Cardiopulmonary resuscitation , also known as the CPR acronym is an emergency procedure performed in an attempt to maintain permanent brain function until further action is taken to restore the spontaneous blood circulation and breathing of a person experiencing cardiac arrest. This is a first aid skill but is proven first, practiced all over the world. This is an effective method to keep the heart attack victims alive long enough for the definitive treatment to be administered (usually defibrillation and intravenous heart medication).
Before the start of Lung Heart Resuscitation, there were several techniques to keep people alive in the 18th century, both in Japan and in Europe, but it was not until the middle of the twentieth century that James Elam and Peter Safar discovered and published methods now known as CPR. Safar conducts research on existing basic life support procedures including controlling one's airways by tilting his head open-mouthed; and use mouth-to-mouth breathing. He combines this with a procedure known as chest enclosed heart massage to become a basic life support method of CPR.
Throughout his life, Safar hesitated to take credit for "creating" CPR. The way he sees it, he only explains the effective procedure that humans have found, puts them together into what he calls "ABC" - maintaining Airway, Breathing and Circulation patients. He worked hard to popularize procedures around the world and collaborated with Norwegian toy maker Asmund Laerdal to create "Resusci Anne," a CPR training mannequin. Laerdal is now a manufacturer of medical equipment.
Safar also created the first guidelines for large-scale emergency medical services, or EMS; he founded the International Center for Resuscitation Research (IRRC) at the University of Pittsburgh, which he directed until 1994; and he was nominated three times for the Nobel Prize in medicine.
Video History of cardiopulmonary resuscitation
First attempt to resuscitate in the 18th century
In August 1767, some wealthy and civil-minded citizens in Amsterdam came together to form the Society for the Restoration of the Drowned. This society is the first organized effort to respond to sudden death.
Community techniques involve various methods to stimulate the body. Community members recommend:
- warms the victim;
- dispose of swallowed or aspirated water by positioning the victim's head lower than the foot;
- apply manual pressure to the stomach;
- respiration to the victim's mouth, either using a bellows or by mouth-to-mouth method;
- tickling the victim's throat;
- 'stimulate' the victim in ways like rectal and oral fumigation with tobacco smoke; Bellows are used to encourage tobacco smoke, known to irritants, to the intestines through the anus, since this is considered sufficient from stimulants to cause a response in "almost" to die; and
- bloodshed.
Communities in Amsterdam claim to have saved 150 people, within four years of its establishment, with their recommendations.
These first four techniques, or variations, are in use today.
Following the success of this first society, rescue societies soon emerged in most European capitals, all with the intention of finding ways to successfully awaken sudden death victims. This theory proved so popular that Hamburg, Germany passed a regulation in 1769 by giving notice to be read in churches describing aid to drowned, strangled and frozen people and those treated with dangerous gases, perhaps the first example of training medical bulk. The Royal Humane Society in London, founded in 1774, serves as a model for communities in New York, Philadelphia, and Boston. This 18th century rescue community is the precursor of emergency medical services today.
A similar technique is described in the early twentieth century jujutsu and judo books, used since the early 17th century. The New York Times correspondent reported that the techniques were successfully used in Japan in 1910. In jujutsu (and later, judo), the technique is called kappo or kutasu
Maps History of cardiopulmonary resuscitation
Modern resuscitation
Scientists and doctors began to try and tackle problems from many different facets including developing new drugs, designing new surgical techniques and identifying risk factors. Doctors James Elam, Peter Safar and Archer S. Gordon manage to educate the world about respiratory rescue, precautions and try to find ways to treat acute heart attacks.
Gordon initially did not support rescue breathing until he conducted his own research using pediatric patients, reproducing Elam's results. Safar has also worked on the feasibility of rescue breathing, so they agree that joint efforts will be far more valuable than each work separately and may reproduce their respective work.
Prior to the 1950s, the accepted method of resuscitation was a chest-pressure and arm-lift technique that was proven ineffective by Safar and Elam. In 1954, Elam was the first to show experimentation that the exhaled air vents were sound techniques. Elam and Safar (and later Gordon) conducted many experiments showing the superiority of rescue breathing techniques. The problem then became one of the methods that popularized.
