“Sir, what did you eat?”
I don’t remember saying this to the patient as he roared back to life on the floor in front of me. I’m not denying I said it; that’s very pertinent information to know when someone collapses from a cardiac arrest in your favorite fast food taco restaurant. My colleague later suggested that perhaps I chose the wrong time and place to ask the question.
As it turned out, our patient was eating one of my favorite menu items when the cells of his heart suddenly stopped working together to produce a rhythmic, coordinated heartbeat; and began instead freelancing their attempts at pumping blood in a deadly cardiac electrical malfunction called ventricular fibrillation. There are numerous possible causes for this cardiac arrest condition — thankfully none of them taco related — and survival is possible with the right conditions, and the right people in place. The American Heart Association (AHA) illustrates these conditions with their five-linked Chain of Survival.
Chain link number one: recognition of cardiac arrest, and activation of the emergency response system.
This first step to saving the life of a person in cardiac arrest starts long before their collapse, with the awareness and demolition of normalcy bias. Normalcy bias is our natural tendency to reject the obvious reality before us, and underestimate the gravity of an emergency situation. We fall into this behavioral pattern because it is more comfortable to believe that everything is fine and normal, and very psychologically uncomfortable to acknowledge when something dangerous and different is happening.
Do not underestimate normalcy bias — it is powerful and innate. To recognize that a cardiac arrest is occurring, you must break through this mental wall. You must consciously give yourself permission to accept the reality of the life threatening emergency unfolding before your eyes, and then give yourself permission to take action.
Activation of the emergency response system means calling 911, or specifically ordering another person to call 911. It’s not enough to simply holler “somebody call 911.” Unless this task is pointedly delegated to an individual, assume the normalcy bias of those around you will prevent the call from being made.
The sooner 911 is called, the sooner emergency dispatchers can send the right resources to your aid, which may include law officers and firefighters in addition to Boundary Ambulance Service responders. Be prepared to tell the 911 dispatcher your location, callback information in case the call drops, and a clear, concise explanation of the problem. Answer the dispatcher’s exact questions to the best of your ability, and follow their instructions precisely.
Chain link number two: early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions.
CPR is a stopgap measure. It does not alone resuscitate people in true cardiac arrest. All of the movies and TV shows you’ve ever watched are wrong.
Here’s why CPR is important: without a properly beating heart to push blood and nutrients to the brain, the brain begins to die within minutes. Although chest compressions only inefficiently squish blood around the body to keep the brain alive longer, this effort is sometimes enough to extend the survival window out slightly longer until people with advanced equipment arrive to restart the heart.
In the past, there was much confusion about how to perform CPR. The recommended ratio of breaths to chest compressions changed constantly, and many people were unwilling to perform CPR if it required mouth-to-mouth contact. We now know from scientific studies that chest compressions are the most important component of CPR. Thankfully, the AHA now recommends a technique called Hands Only CPR. There is no longer a need for the average rescuer to recall an ever changing compression to ventilation ratio, or a need to put your mouth onto a stranger. If you recognize a victim of cardiac arrest and can’t find a definite pulse, move them onto their back on the floor. Kneel directly over them with your arms straight and your hands interlocked, then press hard and fast in the center of their chest with the heel of your hand until help arrives.
At the beginning of this letter I told you that cardiac arrest survival is possible when the right conditions and people are in place. The right conditions are the AHA Chain of Survival; the right person is you. Next month we’ll continue our discussion on how you can become the most effective CPR rescuer possible. I’ll cover the remaining links in the AHA Chain of Survival, and give you an update on how our resuscitated patient fared. I’ll also tell you the exact name and address of the taco restaurant, and finally I’ll reveal which one of my statements in this last paragraph is false.
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Drew Rinella is a paramedic, and the captain of operations for Boundary Ambulance Service in Bonners Ferry.