Trevor Brown didn’t think or hesitate, he just acted when he saw a stranger have a cardiac event and stop breathing at Del Mar Highlands Town Center on April 10. Read more »
By now you know the story—or at least think you do: A nursing home nurse sees an 87-year-old resident in cardiac arrest and calls 911. Despite desperate pleas of the call center operator, the nurse refuses to do CPR and the resident dies.
Except most of the story isn’t true. Lorraine Bayless lived at a Bakersfield (CA) continuing care community called Glenwood Gardens, but in independent living, not in its skilled nursing facility. She did not die of a heart attack but of a stroke, according to the death certificate signed by her personal physician. CPR may have saved her, but it is very unlikely.
And there is more. Mrs. Bayless did not want life-prolonging medical interventions, and her family is fully satisfied with the care she received. And the staffer who called 9-11 may not have been a licensed nurse at all. One piece of the story is true: Glenwood Garden staffers are prohibited from performing CPR or other medical interventions and are instructed to call 9-11 in the event of emergencies.
Still, even the real story raises some important questions. If you or a loved one live in residential care, here are five lessons to learn from this episode:
What level of care can you expect? Independent living communities are not nursing homes or assisted living facilities. You should not expect them to provide medical care or even personal assistance. You have an apartment and perhaps access to a dining room and some social activities. Emergency response is probably limited to a pull cord in your unit.
If you need additional assistance, you’re responsible for hiring your own aide. CCRC’s are more complicated since they may have a licensed nursing facility on site. Still, if you are living in an independent unit, don’t expect skilled nursing care.
Is staff trained and permitted to perform emergency care? Does the facility have at least one staffer trained in CPR and first aid on duty at all times? She doesn’t need to be a licensed nurse. And what is the staff allowed to do—bandage a cut, put ice on a bruise, CPR, or nothing? One CCRC director told me her staffers are trained in first aid but her facility’s lawyers urged her to instruct employees to always call 911.
What emergency care do you want? This may be the most important question of all. Mrs. Bayless’ family says she did not want life-prolonging emergency care. It is not clear whether she had a living will or do not resuscitate order, or had designated a family member as her healthcare proxy. But if you are old enough to be reading this, you should discuss end-of-life issues with family members and prepare your own advanced directives. Right now.
Is the facility aware of your wishes? It does you no good to prepare these legal documents if you don’t share them with the care facility, your physicians, your local hospital, and your family. You should distribute advanced directives as widely as necessary. Remember, people cannot follow your wishes if they don’t know what they are. The best outcome for Mrs. Bayless may have been for the staffer to not call 911 at all but rather to hold her in her arms until she passed away. But she had to know that.
Finally, lesson No. 5: Don’t believe all the news you read on the Web.
Thanks to the AHA for this valuable study!
- Many hospitalized children survive after prolonged resuscitation (more than 35 minutes) for cardiac arrest. Read more »
December 10, 2012
- A new Japanese study shows that early compression-only CPR, without rescue breathing, kept more people alive with good brain function after they had a sudden cardiac arrest.
- Survival rates of more than 40 percent were noted when cardiac arrests were observed, bystanders provided early compression-only CPR, and an electric shock was given from a publicly accessed defibrillator.
- More than 46 percent (46.4) of the compression-only CPR patients were alive, compared to 39.9 percent of those who received conventional CPR.
- The chest-compression-only CPR led to 40.7 percent of patients having favorable brain function compared to 32.9 percent of those who received traditional CPR. Patients were considered to have favorable neurological status if they had normal brain function or if they lived independently — even if they had some neurological impairment.
COLUMBUS, Ohio — A woman called 911 recently and told dispatchers that her grandmother wasn’t breathing. The Columbus firefighter who took the call double-checked the address and phone number and then told the woman that they were going to start CPR together.
She hesitated but answered yes when Russell McGinnis asked whether she knew how to do cardiopulmonary resuscitation. Even if she hadn’t known the basics, McGinnis would have talked her through the procedure.
These days, instead of asking callers whether they want to do CPR, Columbus firefighters are telling callers they’re going to do it.
The American Heart Association changed its CPR guidelines last year to an option of compressions only — no more mouth-to-mouth — in an effort to get more bystanders to help people whose hearts have stopped. That prompted the Columbus Division of Fire to have its 911 staff be a little pushy with callers and not take no for an answer.
“We work with dispatchers to be as aggressive as they can and encouraging to callers to do CPR until the paramedics arrive,” said Dr. David Keseg, medical director of the Columbus Division of Fire. The national survival rate of cardiac arrest is 6.4 percent. In Columbus, the survival rate is about 11 percent, Keseg said.
Several studies, including two published in 2010, in The New England Journal of Medicine and The Journal of the American Medical Association, found that people in cardiac arrest have a better chance of survival when chest compressions are started quickly.
Emergency dispatchers can play a pivotal role. Columbus dispatchers aim to get CPR started within 20 seconds of the call.
That was the case with the woman and her grandmother. McGinnis told the woman where to place her hands on her grandmother’s chest and how deep to push.
“Come on, you got to do this,” he told her. “Chest compressions, 1-2-3-4. Count. 1-2-3-4-5-6-7-8-9-10. Don’t stop, don’t stop, keep going. Come on.”
The woman cried, counted with McGinnis, and then cried some more. Through heavy breaths, she told him it wasn’t working.
“This is probably going to be the hardest thing you have to do your whole life,” he said. “Don’t stop until the paramedics walk through the door.”
Five minutes and 37 seconds after she called, paramedics arrived. Her grandmother survived that day but died a week later in a hospital.
Keseg said the stepped-up approach is making a difference, although he doesn’t have the data yet to show how many more lives have been saved.
Che Sitton called 911 in January after his mother, Nancy, collapsed in her room at their North Side home. He told the dispatcher that he knew CPR, but that was the last thing on his mind as he stared at his mom.
Sitton, 40, said of the dispatcher: “He could tell the stress of my voice, and he said, ‘You can do this,’ and I started the chest compressions.”
The dispatcher kept him motivated by counting compressions and reminding him to push deeply and fast even as his arms tired and his hope faded.
If Sitton hadn’t had that encouragement, “I would have given up,” he said.
His mom spent about a month in a hospital, had a pacemaker implanted and has recovered.
Other local dispatching agencies vary on how aggressive they are about getting callers to start CPR.
The Franklin County sheriff’s office asks callers whether they want to do CPR and leaves it up to them.
An official at the Metropolitan Emergency Consortium Communications Center, a consortium of townships on the east side of the county, said dispatchers there push callers to do compressions.
Dr. Michael Sayre, an associate professor of emergency medicine at Ohio State University who helped Columbus fire officials develop their protocol, said one-third of cardiac-arrest victims in Columbus get CPR before paramedics arrive.
A key is for dispatchers to help callers through difficult situations.
“You don’t have the luxury of a lot of time,” Sayre said. “There are a few effective methods, including taking control and getting the rescuer to get done what needs to be done.”
Columbus fire officials strive for a response time of zero.
“You don’t want to ask them if they want to do it,” said Rick Johnson, a Columbus firefighter who takes emergency calls. “You’re letting them know this is the best way we know for your loved one to survive.
“You need to be forceful, direct and respectful.”
Approximately 460,000 individuals die every year from out-of-hospital cardiac arrest Read more »