Year: 2020

The American Heart Association (AHA) recently published its 2020 AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC) in the organization’s flagship journal, Circulation. Among the major changes are the addition of a sixth link focused on recovery in the AHA’s Chain of Survival, a widely-adopted series of critical actions that work to maximize the chance of someone surviving cardiac arrest.

The latest research shows that the recovery phase following cardiac arrest continues long after hospitalization. The physical, social, and emotional aspects of recovery among patients and their caregivers are emphasized after survivors leave the hospital.

The guidelines contain updated or new algorithms and graphics to reflect the latest resuscitation science, including:

• a new Recovery link in the Chain of Survival was created for in-hospital and out-of-hospital cardiac arrest in infants, children, adolescents, and adults;
• a new algorithm and updated recommendations on resuscitation during pregnancy focuses on the best outcomes for both the mother and baby. Team planning for cardiac arrest in pregnancy should be done in collaboration with the obstetric, neonatal, emergency, anesthesiology, intensive care, and cardiac arrest services;
• addressing the increase in respiratory and cardiac arrests due to opioid overdoses, two new opioid-associated emergency algorithms are included for lay rescuers and for trained responders; and
• new data on respiratory rates during CPR in children are now available, and the recommendations for pediatric CPR is one breath every 2 – 3 seconds (20 – 30 breaths per minute).

The AHA Chain of Survival now includes a sixth link focused on recovery.

Guidance calls for increasing bystander CPR

The 2020 guidelines offer suggestions for increasing lay rescuer CPR rates, noting that currently less than 40% of non-hospitalized adults who experience cardiac arrest receive layperson-initiated CPR before the arrival of emergency medical services. Among the new or updated suggestions are the following:

• raise awareness of the need for laypersons to initiate CPR for presumed cardiac arrest, underscoring that the risk of harm to the patient is low;
• emergency dispatch systems are encouraged to use cell phone technology to recruit laypersons to assist with CPR rescues, especially in under-resourced areas in an effort to increase the rate of bystander CPR and automated external defibrillator use; and
• bystander CPR training should target specific socioeconomic, racial, and ethnic populations who have historically exhibited lower rates of bystander CPR. CPR training should address gender-related barriers to improve bystander CPR rates for women.

Bringing science to life

For the first time ever, the latest resuscitation science is reflected in new high-quality CPR programs that released simultaneously in the form of a new digital resuscitation portfolio — a milestone achievement and breakthrough for the AHA.

The programs are rooted in a true adaptive learning design that delivers personalized instruction tailored to individual needs and knowledge and confidence levels.

The simultaneous release upholds an AHA Guiding Value – Bringing Science to Life.

The AHA also released Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), and Pediatric Advanced Life Support (PALS) course materials for instructor-led training.

Guidelines’ approach and history

The approach for the 2020 Guidelines reflects alignment with the International Liaison Committee on Resuscitation (ILCOR) and associated member councils and includes varying levels of evidence reviews specific to the scientific questions considered of greatest clinical significance and new evidence.

Since the first AHA Guidelines for CPR and ECC were published in 1966, the guidelines have been reviewed, updated, and published periodically by the AHA.

In 2015, the process of five-year updates was transitioned to an online format that uses a continuous evidence evaluation process rather than periodic reviews. This allowed for significant changes in science to be reviewed in an expedited manner and then incorporated directly into the guidelines if deemed appropriate.

The AHA has been a leader in resuscitation science and innovation for over 50 years, training millions of people each year in CPR, first aid and advanced cardiovascular care around the world through its programs and awareness campaigns.

 Visit the ECC Digital Digest to view infographics that cover key guidelines changes and listen to podcasts from resuscitation experts who were involved in creating the guidelines.

By Gina Mayfield

In May 2019, just as San Antonio, Texas, started to heat up for the summer, Adam Biechlin decided to take his two kids for a swim while his girlfriend, Jennifer, finished making dinner. As he was heading out the door, he had a fleeting thought that barely registered in his mind: It’s always better not to be outnumbered by kids at the pool. And off they went.

