by Susan Hellauer
It happens about 350,000 times a year in the US, and it can happen anywhere: the mall, the office, the park and, most commonly, your own home. Out-of-hospital cardiac arrest, often with no warning at all, offers slim hope for survival—less than 10%, according to the American Heart Association (AHA).
Now, with changes to guidelines for “bystander CPR,” the AHA is taking aim at those grim statistics—but they need your help.
Hands-Only CPR for more “saves”
For decades, CPR protocol has included “rescue breaths,” along with the essential chest compressions that keep blood circulating to the brain until more aggressive resuscitation methods can be used. Outside of a healthcare setting—say at a park or playground—those rescue breaths would have to be administered “mouth-to-mouth,” and that requirement alone was enough to make unacquainted bystanders unwilling to get involved.
So the AHA changed its tack, and is now pushing a new kind of bystander CPR called Hands-Only. It dispenses with the rescue breaths, and focuses on two simple steps: 1) Call 9-1-1 and 2) push hard and fast in the center of the chest until help arrives. The ideal tempo? About 100 beats per minute—the precise tempo, coincidentally, of the BeeGee’s 1977 disco hit “Stayin’ Alive.”
Simple, clean, effective
Hands-Only CPR is simple, it’s easy to remember, and, because bystanders are willing to carry it out, it’s effective. A teen’s or adult’s blood contains enough oxygen at collapse to nourish the brain for several minutes of CPR without rescue breaths. And that’s just about how long it takes for EMS to arrive and start rescue breathing and defibrillation.
Why is bystander CPR so important? Without circulation to the brain, the chance of a mentally intact survival plummets with every minute of that five-minute wait for the ambulance. Chest compressions that start immediately will double or triple the odds of recovery. And if you don’t believe it, just take a look at Seattle and its surrounding King County, Washington. Public health officials there have made a major effort to train citizens, including all high school students, in CPR, and have undertaken intensive re-training of first responders. The survival rate for witnessed cardiac arrest more than tripled there, making it the highest in the U.S.
High School Hands-Only
There’s one CPR booster around here who needs no convincing. Nyack High School physical education instructor Emily Dempsey’s own father was saved by bystander CPR several years ago and now, along with her department colleagues, she teaches a Hands-Only CPR course once a year to all N.H.S. students. Dempsey designed and implemented the project last spring, realizing a long-standing goal, and conforming with a new N.Y. State requirement that all high schools teach CPR.
“The students are taught Hands-Only and learn to use an AED (Automated External Defibrillator),” said Dempsey in a phone conversation. “We go over child and infant CPR hand positions,” which differ from the two-hand teen and adult techniques, “but we only have the adult dummies.” Dempsey and her phys. ed. and health department colleagues are looking into ways to get certified to teach a higher level of CPR to their students.
How have N.H.S. students been reacting to learning these new skills?
“In the beginning they were unsure, because they wanted to be moving around in the gym instead, but they’ve ended up really liking the lesson,” Dempsey said. “We use a fun video from the AHA, and you can hear students singing the song ‘Stayin’ Alive’ in the halls for the rest of the day.”
Answers to your CPR questions
Learn Hands-Only by watching a video, or in person at a group event, or from a certified instructor. Use of community AED may be taught in some live classes.
Family and Friends adds rescue breathing (mouth-to-mouth or with a barrier device to prevent contamination), use of community AED devices, airway obstruction, and optional training in CPR for infants and children.
AHA “Heartsaver” courses add naloxone (opioid overdose reversal) training and come with a 2-year certification card.
Basic Life Support is CPR for the healthcare setting, with team response and rescue breathing apparatus.
Anyone can watch an AHA Hands-Only CPR video and be ready to act in an emergency. But there are bound to be questions. Willie Ray White is the Training Officer at Nyack Community Ambulance Corps (NCAC), where he’s been a member since 1987, and has taught CPR to 500+ people. When not volunteering at NCAC, he works as a professional Emergency Medical Technician and also runs his own business teaching CPR and first aid. White answered my questions at the NCAC corps building on Midland Avenue.
What if I do CPR on a stranger and I’m not successful, or someone says I did it wrong? Can I get in trouble?
If you’re not being paid to provide rescue services, you’re protected from liability under the New York State “Good Samaritan Law.”
What if I push too hard and break a person’s rib?
Yes, it’s possible that you could break a rib. But we can fix a broken rib if we revive the patient.
The online instructions say that I should do this on an adult or teen who has collapsed. What about a child or infant?
The online Hands-Only instructions don’t show you correct hand placement on infant or child. You can find out more about this with another kind of CPR training (see box).
The instructions online say that I should call 9-1-1 first. But what if a phone or other help is not nearby?
Do CPR for at least two minutes and then go find help. And when you call, always be clear and specific about your location. Dispatch normally can’t find you via your cell phone’s GPS.
How do I know if the person is not breathing? What if I make a mistake about that?
First shake your patient by the shoulders and shout “Hey, are you okay?” Observe for chest movement for a couple of seconds. If there’s no response, and no air seems to be moving, start CPR. It’s better to do compressions when in doubt. Just stop if the person wakes up.
If I live with someone with a heart condition, should I get special training, or is Hands-Only CPR my best bet?
You should take a regular CPR class, which will include use of an AED, and hand placement for child and infant CPR, along with rescue breaths and dealing with airway obstructions. Babysitters and new parents should consider this as well.
Where can I learn CPR in person? I’d feel better about it if I could practice it first.
You can check with the American Heart Association or the American Red Cross for nearby courses, or do an online search for “CPR training.” Some members of Nyack Ambulance (845 358 4824) are certified instructors who run private businesses that provide CPR instruction.
I have no medical experience at all. Can I really learn this?
Yes. And in my opinion, it’s everyone’s obligation. Just do it.
American Heart Association’s Hands-Only CPR with video
AHA Spotify Hands-Only CPR playlist: more songs to keep the CPR beat
British Heart Foundation Hands-Only demo with good detail of hand position
Real cardiac arrest and save by British medics, including defibrillation.
Sustainable Saturday is working to set up Hands-Only CPR community training in Nyack. Stay tuned.
Sustainable Saturdays, a weekly feature that focuses on conservation, sustainability, recycling and healthy living, is sponsored by Green Meadow Waldorf School, Maria Luisa Boutique and Strawtown Studio.