what you mean by "working." CPR alone doesn't restart a heart. It's simply an attempt to keep blood flowing and maintain perfusion to vital organs until you can deliver drugs and/or defibrillate. The majority of the codes I have been a part of have been successful, and by successful I mean that we regained a normal heart rhythm. However, my experience is exclusively in hospital. I can't speak for EMS who are probably dealing with mostly unwitnessed arrests.
I literally just got back from an overnight at the firehouse last night (I'm an EMT), and I was talking about this with one of the master paramedics just last night. She told me that out of her many years in the fire service, she's successfully resuscitated three people with CPR, defibrillation, and drug delivery. The only thing that she said was that she doesn't count the people that she resuscitates but end up basically braindead. And how many codes has she run? Hundreds. So sure, CPR can work, but remember that even if it does, that person isn't necessarily going to be good as new. As for the whole doing CPR to put up a show idea, it's kind of a yes and no, from what I've seen. Experienced medics have run so many codes and understand that when they run one, the person will probably die (a lot of them say that the person is actually dead). But they aren't at the point where the CPR they're doing is half-assed. They still intubate, start IV lines, push drugs, and continue CPR and defibrillation all the way to the hospital, because you never know when your CPR is going to work well. Then again, I have heard stories where CPR has been performed on people who are seriously dead (our protocols say we don't need to initiate CPR when rigor mortis sets in, for injuries incompatible with life, etc.), but the CPR is basically done for the sake of the families so that they think efforts were made for their loved ones. To me, these two situations are pretty different. And yeah, I read over the new protocols for CPR (we're still operating under the old ones until June I believe), and as EMS providers, our protocol really doesn't change as far as giving ventilations along with CPR. The main point of the protocols, as I see it, is for bystanders who don't have the proper protective equipment and who haven't been trained to properly open an airway (because if you give breaths to a person with a closed airway, you might as well not give breaths). In that case, chest compressions are definitely better than sitting around and waiting for EMS.
I can't speak for other areas of the country, but I was taught if they're dead, they're dead, no use doing a bunch of stuff to the patient half assed or otherwise and get the family's hopes up. Furthermore, I looked at it as a safety issue. What if we were blasting through the city and got in an accident on the way to the hospital? No use in it at all. In ten years as a paramedic, I can't think up a number of times we successfully got someone back, but I can say it was more than "a handful". Two come to mind where they were sitting upright and extubated before I got the paperwork done. I think part of that may be a numbers game though, depending on where a medic lives and how many calls they run a year.
Some of you guys are better people than me...I keep thinking of a Pimp Named Slickback from The Boondocks beside my shoulder, yelling "This here's a HO!" everytime I got near that disease infested skank. There are losers and winners in life. Associate with the latter. (Except for charity and community service, that shit's cool)
The idea of CPR is to keep oxygenated blood circulating, thus giving vital organs the best chance of survival. It sounds like most of the EMS people on here have found that CPR in the field is mostly futile, which makes sense. Most than 3 minutes and you start to sustain brain damage. In the hospital setting, it's quite different. I've been a part of may codes where the end result was positive. As for organ transplantation. While the concept in theory holds some water (depending on time down), I don't know any person who has ever done CPR thinking "well, at least someone can use this guy's kidney." In fact, I'm not even sure if the donation guidelines will let you harvest from an unwitnessed arrest. I have been a part of a few donations, and the guidelines are pretty stringent.
I went through a few emails today that I'd put in the "not screaming at me to do something now" pile, and came across one on updated CPR guidelines as of December 2010 from the Australian Resuscitation Council. The guidelinesare: - Immediately start compressions and give rescue breaths at a ratio of 30 compressions to 2 breaths; but - If unwilling or unable to give ventilations, compression only CPR should be given. The emergency line operator wasn't complying with accepted industry guidelines when he told the guy he had to give the breaths in January.
I was actually in a situation like this. I was at work a few years ago on a hot summer day. Out of the blue a guy comes in to the shop and says: "You may want to call the police. There's a man who has 'expired' on the bus bench outside." I still remember that word, expired. Anyway, I dial 911 and go outside with the cordless phone. And there's this dirty, gross ass bum probably in his 60's is laid out on the bus bench. Mouth open, not moving, still clutching the dollar he had ready for the bus. A group of several people had gathered by this time all waiting for somebody to do something. The 911 operator picks up, I tell her what's going on. She instructs me to violently shake the guy and scream in his ear just in case he's just passed out drunk. I scream in his ear, punch him in his arms and shake the shit out of him. Nothing. No mumbling, nothing. She asks me to feel his chest and put my face by his mouth to see if he's breathing. Nothing. Dude is out like a light. Then she asks, "Do you feel comfortable doing CPR?" Let me tell you, this guy smelled like a dumpster. Like pure shit and garbage rolled together and set out in the sun. He was old, had a beard with all sorts of shit in it. Who knows what kind of disease he had rolling around in his blood. No fucking way was I putting my mouth on his. So I calmly told her, nope. Not gonna happen. Paramedics better hurry the hell up, because I had done as much as I was gonna do. Luckily, not more than 10 seconds later, Sheriff's deputies & EMS show up and screech to a stop. They jump out, throw the guy on the ground and get to work. They were able to get his heart started, loaded him up and took him away. Not sure what finally happened to him, but when they left the deputies were pretty confident he was going to be OK. So in short, no way I'm putting my lips on some gross strangers'.
For future reference, don't do that. Don't shake the shit out of them. Don't scream in the ear. And I don't know what possessed you to punch him in the arm. Gently but firmly shake at the shoulder (if there's no apparent injury) and talk to them in a clear voice. If no response, check for respiration. If there is, try a chest rub where you vigorously rub your second knuckles on the sternum along its length. Guaranteed response unless they're unconscious. You can check for respiration if they're on the ground by lying them flat, turning your ear towards their mouth and nose and looking down the body. Listen for and feel for air movement and watch to see if the chest is rising and falling. This is also good to see if the movement is not bilaterally equal.