Organizations such as the American Red Cross provide training in local chapters in proper administration of artificial respiratory procedures. The Red Cross has taught this technique since the mid-1950s. For example, in Kalamazoo, Michigan, volunteer Roger Mehalek introduced a breathing coach named Miss Sweet Breath 1959, a plaster and plastic training mannequin he made.
In New York, then State Health Commissioner Herman Hilliboe was impressed with this technique. He commissioned Elam to write an instruction book entitled Rescue Breathing, which was nationally distributed in 1959. The success of the booklet spurred Elam to produce a film demonstrating this new life-saving technique.
In the 1960s, respiratory rescue was adopted by the National Academy of Science, the American Society of Anesthesiologists, the New York State Society of Medicine and the American Red Cross as the preferred resuscitation method.
Some key inventions and insights are needed to deal with problems, which will take decades to succeed, and even now are not 'solved'. Doctors talk about the natural history of the disease as a way to understand how therapies alter the development of common ailments. For example, a natural history of breast cancer can be measured in a few months but treated with surgery or chemotherapy this disease can be measured in years or even cured. Sudden cardiac arrest is a disease with a very rapid natural history, measured in minutes, with unavoidable results. But when treated with CPR, the death path may be prolonged (CPR will delay the death process) and if treated with appropriate death defibrillation can be canceled.
The modern elements of resuscitation for sudden cardiac arrest are cardiopulmonary resuscitation (CPR in turn consists of mouth-to-mouth and chest compressions), defibrillation and emergency medical services (a means to bring this technique to the patient quickly).
Verbal mouth-to-mouth
For a long time before it was formalized, it was well known to doctors and midwives that mouth-to-mouth resuscitation could be useful in carrying a live baby without life around. In 1946, during the middle of the polio outbreak, the anesthesiologist James Elam applied this principle to an older child in an emergency situation. Elam describes the show in his own words, "I was wandering around to get to the ward when the corridor was in a double race - a nurse pulled him and two spells pushed him, and the child above was blue.I went into total reflex behavior, I stepped out in the middle of the corridor, stopped the gurney, grabbed the sheets, wiped the excess mucus from his mouth and face,... sealing my lips around his nose and puffing his lungs pink.
On the night before this rediscovery, Elam reads a chapter on the history of resuscitation in which mouth-to-mouth ventilation for the newborn is described. He praised this chapter for his "reflex behavior." Elam's spirit causes his evangelism about the benefits of mouth-to-nose ventilation. He set out to prove that the exhaled air was sufficient to oxidize the non-breathing person. In 1951, Elam became a staff of the Department of Anesthesiology at Barnes Hospital in St. Petersburg. Louis, Missouri. When he will begin his research into CO 2 homeostasis, the newly appointed department chairman wants all research in anesthesiology done using animals, not humans. Elam realized this would not be feasible and moved to the Buffuel Roswell Park Memorial Institute along with his two principal collaborators, Elwyn S. Brown, MD, and Raymond H. Ten Pas, MD He obtained permission from the head of surgery to conduct a study on postoperative patients before anesthesia ether missing. In this study, he showed that the expired air that was blown into the endotracheal tube retained normal oxygen saturation.
A few years later James Elam met with Peter Safar, also an anesthesiologist, convincing him to join in an effort to convince the world that the expired air vent was effective. Safar conducted a series of experiments using a paralyzed individual to show that this technique can maintain adequate oxygenation. Peter Safar explains the experiment:
"Thirty-one doctors and medical students, and one nurse willingly... Approval is very informed All volunteers should observe me giving an anesthetized and curved patient vent without a tracheal tube I drugged the volunteers and paralyzed them for several hours each Blood O2 and CO 2 were analyzed.I demonstrated this method to more than 100 laymen who were then asked to perform methods on the twisted volunteers. "
This experiment provides interesting data to switch from manual to mouth-to-mouth ventilation. The United States military received and certified the method in 1957 and the American Medical Association followed it in 1958 May 17, 1958 Edition JAMA contains the following support: "The skilled performance of expired airborne breathing is an easy-to-learn and life-saving procedure. unresponsive to other methods and has been proven in real emergencies under field conditions Information about expired airborne breathing should be widely disseminated. "
Chest compression
Unlike the cessation of respiration, clear signs of sudden death, circulatory cessation, and especially heart rhythm, are not easily found for the lay watcher, although trained eyes can now see signs such as lack of perfusion. Perhaps as a result of this being less clear, the appreciation of artificial circulation as a key factor in resuscitation lags far behind the obvious need for artificial respiration.
