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(First Responder Network)   It's not every day that a cardiac arrest is caught on camera. Then again, it's not every day it happens at an ambulance station either   (firstrespondersnetwork.com) divider line 75
    More: Hero, cardiac arrest, cinematographers, ambulances, police stations, cameras  
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4746 clicks; posted to Video » on 21 Feb 2013 at 3:39 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-02-22 12:12:25 AM
In boy scouts, and later in medical science class in high school, I was taught to do 15 compressions, stop to either breath twice for the person or have another person breath twice, then repeat. Basically what you would see on any movie or tv show where CPR is performed.

I was told recently that the chest compressions were by far the most important part of CPR, and that you should never stop doing them until the EMTs arrive. Is that really the case?

Also, in the video, why did they call an ambulance, only to later transport the person in the helicopter?
 
2013-02-22 12:39:52 AM

I Havent Killed Anybody Since 1984: In boy scouts, and later in medical science class in high school, I was taught to do 15 compressions, stop to either breath twice for the person or have another person breath twice, then repeat. Basically what you would see on any movie or tv show where CPR is performed.

I was told recently that the chest compressions were by far the most important part of CPR, and that you should never stop doing them until the EMTs arrive. Is that really the case?

Also, in the video, why did they call an ambulance, only to later transport the person in the helicopter?


Ideally, under the current AHA guidelines (2010) the ratio is 30:2 for single rescuer and 2 rescuer adults (and continuous compressions with an advanced airway). HOWEVER, if you don't want to give breaths (e.g. no barrier device), then just do compressions continously.
 
2013-02-22 01:35:23 AM
And *that* is why I have an ICD.

CSB: recently showed up to my cardiologist for a regular follow-up and was met first by three Fellows. They tried taking my blood pressure using an automatic BP machine: no luck. They tried a second machine: no luck, just errors. So they tried manually found the cuff defective. As they were trying another cuff and saw they were getting the same results, my normal doc poked in head in and said "oh yeah, that happens." The Fellows were in awe that I was fully conscious with a BP of 50/30, but even better were the faces they made when I told them I drove there!

/ on a good day I'll make triple digits
// still young enough to get off your lawn
 
2013-02-22 03:44:41 AM

Marshall Willenholly: I wonder if the stress of being filmed for a TV show had anything to do with him having a heart attack right there in front of the cameras?


Lolz. Any stress from being filmed is negligible compared to the stress of simply doing his job.

My wife's an ESD/911 Op. I'm a state-certified firefighter (volunteer). Emergency services is stressful work, and you don't always eat that well considering the hours involved (wife does 12-hours shifts, overnight... no lunch break. Eat when/if you can, generally quick and easy, less-than-healthy food). #1 cause of death for emergency service workers is heart attack. As a firefighter, you're MUCH more likely to drop dead in the station/at home/on the fireground than you are to actually DIAF.

I can't speak for the firefighter/police/EMT crews, but there isn't a single dispatcher in our county that isn't medicated for stress/anxiety/depression/blood pressure/cardiac issues. Being on the line with someone as they shuffle off their mortal coil is a regular occurance for the folks on the phones and radios. People dying on you all the time wears on you over the course of a career.
 
2013-02-22 03:46:44 AM

I Havent Killed Anybody Since 1984: In boy scouts, and later in medical science class in high school, I was taught to do 15 compressions, stop to either breath twice for the person or have another person breath twice, then repeat. Basically what you would see on any movie or tv show where CPR is performed.


It changed back in 2005 with the AHA guidelines update to 30:2 in adults and one man child/infant CPR. The reason being is that they found in adults that the compression were more important than the ventilation in a patient with a primarily heart-related cause for their cardiac arrest (Most kids have healthy hearts, and arrest because of respiratory causes or shock, so ventilation is more important in them). Two man child CPR is 15:2 now, which emphasizes the importance of ventilation in that population.

I Havent Killed Anybody Since 1984: I was told recently that the chest compressions were by far the most important part of CPR, and that you should never stop doing them until the EMTs arrive. Is that really the case?


In Adults who suffer a sudden cardiac arrest, you're absolutely right. Hands-only CPR buys time for defibrillation for certain heart rhythms, and to correct the underlying cause for the others, and most adults who suffer a cardiac arrest, unless it's from a respiratory cause, have adequate blood oxygen saturation to support the minimal oxygen requirements of the body during cardiac arrest.

You shouldn't stop CPR unless you get signs of circulation back, i.e. the patient is spontaneously breathing (not gasping), wakes up and says get off me, or you are physically unable to continue due to danger or exhaustion.

I Havent Killed Anybody Since 1984: Also, in the video, why did they call an ambulance, only to later transport the person in the helicopter?