That day, wind ripped around the 21-floor condominium tower where Jennifer lives, but Adam made it to the ground floor pool where he watched his 5-year-old daughter, Eleanor, do handstands in the water and played catch with his 3-year-old son, Max.

Eventually, Jennifer texted to say dinner was ready, and Adam called for both kids and watched them come running out of the water. He began collecting their belongings, which the wind had strewn across a small area, when Eleanor asked for just one more “Watch this, Dad!” moment.

Adam, who had turned his back for a few seconds knowing both kids had cleared the pool, turned back around. Then it hit him.

“I didn’t see Max,” he remembers. “I said, ‘Where’s your brother?’ Eleanor turned completely pale. My heart just sank. And then it started racing.”

Adam ran toward the pool and found Max floating face first in just 4 feet of water.

“It was an indescribable feeling,” Adam says.

He just remembers thinking, ”This is not happening. This can’t happen. This is not going to happen.”

Adam pulled Max from the pool. “He was like a sack of potatoes. His face was white, his eyes were closed, his lips were blue,” Adam says. “I just started screaming at the top of my lungs for someone to call 911.” But there wasn’t anybody around. “I had to do something,” he says.

Adam laid Max on the ground and began performing CPR. Turns out Adam’s cousin is married to longtime American Heart Association employee, Kelly Griesenbeck Carter, who had offered Adam and other relatives an Infant CPR class right before Eleanor was born. Everything he learned that day came rushing back to him.

After several attempts to revive Max, nothing seemed to help. So, Adam scooped him up and ran through a gate into a patio area where they found an elderly doctor they knew.

Once again Adam laid Max on the ground and began chest compressions, while the doctor stood watch.

“Keep going Dad, you’re doing alright,” the doctor said.

Then it happened. Max projectile vomited the Slurpee he had enjoyed earlier that day all over Adam.

“It was the most wonderful feeling,” Adam says with a smile of that first sign of recovery. Then, Max took a breath and started crying.

About that time, the paramedics arrived. (Residents as high as eight stories up had heard Adam’s frantic cries for help and called 911.) They checked Max’s vitals and rushed him off to the local children’s hospital.

It was there that Adam learned what had happened during the 10 seconds his back was turned. “I got blown in,” Max still explains to this day. Yes, that heavy wind had literally blown him right into the water as he was running.

Today, he’s a perfectly happy and healthy 5-year-old – and a strong swimmer. But about a month after the incident Adam learned how truly fortunate he was that he took that Infant CPR class all those years ago.

He ran into the doctor who had stood over him while he performed CPR at the pool that day. The doctor pulled Adam aside and said, “I just want to tell you, Dad, you did a great job because that boy was dead.”

In the year that has followed that fateful day, Adam has become an evangelist for CPR in his Alamo Heights community, warning other parents not to be lulled into a false sense of security at even a crowded community pool, often staffed by teenage lifeguards who are just kids themselves.

“Pay attention and stay hypervigilant near the water,” he says. “This happened in 10 seconds. Ten seconds. Things change in the blink of an eye.”

By Gina Mayfield

Their week-long cruise had returned to port the night before, and with the ship safely docked in Fort Lauderdale, Florida, Mark and Diane Jones had slept in knowing that their disembarkation time was still hours away.

But just as the Joneses started to rouse, they heard a loud thump next door.

“Next thing I know, I hear a lady screaming at the top of her lungs in the hallway,” Diane recalls. “She was really, really screaming.”

Still in her nightgown, Diane ran out the door and found a small crowd gathered outside Andy and Michelle Katon’s room.

Inside, Andy had collapsed against the bathroom door. Mark, who had closely followed Diane, had to pull Andy away from the door and flip him over. That’s when Diane realized he was “extremely diaphoretic and cyanotic.” Those are the words an RN who spent a good part of her 38-year career in critical care uses to describe someone who is sweating profusely and turning blue.

“Get me an AED unit, call 911, get me some help here,” Diane said to the crowd while supporting Andy’s airway and constantly checking his pulse … until there wasn’t one.

She started Hands-Only CPR and waited for an AED unit. When it finally arrived, they shocked Andy once and his pulse returned to normal. He eventually started breathing on his own, and they transported him to a local hospital.