If the scientists who work on the matter appreciate the need to circulate blood, there is no effective way to do it. Although a closed chest massage was described in 1904, its benefits were not appreciated and anecdotal case reports were of little use to promote the benefits of closed chest massage. The prevailing beliefs are described in a doctor's quote from 1890, "We are powerless against the circulatory paralysis."
The formalized chest compression system was an unintentional discovery made in 1958 by William Bennett Kouwenhoven, Guy Knickerbocker, and James Jude at Johns Hopkins University. They are studying defibrillation in dogs when they realize that by applying a forced paddle to a dog's chest, they can reach the pulse in the femoral artery. More rigorous experiments involving dogs answer fundamental questions such as how fast to press, where to press, and how deep to press. This information gives them confidence that they are ready for human trials.
The first person to be rescued by this technique was called by Jude: "He is rather a fat woman who... has a cardiac arrest due to flurothane anesthesia.This woman has no blood pressure, no pulse, and usually we will open up to her chest. instead, as we are not in the operating room, we apply an external cardiac massage, the blood pressure and pulse return immediately.We do not have to open his chest They go forward and do surgery on him, and he's fully recovered. "
In 1960, three researchers reported their findings on 20 cases of heart attacks at hospitals in JAMA. Fourteen of the 20 patients (70%) survived and were discharged from the hospital. Many patients experience cardiac arrest due to anesthesia. Three patients documented were in ventricular fibrillation. Chest compression duration varies from less than 1 minute to 65 minutes. The JAMA article is very simple: chest compression buys time until an external defibrillator arrives on the scene. As the authors wrote in the article, "Anyone, anywhere, can now start a cardiac resuscitation procedure that takes just two hands". However, respiration received relatively little attention in the 1960 JAMA article. Many patients have been intubated and thus the need for mouth-to-mouth ventilation is not necessary. However, it was not long before the newly discovered technique was used along with longer-lasting artificial respiration techniques.
Use of shared compression and ventilation
The formal relationship of chest compression with mouth-to-mouth ventilation to create CPR as practiced today occurs when Safar, Jude, and Kouwenhoven presented their findings at the Maryland Medical Society's annual meeting on September 16, 1960 in Ocean City. In the opening address, the moderator said, "Our goal today is to bring to you, then, this new idea." It's so new that it's still nameless. The moderator states that the two techniques "can not be considered longer as separate units, but as part of a comprehensive and complete approach to resuscitation". In his speech, Safar stressed the importance of combining ventilation and circulation. He presented convincing data that chest compression alone did not provide effective ventilation; mouth to mouth respiration must be part of the equation.
To promote CPR, Jude, Knickerbocker, and Safar embarked on a world tour. In 1962 Gordon, along with David Adams, produced a 27-minute training film called "The Pulse of Life." The film is used in CPR classes and is seen by millions of students. For the film, Gordon and Adams designed the mnemonic A, B & amp; that is easy to remember. C stands for the sequence of steps in CPR, airway, breathing, circulation. However the sequence has been revised to C, A, B, placing emphasis on the first compression. The reason is that the oxygen reserves in the body have been found to be adequate to maintain blood oxygenation.
In 1963, cardiologist Leonard Scherlis started the CPR Committee of the American Heart Association, and in the same year, the Heart Association officially endorsed CPR. In May 1966, the National Research Council of the National Academy of Sciences held an ad hoc conference on cardiopulmonary resuscitation. The conference is a direct result of requests from the American National Red Cross and other agencies to set standard training and performance standards for CPR. More than 30 national organizations are represented at the conference. The recommendations of this conference were reported in JAMA in 1966.