Possibly because they couldn't fly at the time they called for ground transport, or they felt he was stable enough initially to go by ground. I don't know what the UK's aviation rules are, but here there are very specific criteria for when a medical helicopter can and cannot fly. Based on what they said in the video, I'm assuming he was having an Inferior/Posterior Wall STEMI, which is a type of time dependent heart attack they identified on his EKG after he arrested and was brought back, so they made the decision to fly once they were able to.
 
2013-02-22 03:51:31 AM

JPINFV: then just do compressions continously


As I understand it, the act of compressing and releasing the chest does expel and inhale a little bit of air, enough to keep things working if you don't have the time to give breaths. Here is my favorite video on the subject
 
2013-02-22 03:53:57 AM

Lets talk frankly about internal cleanliness: Marshall Willenholly: I wonder if the stress of being filmed for a TV show had anything to do with him having a heart attack right there in front of the cameras?

Lolz. Any stress from being filmed is negligible compared to the stress of simply doing his job.

My wife's an ESD/911 Op. I'm a state-certified firefighter (volunteer). Emergency services is stressful work, and you don't always eat that well considering the hours involved (wife does 12-hours shifts, overnight... no lunch break. Eat when/if you can, generally quick and easy, less-than-healthy food). #1 cause of death for emergency service workers is heart attack. As a firefighter, you're MUCH more likely to drop dead in the station/at home/on the fireground than you are to actually DIAF.

I can't speak for the firefighter/police/EMT crews, but there isn't a single dispatcher in our county that isn't medicated for stress/anxiety/depression/blood pressure/cardiac issues. Being on the line with someone as they shuffle off their mortal coil is a regular occurance for the folks on the phones and radios. People dying on you all the time wears on you over the course of a career.


An interesting note is that any Firefighter, EMT, or Police Officer who dies of a heart attack or asthma attack within 12 hours of leaving a working fire or accident scene is considered a line of duty death for the purposes of federal death benefits. Cancer deaths in Firefighters and EMTs too. Volunteers are notorious for this, they'll work too hard or get too much CO or Cyanide, or other products of combustion while fighting a fire, go home, and then be found dead the next day from a coronary.

To be quite honest, dispatchers have it harder than EMTs and Paramedics do. We have the advantage of knowing we did everything we could for someone. Dispatchers have to deal with that feeling of helplessness with every call.
 
2013-02-22 07:44:18 AM
I have an old acquaintance who is an EMT that I bump into from time to time. He is very morose about his job. I asked how thing were going and he responded with, "Oh, saving lives, prolonging suffering."

That statement sticks with me.
 
2013-02-22 10:16:44 AM
QFT:

BronyMedic: stop cranking out medics wholesale from unaccredited, often corporate affiliated programs that spring up overnight and give substandard education - teaching people to pass the Registry rather than teaching them to be Paramedics.


...and nurses.
(fired a few in my time)

/REALLY gets my goat
//former paramedic and ER nurse... getting a kick, etc., etc.
 
2013-02-22 10:40:34 AM

BronyMedic: . JEMS did an article not too long ago on it where they deconstructed the study and pointed out the major issues it ignored - namely Paramedic oversaturation, and fewer avenues for them to practice a high risk, low volume skill.


My EMS system has something called "Paramedic Engines." When someone dials 911 for a medical emergency, in almost every single case (EMD can decide otherwise,) a Fire Department engine with at least one medic aboard is dispatched, as well as an ambulance with (most likely) one medic and one EMT aboard. (Sometimes it's two medics, but never less than one.)

The issue we're seeing is not strictly oversaturation in our system, but that the FD medics are, by an overwhelming majority, getting beat to the call by the ambulance medic. Because medical command goes to the transporting medic, AND the FD won't allow one of their firefighters to go in the ambulance unless the patient is literally circling the drain, our FD medics don't get to perform ETIs and other medic-only skills very often. Then every 2 years they go to recertify and they're failing certain motor skills over and over and over again. We do have one FD that transports (Petaluma) and another city only sends an ambulance (no FD) for calls (Rohnert Park) but for the rest of the county, that's generally how it goes.

On the time-to-transport issue vs ETI, I agree in the helicopter/CCT environment. I was talking mostly about having the EMDs change protocols to make ETI a third or fourth choice for advanced airway in 10-or-less transport situations.
 
2013-02-22 11:20:50 AM
That was a pretty cool video and I'm happy the guy made it. First responders have my unqualified respect, that is a job I simply couldn't do.

I don't mean I wouldn't want to do it, I seriously think that I would be incapable, mentally and emotionally, to perform under those circumstances.

/best I could do is balance your checkbook while you stroked out.
//Fine lotta good that would do.
//Seriously, hats off to first responders. I am constantly in awe of what you are capable of.
 
2013-02-22 12:52:29 PM
In America he would have then been handed a bill for $30,000 as he regained consciousness.
 
2013-02-22 02:23:53 PM

I Havent Killed Anybody Since 1984: Also, in the video, why did they call an ambulance, only to later transport the person in the helicopter?