Then it was time for Diane and Mark to go downstairs – and have breakfast. When they met their friends, the conversation started with, “You guys aren’t going to believe what happened … .” What a morning it had been.

Turns out, Andy had a widow maker heart attack, which is almost always fatal without emergency care. “You’re only alive because of your next door neighbor’s actions,” the cardiologist told Andy.

Turns out this was the second time Diane used CPR to save a life outside of the hospital, the first time being at a college football game.

“I tell people, I don’t leave home without her,” Mark says with a laugh.

Since the rescue, the Joneses and Katons, who had never met before this incident, have gotten to know each other and planned on being together to mark the one-year anniversary of Andy’s survival in March 2020, then COVID-19 got in the way. Still, their bond is strong.

“It’s like we have a new family,” Mark says. “They’re very, very good people.”

“They call me their hero,” Diane says. “They always say they know Andy survived because of what I did. It was real rewarding to know that I saved his life. He was only 49 years old and had three children at home. They’ve all reached out to me to say, ‘Thank you for saving my dad.’ ”

Visit our Hands-Only CPR webpage to learn the two easy steps to save a life and check out Heartsaver® First Aid CPR AED for additional eLearning opportunities.

 

 

 

Left to right: David Dibble and Zach Sievers

By Gina Mayfield

In Spring 2017, youth baseball coach Zach Sievers got a call from former player David Dibble looking to land a spot on a local team. After having a hard time finding a place for the 19-year-old college freshman, Zach did the next best thing and offered him an assistant coaching position on his own 16 and under Wisconsin Wave team in Kenosha.

June rolled around, and David was in the bullpen going through the usual drills with the team.

“Then it happened,” Zach remembers. “David threw a pitch, the catcher threw it back to him. David looked at me, grabbed his chest and fell to his knees.”

Then came the face plant, which was so slow and controlled that Zach wasn’t sure what to make of it.

“I thought he might be playing a prank on somebody.” But David didn’t budge, even after Zach called out to him.

Zach ran over and realized this was no joke.

“David’s eyes were glazed over, his face was gray, his lips were purple,” Zach recalls. He directed another coach to call 911 and sprung into action.

“I checked David’s airways and didn’t feel any breath. I couldn’t see his chest rising. I checked for a pulse and couldn’t find one, so I started CPR.”

No one else at the ballpark that day knew CPR. Thankfully, Zach had been an electronics technician in the Navy, where he went through regular CPR and AED  training.

While to Zach it felt like 15 seconds had passed between the time he started CPR and the time a fire truck arrived, it had actually been nine to 12 minutes.

“Where we were wasn’t the easiest place to get to, and we were between fire zones,” he says. One fireman took over CPR, while the other ran to get the portable AED.

“When I heard the AED announce it couldn’t detect a pulse, I knew for a fact at that point that David was in some trouble. At that point it became real.”

When Zach got to the hospital, paramedics told him they had to stop the ambulance twice to restart David’s heart. He still wasn’t stable.

“I was really just hoping he was going to make it,” Zach says.

Eventually the doctor came out and pulled him aside.

“He told me that if I hadn’t done what I did, David would have died. He wasn’t out of the woods yet, but his chances of living were much better. That was hard to hear. It could have gone either way.”

Flight for Life flew David to a major hospital in Milwaukee where it was discovered that he had atrial fibrillation (AFib).

“So, essentially his heart was just beating out of control, so much so that he didn’t have a pulse,” Zach says. “It was beating at such an interval that it was more like a flutter than a beat.”

David had a defibrillator inserted and spent a week in the hospital. While he was still there his Aunt Connie had an epiphany. She realized that what happened to David could happen to anyone. She went on to start the Dibbs17 CPR Challenge (a name created by combining David’s nickname and number) with the goal of training 1,700 people on CPR within one year.

Connie partnered with the American Heart Association and used its tools to train every last one of them, and that was just the beginning of the organization. They’ve also hosted AED Challenges, where participants take pictures of the AED in whatever building they’re in, just to see if they can find it.

“Connie has done more for David than I ever did,” Zach says humbly.