Defibrillation
In the early 1930s it was discovered that electric shocks, even small shocks, could induce ventricular fibrillation in the dog's heart and a stronger shock could reverse fibrillation. This preliminary study was funded by the electric industry concerned about fatal accidents for linemen. Claude Beck, professor of surgery at Western Reserve University (later Case Western Reserve University) in Cleveland worked for many years in techniques for human heart defibrillation. Beck believes that electricity can equally benefit surgical patients whose hearts undergo fibrillation during surgery or induction of anesthesia.
Beck probably witnessed his first heart attack during his internship in 1922 while undergoing surgery at Johns Hopkins Hospital. During urological surgery, the anesthesiologist announces that the patient's heart has stopped. To surprise Beck, the surgical resident took off his glove and went to the phone in the corner and called for the fire department. Beck remained completely bewildered as the firefighter rescue team rushed into the operating room 15 minutes later and used an oxygen-powered respirator to the patient's face. The patient died, but the episode left an indelible impression on him. Beck will continue to develop techniques to take back the cardiac arrest management of the fire department and place it in the hands of surgeons.
Beck realizes that ventricular fibrillation often occurs in a basically healthy heart and he creates the phrase "The heart is too good to die." In 1947, Beck completed his first successful resuscitation on a 14-year-old boy using an open chest massage and internal defibrillation with alternating current. The boy is in surgery for an inborn congenital funnel. In all other ways, the boy is normal. During the closing of a large incision in the chest, the pulse suddenly stops and the blood pressure drops to zero. The boy is in a heart attack. Dr Beck immediately reopened the chest and started a manual heart massage. When he sees and feels his heart, he realizes that ventricular fibrillation is present. The massage was continued for 35 minutes at the time the electrocardiogram was taken which confirmed the presence of ventricular fibrillation. Another 10 minutes pass before the defibrillator is taken to the operating room. The first shock using a pedal electrode placed directly on the sides of the heart did not work. Beck is given an amide procaine, a drug to stabilize heart rhythm. Beck gives a second shock that removes fibrillation. In a few seconds, weak, regular, and rapid heart contractions occur. Blood pressure increases from zero to 50 millimeters of mercury. Beck notes that the heart rate is fixed and sees that the pressure is slowly rising. Twenty minutes after successful defibrillation, the chest wound is closed. With three hours, blood pressure rises to normal levels, and the child wakes up and is able to answer questions. The boy recovered completely, without any nerve damage.
Beck pioneered internal heart defibrillation. In other words, the chest should be open and the defibrillator pedal placed directly in the heart. It is a ground-breaking work but soon it will be eclipsed by devices that can externally defibrillate the heart through a closed chest.
For Paul Zoll, very aware of Beck's achievements, the development of an external defibrillator is a natural extension of his previous work with an external pacemaker In 1955 a 67-year-old man survived several episodes of ventricular fibrillation, thanks to Zoll's external defibrillator, and returned home from hospital a month later. Over a four-month period, Zoll managed to stop ventricular fibrillation eleven times in four different patients. The energy required for defibrillation ranges from 240 to 720 joules. Zoll's findings were published in the New England Journal of Medicine in 1956.
Defibrillators designed by Zoll, as well as previous versions created by Kouwenhoven and Beck, use alternating current and run from the mains voltage, electricity from the socket. The decision to use alternating current rather than direct current is practical. Direct current batteries and capacitor technology are powerful enough to do the job and portable enough for practical use did not exist in the early 1950s. These AC defibrillators are very large and heavy, especially since they contain transformers to increase line voltage from 110 volts to 500 or 1000 volt . The only good feature is that they can be mounted on wheels and pushed down the hall from one part of the hospital to another. Not many lives will be saved unless the inherent AC defibrillator's inability can be resolved.
Portability problem solved by Bernard Lown. Lown designed a defibrillator that uses direct current instead of alternating current. A series of animal experiments on dogs in 1960 and 1961 and clinical use in patients in the early 1960s determined that DC shocks were very effective in shocking the heart. What's more, it is clear that DC is actually safer than air conditioning when applied through the chest wall. With direct current, it is possible to use the power, provided by the battery, to charge the capacitor for a few seconds. The capacitor stores energy until it is released in one large shock to the chest wall. The availability of new small capacitors greatly reduces the size and weight of the device. The defibrillator can now travel to the patient.