May have been answered, but there is probably a local hospital within 10 minutes or so ground transport. If he were not stable, that is had his vital signs not improved and his EKG still looked bad, it would be better to take him there for further treatment and stabilization before taking him to a big hospital that would have the capability of doing angioplasty or other immediate invasive procedures.
The fact remains, most people who suffer from cardiac arrest die, even if advanced CPR starts right away. WHen the heart is starved of oxygen by a blocked artery the muscle dies and you get what is called an infarct. That dead tissue generates an electrical charge that if it gets big enough, disrupts the normal electrical charge that makes the heart work correctly. If that area of dead muscle is too big then we can correct the electical problem (the arrythmia) but the physical problem can't be overcome.
By god I'll try though.
 
2013-02-22 02:38:11 PM
My father went into cardiac arrest while being examined by his cardiologist.
 
2013-02-22 04:00:37 PM
Remember when I was having a tachycardia - wasn't feeling well so drove myself to the hospital and for the first time ever the triage nurse checked my pulse and, ignoring a full waiting room, said "Please follow me." Was in a bed with 4 doctors immediately there with a cash-cart.

It's always nice to see professionals at work.

/pulse stayed steady at 199 - managed to fight them off from using the crash-cart until it went down
//doing the vagal maneuver on yourself is a great party trick
 
2013-02-22 04:08:01 PM

dramboxf: My EMS system has something called "Paramedic Engines." When someone dials 911 for a medical emergency, in almost every single case (EMD can decide otherwise,) a Fire Department engine with at least one medic aboard is dispatched, as well as an ambulance with (most likely) one medic and one EMT aboard. (Sometimes it's two medics, but never less than one.)


You can thank the Fire Department unions for that. The IAFF is a powerful lobbying group when it comes to Paramedic deployment and education in the United States, and is responsible for a LOT of the troubles involving it today. There's actually evidence that having more paramedics in a system causes worse patient outcomes. Fire Departments want Paramedics, and in turn - want to take over EMS from the Third Services and Hospitals because it lets them justify manpower and apparatus budgets. What invariably happens in large departments is that the Fire side siphons off the EMS side. While there ARE departments which do EMS very, very well - like Seattle, Nashville Fire, Memphis, etc, many of them get into the business because of union and special interest group pressures.

dramboxf: The issue we're seeing is not strictly oversaturation in our system, but that the FD medics are, by an overwhelming majority, getting beat to the call by the ambulance medic. Because medical command goes to the transporting medic, AND the FD won't allow one of their firefighters to go in the ambulance unless the patient is literally circling the drain, our FD medics don't get to perform ETIs and other medic-only skills very often. Then every 2 years they go to recertify and they're failing certain motor skills over and over and over again. We do have one FD that transports (Petaluma) and another city only sends an ambulance (no FD) for calls (Rohnert Park) but for the rest of the county, that's generally how it goes.


We have the exact opposite problem in one of the local cities. The local Fire Department medics in that municipality are under the impression that they own the patient, and the transporting Paramedic is just there at their beck and call. There is no team work. I've actually refused to work in this municipality because there is unbridled hostility towards us. There's no method for correcting errors or deficiencies in patient care - anyone who speaks up about it is reassigned to another municipality. One shift I worked there we had a drug error that caused no patient harm, and by the next day their command staff was trying to get me to take the blame for it, and trying to get me to sign legal paperwork outside of my employer.

I've had patients who they have not even given me a report on, and time-sensitive patients who they have spent far too much time on scene with doing things that could be done in transport, or are blatantly unnecessary.

Please don't get me wrong - I'm far from against Fire Departments providing EMS care by any means. I just think that EMS, like every other country in the world, should be its own unique branch of emergency services.
 
2013-02-22 05:17:58 PM

cretinbob: I Havent Killed Anybody Since 1984: Also, in the video, why did they call an ambulance, only to later transport the person in the helicopter?

May have been answered, but there is probably a local hospital within 10 minutes or so ground transport. If he were not stable, that is had his vital signs not improved and his EKG still looked bad, it would be better to take him there for further treatment and stabilization before taking him to a big hospital that would have the capability of doing angioplasty or other immediate invasive procedures.
The fact remains, most people who suffer from cardiac arrest die, even if advanced CPR starts right away. WHen the heart is starved of oxygen by a blocked artery the muscle dies and you get what is called an infarct. That dead tissue generates an electrical charge that if it gets big enough, disrupts the normal electrical charge that makes the heart work correctly. If that area of dead muscle is too big then we can correct the electical problem (the arrythmia) but the physical problem can't be overcome.
By god I'll try though.


It appeared that there was no crew at the time for the helicopter, so the called a back up ambulance.  As the ambulance arrived, they were able to get the helicopter out ("fastest ever" said in video) and a crew assembled, so they chose the helicopter for the straight route.

