Homepage / Administration & Leadership / #HM12DoC 4 Fibbing V-Fibbers
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Administration & Leadership, EMS, EMS 2.0, Patient Care, Rescue, Safety

#HM12DoC 4 Fibbing V-Fibbers

On the fourth Day of Christmas Happy Medic gave to me…

4 Fibbing V-Fibbers

3 Tripple Os

EMS 2.0

and a British Medic dressed in green

“Witnessed Arrest” is not as black and white as we would like.  Does that mean a person watched their EKG change from a somewhat normal or non fib rhythm to V-Fib?  Did they witness someone slump over, seemingly unconscious?  Perhaps their blood pressure tanked, or a CVA struck, but how does the person standing there in line at the market know when the heart of the woman behind the register went into fib?  By the time my engine makes it through the traffic and into the busy parking lot 3 minutes have passed since the call was received.

Arguably one of the better response times in the nation is nothing if the information given to us is not accurate and especially not if the only thing happening for our fibbing heart is a load of positive thought from the gathering crowd.

I can count on one hand the number of times I have arrived in a public place and seen CPR being performed on a person who needed it.  That observation includes my entire public safety experience, now at 18 years, not just time in my current system.

CPR can be very uncomfortable for the woman in the nursing home trying to fight off her would be rescuers (caretakers) and does little for the man decapitated in the motor vehicle collision.  But now that we’re taking away the yucky mouth to mouth component to traditional CPR, perhaps more folks will start to get involved when their fellow citizens fall unconscious.

But that still won’t solve the “witnessed arrest” issue will it?

Not until we have a wide spread Public AED program will the concept of a witnessed arrest make sense to me.  It is possible that if we have a well trained, well armed armada of first responders in waiting, then less arrests will be witnessed and we can change the term to witnessed conversion prior to EMS arrival.

Lofty dreams indeed, but if we can get them into airports, schools and shopping malls, how about Doctor’s offices, care homes, police cars, mail delivery vans, school buses, taxi cabs…need I go on?

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20 Comments

  1. Timothy Clemans December 17, 2010 7:29 pm

    Having AEDs at airports doesn’t solve the problem that many police officers responding to arrests waste a lot of time trying to kick a person back to life. My opinion is an unconscious person not breathing normally should get CPR until proven not to be in arrest. If we want to save cardiac arrest patients this is the price we have to pay.

    • Easyduzit25 December 17, 2010 8:36 pm

      UMMMM part of the training for AED’s runs hand and hand with CPR in fact you are doing your checks to begin CPR while someone is fetching The AED and you dont stop pumping for long if at all in order to place the electrodes and then turn the AED on letting it run its checks CPR is only interuppted for “SHOCK ADVISED” “CLEAR” ( I’m Clear, you’re clear, we are all clear) ~shock~ Breathing, pulse checked. CPR continues.

    • the Happy Medic December 17, 2010 11:40 pm

      “My opinion is an unconscious person not breathing normally should get CPR until proven not to be in arrest.”
      This policy will anger many diabetics. We should stick to the training and the voice prompts on the AEDs. If there is a pulse, perhaps still attach the machine, but it will not shock if the rhythm is not indicated.
      My point wasn’t that PD is “wasting time” but that many PD cars still do not have this piece of equipment but are still sent to these calls.

      • Timothy Clemans December 18, 2010 12:02 am

        Are these diabetic patients breathing normally?

        My wasting time comment refers to three separate incidents where police failed to rapidly identify cardiac arrest and a third party made the decision to start CPR. The one incident I observed in 08 JetBlue personnel grab one of the nearby AEDs after about ten minutes of the police kicking the patient.

        If you want high survival rates then you can’t waste time waiting for confirmation. High performing communities including Wake County, Boston, and Austin understand this.

  2. Timothy Clemans December 17, 2010 7:29 pm

    Having AEDs at airports doesn’t solve the problem that many police officers responding to arrests waste a lot of time trying to kick a person back to life. My opinion is an unconscious person not breathing normally should get CPR until proven not to be in arrest. If we want to save cardiac arrest patients this is the price we have to pay.

    • Easyduzit25 December 17, 2010 8:36 pm

      UMMMM part of the training for AED’s runs hand and hand with CPR in fact you are doing your checks to begin CPR while someone is fetching The AED and you dont stop pumping for long if at all in order to place the electrodes and then turn the AED on letting it run its checks CPR is only interuppted for “SHOCK ADVISED” “CLEAR” ( I’m Clear, you’re clear, we are all clear) ~shock~ Breathing, pulse checked. CPR continues.

    • the Happy Medic December 17, 2010 11:40 pm

      “My opinion is an unconscious person not breathing normally should get CPR until proven not to be in arrest.”
      This policy will anger many diabetics. We should stick to the training and the voice prompts on the AEDs. If there is a pulse, perhaps still attach the machine, but it will not shock if the rhythm is not indicated.
      My point wasn’t that PD is “wasting time” but that many PD cars still do not have this piece of equipment but are still sent to these calls.

      • Timothy Clemans December 18, 2010 12:02 am

        Are these diabetic patients breathing normally?

        My wasting time comment refers to three separate incidents where police failed to rapidly identify cardiac arrest and a third party made the decision to start CPR. The one incident I observed in 08 JetBlue personnel grab one of the nearby AEDs after about ten minutes of the police kicking the patient.

        If you want high survival rates then you can’t waste time waiting for confirmation. High performing communities including Wake County, Boston, and Austin understand this.