First out of hospital defibrillation
The National Highway Safety and Traffic Act of 1966 authorized the Ministry of Transport to establish a national curriculum for pre-hospital personnel, which led to the training of emergency medical technicians (EMT). EMT does a lot to improve the general performance of ambulance services across the United States. Their 80-hour course and certification, including CPR, ensures that appropriate care will be provided to victims of motor vehicle accidents and other emergencies. Thus they can provide artificial ventilation and a closed chest massage at the scene and on the way to the hospital.
However, EMT is not trained or authorized to provide definitive care for cardiac arrest. They can not provide defibrillation; intravenous drugs; or advanced airway control, such as endotracheal intubation. EMT rescues little, if any, victims of sudden cardiac arrest, mostly because heart attacks occur mostly in people's homes. The time it takes for EMT to arrive and transport the patient to the nearest emergency department is too long to reach resuscitation in order to succeed. Even imperfect CPR can save lives if too long for defibrillation and other advanced procedures occur.
In 1965, Frank Pantridge turned his attention to the irritating problems of heart attack and sudden cardiac death. The sensitivity to the problem comes from two sources. First, personnel in the emergency departments of the Royal Victoria Hospital in Belfast often comment on the number of patients who died on arrival (DOA). Secondly, Pantridge recently read a study in medical journals that indicated that among middle-aged or younger men with acute myocardial infarction (MI), more than 60% died within 1 hour of symptom onset. Thus the problem of death due to acute MI should be solved outside the hospital, not in the emergency room or coronary care unit. "The majority of deaths from coronary attacks occurred," he wrote, "outside the hospital, and nothing was done about them." It became very clear to me that the limited coronary care unit to the hospital would have minimal impact on death. " He wants a coronary care unit in the community.
Pantridge's solution is to develop the world's first coronary heart care unit, or MCCU. He arranged it with an ambulance driver, a doctor, and a nurse. Pantridge encountered many obstacles to create MCCU. He deals with them in a distinctive direct style, with determination for success and transparent humiliation for politicians and authority figures who oppose it. Even his cardiologist colleagues are skeptical. "My noncardiologist medical colleague at the hospital is completely unsure and totally uncooperative," Pantridge said. "It's considered unorthodox, if not illegal, to send junior hospital personnel, doctors, and nurses outside the hospital." Pantridge's new program began operations on January 1, 1966.
John Geddes is a resident in cardiology at Royal Victoria Hospital in Belfast and works at the Pantridge service. As a member of the junior team, it was Geddes's responsibility, which he shared with four other residents in the service, to ride a newly baptized ambulance when called to serve.
Why this breakthrough in cardiac care took place in Belfast, from all places? Geddes thinks he knows the answer:
"I will say two reasons: One is Pantridge himself, he is an incredibly persuasive personality, he can persuade people to do something, and... actually makes them happy to do the things he has done them because they were successful So there was tremendous enthusiasm behind the system, Then there was the fact that the [Royal Victoria] hospital layout was flat and fast and easy to reach people and make them aware.I was not aware of this in time, but I then visit hospitals in various parts of the UK They have slow lifts and so on, and you will never be able to move around the hospital quickly with any emergency equipment. "
The success in the hospital ward made them believe that success in the community would be possible. So it is a combination of hospital architecture and the driving force of a doctor and a persuasive personality that gives a boost to this breakthrough. But one can not ignore the existing resuscitation infrastructure: mouth-to-mouth ventilation, chest compression, and portable defibrillation. Without each of these three elements, the Belfast program will be a waste of time and effort.
The team reported the preliminary results of their program in The Lancet August 5, 1967 edition; Their findings in 312 patients covered a 15-month period. Half of patients had MI and no death during transport. The most important is information about 10 patients who have a heart attack. All have ventricular fibrillation; six arrests occurred after the arrival of the MCCU, and four occurred shortly before the arrival of the ambulance. All 10 patients were resuscitated and hospitalized. Five were then thrown away alive. This article has an important history as it serves to stimulate pre-hospital emergency heart care programs around the world.