All in all, if you're going to have a massive heart attack, being surrounded by paramedics with a chopper on hand is the best way to do it.  Only way better is to actually have it in the ER.

Many times, the first warning you are about to have a heart attack is sudden death.  Seriously.  More people just die than ride it out.
 
2013-02-22 08:00:33 PM

dramboxf: Back in 1998, I was living in Tucson, AZ. I was 33 years old. I was about 100lbs overweight. I fell asleep one night on my left side, fully dressed. Side note: My father died of a massive MI when he was 47.

I woke around 2:30am, feeling very hot and sweaty and dizzy with my left arm hurting. I felt a tightness, a pressure in my chest.

I had my roommate drive me to the ER since the hospital was only about 3 blocks away. Walked into a triage nurse yakking on the phone. She points to a chair. I shake my head. "Chest pain, left-arm pain, sweating." She directs me to a treatment room. They get me hooked up to the 12 lead, and as I'm shifting on the gurney to make myself more comfortable, I let out a belch that probably rattled the 3 floors above me. ER resident comes in, sees my EKG is a nice NSR (if a touch tachy, LOL) and correctly determines that my left arm hurts because I slept on it, my chest is tight because I have gas, and I'm sweaty because I fell asleep in Tucson fully dressed.

....thiiiiis close to getting discharged and she asks some personal history questions. "Both parents alive?"

"Dad's dead...47, MI."

"Welcome to an overnight stay in our telemetry unit."

FARK.

Stress test 3 days later revealed I have the heart of an Ox. My doctor now hates me. My bloods are great, my EKG is fantastic, and I'm still 75lbs overweight. (Losing quickly though...) My resting bp is usually 110/80 or so.


Good luck.
 
2013-02-22 08:05:54 PM

kim jong-un: Good luck.


It was in 1999. Or, 14 years ago.
 
2013-02-22 11:44:53 PM
Why hasn't anyone talked about how fake this is?
 
2013-02-22 11:48:45 PM

blackySM2: Why hasn't anyone talked about how fake this is?


Because it's actually not.
 
2013-02-23 01:56:11 AM

cretinbob: dramboxf: cretinbob: Happens in station more than you might think. B

Laws, yes. M-O-O-N spells "Firefighter/medics drop in station all the damn time." And on the fireground, too.

We've lost 5 or 6 firefighters/EMTs/Medics in station or on a fireground in the last 7 or 8 years. One guy was the last you'd ever think had heart issues. Ran marathons, didn't eat anything that cast a shadow, trim, about 5'8 and 140lbs, dropped on the golf course. 39 years old. Standing chatting with his guys (he was a Captain), his eyes rolled back and he went down like a sack of potatoes.

There was a medic who was transporting a patient around here who went into sudden cardiac arrest and died.
I also had a patient who was having a massive cerebellar stroke, and the closest hospital that could deal with it (requires surgery) was about an hour and a half away, so of course we flew him out. Came to find out later they had just finished working one of their own they found deceased in his bunk at the station.

But again, everyone thinking they need to go out and buy an AED, it was the chest compressions that did the most good here. It was a witnessed arrest and he was in a rythm that could be interupted. An AED will not reverse asystole or restart your heart. There was a lot that was cut out of this, and my only complaint is that the editing made it look too easy.

Why yes, I expect to die in the back of an ambulance myself. I just hope I'm not transporting at the time.


I've had a couple of codes in the ICU on patients with arterial catheters, which allow you to actually see how effective your compressions are.  First, it's damn hard to get up to a MAP of 55 or so.  Second, when you finally adjust your compressions to reach that rate, you really DO get tired as hell after about three minutes.  You can keep going for longer, but you can actually see your compressions are no longer as effective.

I'm in pretty decent shape.  I run to work with 10 lbs on my backpack, up a few hills and average 8 minute miles over three miles.  Even I can't do more than 3 minutes of CPR without breaking into a sweat and sucking air.

/good CPR is frickin' exhausting.
 
2013-02-23 01:58:09 AM

blackySM2: Why hasn't anyone talked about how fake this is?


if it's fake, it's incredibly, incredibly well done, down to the most minute detail.  Easier explanation is that this is real.  And yeah, this is how calm and collected well trained helicopter paramedics are in emergencies, even with their friend on the floor.
 
2013-02-23 10:13:10 AM
I was on a Boy Scout hike last year and went into SVT/AVNRT in the mountains of New Mexico.  The ranger team got me to pavement where an ambulance met me for the ride to the hospital. I was treated very well by everyone along the way.  Heroes all in my case.

The care these lads gave their friend and coworker made me a bit emotional.  Heroes is too light a word.
 
2013-02-24 11:52:22 AM
Nice find, BronyMedic.  Very informative.  And somewhat scary.
 
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