  3. Rdj24fan December 17, 2010 8:57 pm

    All the ad’s say if someone suddenly drops then just start pumping, sorry but I feel somewhere in there there should check for a pulse or a least check for breathing. I feel a lot of unneccasary damage could be done as not everbody passing out is having a coronary. Personally I don’t like the ad, I you want to be helpful than take a cpr course

    • the Happy Medic December 17, 2010 11:42 pm

      I agree to a point. we should still be stressing learning full adult and infant CPR, but emphasizing there is no longer a need for rescue breathing will increase the chance someone, anyone will step forward when a pulseless person goes down and start compressions.

      • Easyduzit25 December 18, 2010 12:47 am

        I believe AED’s should be placed in alot more places with training for a large amount of people who have access to the AED. The New CPR guidelines will hopefully help bystanders to step in more often. The only bad thing I see with the new guidelines is i have seen different schools of thought for EMS one states that we dont need to provide rescue breathing, the other states the red bloodcells and hemo globin can only support the bodies O2 needs for around 10 minutes (enough time for most EMS systems to get a provider to the patient) at which time if there isnt a return of pulse we can drop a tube and provide O2 without having to interupt Chest compressions. so I am leaning more towards the 30 and 2 of the old CPR once the EMS provider gets there. What is everyone elses opinion on this?

        • the Happy Medic December 18, 2010 3:30 am

          Opinion doesn’t enter into it. They dropped the mouth to mouth in hopes of more bystander interventions, something the high survival communities are reporting. We also note that systems where providers had been doing fast and strong compressions had better survival rates.
          The O2 in the hemoglobin is only part of the problem, since the build up of acids returning to the heart as soon as we do arrive and begin compressions is detrimental.
          Indeed rescuers do need to address oxygenation via ventilation, and quickly, but bystanders were withholding compressions BECAUSE of having to include mouth to mouth.
          Indeed 30-2 is nice, but that 30 part needs to be hard, fast and consistent to matter, and the 2 slow steady and targeted to the lungs.

    • Medic-Minx December 21, 2010 4:38 pm

      Well said. Apparently checking for a pulse is being overlooked. I cannot tell you how many times I have walked into a “cardiac arrest” to find the “skilled nursing staff” performing compressions on someone that is gasping for them to stop. Rule 1. If they’re breathing (even agonal resp which is not considered quality breathing and needs intervention is still breathing on their own) they HAVE a pulse! Compressions on an already beating heart isn’t helping the person out.

      Checking for other causes of why they are unconscious (sugar, blood pressure, allergic reaction, heat, anxiety? etc…)

  4. Rdj24fan December 17, 2010 8:57 pm

    All the ad’s say if someone suddenly drops then just start pumping, sorry but I feel somewhere in there there should check for a pulse or a least check for breathing. I feel a lot of unneccasary damage could be done as not everbody passing out is having a coronary. Personally I don’t like the ad, I you want to be helpful than take a cpr course

    • the Happy Medic December 17, 2010 11:42 pm

      I agree to a point. we should still be stressing learning full adult and infant CPR, but emphasizing there is no longer a need for rescue breathing will increase the chance someone, anyone will step forward when a pulseless person goes down and start compressions.

      • Easyduzit25 December 18, 2010 12:47 am

        I believe AED’s should be placed in alot more places with training for a large amount of people who have access to the AED. The New CPR guidelines will hopefully help bystanders to step in more often. The only bad thing I see with the new guidelines is i have seen different schools of thought for EMS one states that we dont need to provide rescue breathing, the other states the red bloodcells and hemo globin can only support the bodies O2 needs for around 10 minutes (enough time for most EMS systems to get a provider to the patient) at which time if there isnt a return of pulse we can drop a tube and provide O2 without having to interupt Chest compressions. so I am leaning more towards the 30 and 2 of the old CPR once the EMS provider gets there. What is everyone elses opinion on this?

        • the Happy Medic December 18, 2010 3:30 am

          Opinion doesn’t enter into it. They dropped the mouth to mouth in hopes of more bystander interventions, something the high survival communities are reporting. We also note that systems where providers had been doing fast and strong compressions had better survival rates.
          The O2 in the hemoglobin is only part of the problem, since the build up of acids returning to the heart as soon as we do arrive and begin compressions is detrimental.
          Indeed rescuers do need to address oxygenation via ventilation, and quickly, but bystanders were withholding compressions BECAUSE of having to include mouth to mouth.
          Indeed 30-2 is nice, but that 30 part needs to be hard, fast and consistent to matter, and the 2 slow steady and targeted to the lungs.

    • Medic-Minx December 21, 2010 4:38 pm

      Well said. Apparently checking for a pulse is being overlooked. I cannot tell you how many times I have walked into a “cardiac arrest” to find the “skilled nursing staff” performing compressions on someone that is gasping for them to stop. Rule 1. If they’re breathing (even agonal resp which is not considered quality breathing and needs intervention is still breathing on their own) they HAVE a pulse! Compressions on an already beating heart isn’t helping the person out.

      Checking for other causes of why they are unconscious (sugar, blood pressure, allergic reaction, heat, anxiety? etc…)

  5. John Broyles December 18, 2010 4:49 pm

    an AED in a school bus. That’s something that the state will have heartburn with and the company I work for will say “DO NOT TOUCH”. I can’t even do first aid by company policy.

    Damn, I need to get a full time job on an ambo service

  6. John Broyles December 18, 2010 4:49 pm

    an AED in a school bus. That’s something that the state will have heartburn with and the company I work for will say “DO NOT TOUCH”. I can’t even do first aid by company policy.

    Damn, I need to get a full time job on an ambo service

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