The Belfast system was established to reach patients with acute myocardial infarction. Resuscitated patients are those whose heart has fibrillation after an ambulance is on the scene or on the way. The system reacts too slowly to alert people who have fibrillated before a call is made. In 1966, it was assumed that most heart deaths in the community were the result of acute myocardial infarction. It is not appreciated that ventricular fibrillation can occur without myocardial infarction and has only a warning moment - or not at all.
Development of emergency medical services
The extensive international readership of the Lancet helps explain why Pantridge's idea spread so quickly to other countries. Within 2 years, MCCU programs of similar physician staff began in Australia and Europe. The first program in the United States began in 1968 by William Grace of St. Vincent at Greenwich Village in New York City. The program is a replica of the Belfast program and utilized a special ambulance equipped with a doctor on board to provide immediate resuscitation treatment at the site of a cardiac emergency. A call for a medical emergency in which chest pain is a complaint passed from 911 police officers to the hospital. There's an ambulance going against New York traffic to arrive at the scene. Grace described the rather full ambulance and how it was sent:
"Personnel including attending physician, general practitioner, emergency room nurse, ECG technician, and nurse nurse, in addition to the driver and his assistant.This team was called from various points in the hospital to the emergency room by a private paging system carried by each team member The team has four and a half minutes to get to the emergency room, get the equipment and get into the ambulance.Anyone who is not there in this time will be left behind. "
In scientific reports of St. Vincent, Grace described the experience with the first 161 patients (ref). Only two events occurred where doctors did not set a time limit of 4 ½ minutes and the ambulance left without a doctor. The ambulance reaches its usual spot within 14 minutes, plus of course the pre-response time is four and a half minutes. One call takes 25 minutes due to heavy traffic. Among the first groups of patients seen by MCCU were the three patients treated for ventricular fibrillation. One in three survived.
Grace took this concept, imported from abroad, and made it work in her community. Doctors with defibrillators rushed across town to reach people who were not breathing, unaware whose hearts stopped quite unusually in 1968. However, the program was limited in vision, and although it may work in some communities, it does not apply nationally. Evolution of pre-hospital emergency care is required.
The evolution of the physician-staffed intensive care unit to the paramedics units in the United States occurs independently and almost simultaneously in some communities. The two leading communities are Miami and Seattle, but others include Portland, Oregon, Los Angeles, and Columbus, Ohio. These communities are a major evolutionary advance compared to the Belfast or New York City programs. Not only are paramedics used instead of doctors, but from the start they are programs that are designed to deal with sudden cardiac arrest problems. The Pantridge program was established primarily to reach out to MI victims quickly and thereby prevent death at an early stage susceptible to this event. Thus a heart attack is successfully treated only if it occurs as an MI complication and only if the ambulance is already at the scene or is on the way. The new paramedic program is much more agile than a doctor-based program and is specifically designed not only for treating the early stages of MI, but also for resuscitation efforts for sudden cardiac arrest wherever and whenever it occurs. The reversal of death itself will be the primary goal and goal of the new paramedic program.
Eugene Nagel became aware of Pantridge's work in 1967. He believes that the model of pre-hospitalized care of doctors will not work for the United States in general or for Miami in particular. Doctors are too expensive to sit around a fire station waiting for a call, and if they have to be picked up at the hospital, it will take too long to get to the scene. When Nagel or his colleague James Hirschman, riding his own ambulance they can, of course, defibrillate and deliver drugs, but they can not be present in all shifts. Nagel became convinced it was time to move from a program using a doctor to a staff by paramedics.
Nagel moves gradually. He did not think he could initially sell the idea of ​​self-employed paramedics, even if they had the authorization to perform a medical procedure signed by a doctor. So instead the first step is to make a radio and telemetry connection between paramedical firemen and the hospital. Nagel has a hidden agenda in promoting telemetry. For Nagel, it gave him access through legal barriers that stopped firefighters from defibrillation patients and drug delivery. Nagel reasoned that if firefighters can send ECG signals to the hospital via telemetry, then firefighters (with special training) may be authorized by doctors to administer the medications and procedures necessary before arriving in the emergency department. He believes paramedics on the scene are legal extensions of doctors. He recalled later, "We saw telemetry as the key to extending our care out of the hospital where until now trying to regulate it was the dark side of the moon of that era.The telemetry looked like it might be 'open sesame' to do some pre- hospital. "
Nagel hopes to get support from the medical community; on the contrary he only experienced despair. Nagel recalls this conflict: "This is a rare doctor who likes us to do this - very rarely.We have an incident on the road when we just send the ECG, where the doctor at the scene will tell the firemen to stop playing and drag the victim. "
Nagel remembers the first save of the Miami paramedics program. The collapse occurred near Station 1, on the outskirts of downtown Miami. He recalled:
"There was a man named Dan Jones who was about 60 years old, who was a wino living in a flea tick in a bad part of town Jones was famous for rescue In June of '69 they got a call - the man - Jones - They put a paddle on him, he was in VF, started CPR, stimulated him, he returned to sinus rhythm, took him to ER and three days later he went out and went for a walk.A week later, he came to Station 1, which he had never done before, and he said he wanted to talk to the man who saved his life They told me they had never seen Dan Jones wearing a clean and calm shirt, "Fine. She was on that day. He will periodically come to the fire house and just say hello and he seems drunk. In my lecture at the time I said this was a new drug for alcoholism. It was our first true salvation. "
The Pantridge article also energized Leonard Cobb in Seattle. He knew the Seattle Fire Department had been involved in first aid and therefore approached the Chief Fire Officer, Gordon Vickery, to propose a new training program to treat a heart attack. The fire department already has one of the first computerized systems in the United States to document first aid operations. Cobb realizes that this system can provide scientific documentation for the efficacy (or lack thereof) of Pantridge's suggestions and advise Vickery that they collect their knowledge and resources. Cobb and his colleagues then provide instruction and training in a heart emergency state including heart attacks for volunteer firefighters. The program began operations in March 1970, nine months after Nagel's first savings in Miami. The mobile unit is placed outside the emergency department of Harborview Hospital. As Cobb himself points out, mobile units are not really innovations. Instead, it is the concept of tiered responses to medical emergencies. The idea is "that we'll get somebody out there quickly" - through the mobile first-aid unit already in the fire department - "and then the secondary response will come from the cellular intensive coronary care unit." The beauty of a tiered response system is the efficient use of firefighters, allowing relief personnel to reach locations quickly (on average three minutes) to start CPR. Then a few minutes later the paramedics arrive to provide a more defined treatment such as defibrillation. In this way the brain can stay alive until an electric shock turns the heart into a normal rhythm. After stabilization the paramedics will transport the patient to the hospital.
The Seattle paramedics program does more than just pioneering paramedics and promotes a tiered response system. This is the first program in the world that makes citizens of emergency systems. Cobb knows from the data the program collects that the faster CPR starts, the better the chances of survival. He reasoned that the best way to ensure early initiation of CPR is to train observers. So Cobb, with Vickery's support, started a program in 1972 called Medic 2. The goal was to train over 100,000 people in Seattle how to do CPR. Cobb recalled how the idea was first proposed:
One day Vickery said, "Listen, if it's important to get CPR started quickly and if firefighters come to do it, it can not be complicated that other people can not learn - firefighters are not created by God to do CPR. train people. "Cobb said," That sounds like a very good idea. "
Cobb decided to use short training. "We will not do it the traditional way in which they have to come for 20 hours (training) so they have to do it all at once - how long will people participate? - well, maybe three hours and that's pretty much like that." Cobb cautiously did not say how long it took to train 100,000 people. He does not know. The facts only take a few years and ahead of the 20th anniversary of a citizen training program over half a million people in Seattle and the surrounding area have received CPR training.
Some people are skeptical about training civilians in CPR; indeed, many feel the potential danger is too great to allow such a procedure in the hands of the layman. Skeptics also have the support of a national medical organization. The alarmist voices stopped by some lucky savings. Cobb recalled a resuscitation as soon as the citizen training program began. "In March 1973, there were these kids playing golf at Jackson Park, they found a quarter-mile victim from the clubhouse." The man was unconscious and not breathing; later confirmed that he was undergoing ventricular fibrillation. "But these kids have taken the [CPR] course to a local high school, two or three of them started doing CPR and the other kid ran off and called the fire department and soon they came with a relief car and Medic 1 yelled over.. "Cobb concluded," They made it start again.He survived, he's alive today [1990] That's a very convincing story I do not mind written in Reader's Digest. "
Recent developments in CPR
In the early 1970s CPR, defibrillation, and rapid means to provide pre-hospital treatment were readily available. The structure to awaken the sudden death toll has been built and proved successful. That most of the world did not have this structure in the 1970s was largely due to the lack of spreading and spreading of ideas, rather than the impossibility of taking them out.
However, the story of resuscitation did not stop in the early 1970s. Great progress continues. In 1980 the first program to train EMT for defibrillation began in King County, Washington, and similar programs scattered throughout the United States. This training takes 10 hours, and in the first demonstration project, the survival of ventricular fibrillation increased from 7% to 26%. In 1984, the first program with EMT firefighters using an automated external defibrillator (AED) also began in King County, Washington. The use of AEDs simplifies EMT training and thereby enables procedures to spread more rapidly across communities. An automated external defibrillator takes far less training time than a manual defibrillator because EMT does not have to interpret the heart rhythm.
The idea of ​​an automatic defibrillator was first conceived by Dr. Arch Diack, a surgeon in Portland, Oregon. His prototype, literally assembled in the crypt, uses a unique defibrillatory path - the tongue to the chest. There is a breath detector which is a refuge to keep people from breathing shaken. The electrode is basically a rate counter, much more rugged than the current sophisticated VF detector. The production model weighs 35 pounds and gives verbal instructions. It was a premature idea. Most people view it as curiosity. In the late 1980s, however, other manufacturers entered the field leading to an automated external defibrillator (AED) that we have today. The current AED, like a regular defibrillator, uses electrode pads attached to the chest. AED is programmed to guide operators (with a series of voice commands) through procedures. The once installed pads automatically detect the type of heart rhythm and if the VF is present the AED instructs the operator to press the button (usually blinking red) to surprise the patient. From EMT defibrillation to AEDs, there is a natural and logical development of first defibrillation respondents (AEDs used by police or security personnel), then Broad Access General Deficiency (AEDs used by ordinary people in public locations such as airports, schools, training facilities, etc.) and finally AEDs at home including the opportunity to buy AEDs on a table without a prescription.
In 1981 a program to provide telephone instructions at CPR began in King County, Washington. The program uses emergency dispatchers to provide instant directions while EMT firemen are on the way to the scene. This demonstration project increases the level of CPR provided by the audience by 50%. CPR dispatcher-aided now standard care for central dispatchers throughout the United States and in other countries such as Israel, UK, Sweden, and Norway.
The American Heart Association uses a four-link metaphor in the chain to illustrate the elements of successful resuscitation. These connections are early access (recognizing cardiac arrest and call 911), early CPR, early defibrillation, and early treatment (such as medication, endotracheal intubation). The initial paramedic program is all designed to provide CPR, defibrillation and advanced care fast enough to awaken the patient in a heart attack.
CPR continues to develop, with recent developments including an emphasis on constant, rapid, non-respiratory heart stimulation. Studies have shown that people who have rapid and constant chest compression are 22% more likely to survive than those who receive conventional CPR, including breathing. Moreover, since people tend to be reluctant to do mouth-to-mouth, only chest CPR is almost twice as likely to survive as a whole, increasing the likelihood of receiving CPR in the first place.
Source
Excerpts from James Jude, Leonard Cobb, Eugene Nagel, Frank Pantridge, and John Geddes are from: Eisenberg MS, Life in the Balance: Emergency Medicine and Quest to Reverse Sudden Death, Oxford University Press, 1997, New York, with permission from the author.
References
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