These days, Dibbs17 is still going strong, and so is David. He got cleared to play baseball again and is back on the field at the University of Wisconsin-Superior. But the Dibble family never forgot what Zach did for them.

“They call me their angel,” he says. “But it’s hard for me to hear ‘thank you’ because I just did what I was supposed to do.”

To hear more about Dibbs17 and David’s story, watch this video on YouTube.

By Marissa Alanis

Each weekday at lunchtime, Maurice Trosclair ran four miles along the Lake Pontchartrain levee near his office building in Metairie, a New Orleans suburb. An avid runner, Maurice, 55, had completed a half-marathon nine days earlier.

But on Feb. 14, 2017, a gut feeling urged Maurice to end his run at the one-mile mark and to return to the office to finish some work. He also needed to pack before he left on a trip to New York City.

Maurice, a geosciences technician, also was a trombone player who was set to perform with Delfeayo Marsalis and the Uptown Jazz Orchestra the next day at Lincoln Jazz Center.

His cell phone buzzed as he walked toward the elevator in his office building. His wife, Nancy, had sent him a text to thank him for the Valentine’s Day card that he had taped to their backyard fence.

He was replying to Nancy’s text on the elevator ride to the ninth floor when he suddenly collapsed and fell facedown. Nancy’s text was the last thing Maurice would remember for the next four days. He had suffered a cardiac arrest.

Two women who were inside the elevator, Sandy Ortego and Kim Duplessis, immediately sprang into action when the elevator stopped.

Sandy dashed out to get help at Premiere Athletic Club located on the ninth floor where Maurice had been headed to take a shower. Kim stayed inside the elevator as it headed up to the 21^st floor. The building has “smart” elevators where people select their floor destination before getting inside.

Kim grabbed Maurice’s phone before it locked up and called the last person he had texted. Nancy answered an incoming call on her cell phone at another gym where she was exercising.

“Hey baby,” Nancy said, fully expecting to hear Maurice’s voice. “Happy Valentine’s Day.”

There was an awkward silence.

“Do you know someone who works in this building?” Kim asked.

“Yes, of course, my husband,” Nancy said. “You called me from his phone.”

Kim tells Nancy that Maurice has just suffered a heart attack much to Nancy’s shock.

“What?” Nancy tells Kim.  “He had just run a half marathon. He’s healthy.”

For the next 50 minutes, Kim keeps Nancy on the phone as the emergency response unfolded that would involve the assistance of six people, each playing a vital link in the chain of survival.

The elevator proceeded to the 21^st floor next. When the doors opened, Suzanne Howard, a nurse for People’s Health, was nearby waiting for another elevator. She saw Maurice lying face down. She immediately ran over to him and started CPR while the elevator doors closed and  proceeded to its next stop, which took about 10 minutes.

Meanwhile, Sandy arrived at the athletic club and told the manager, Roy Fontenelle, about Maurice’s situation. They called 911. Roy grabbed the health club’s Automated External Defibrillator (AED), which was the only AED in the building.  Roy and club employee, Kaitlyn Reis, ran to go find Maurice.

The elevator finally arrived back on the first floor, where Tricha Arabie, another nurse who works for People’s Health, was waiting.  Suzanne screamed that she needed help. Tricha took over the CPR efforts and tagged team with Suzanne.

Roy and Kaitlyn found Maurice on the first floor. The AED was deployed and shocked Maurice one time. Maurice was checked for a pulse before CPR resumed. When the EMT team arrived, they administered four additional shocks. They also put an automatic chest compression device known as a Lucas 3  and administered continuous manual breathing. The EMT team got Maurice on the ambulance and sped to East Jefferson General Hospital.

Doctors intubated Maurice who was put in a medically induced coma. Four days later, he was released from the hospital donning a  bright yellow cape with the letter “M” on the back.

Before he suffered a cardiac arrest, Maurice said AEDS were not top of mind for him.

“That’s the thing – the more we educated ourselves about what happened to me, it got to the point where at every place, I’m looking for an AED,” he said. “I’m performing at venues looking for the AED. It’s mind boggling how many places of high volumes of people traffic don’t have one.”

The lifesaving efforts that unfolded on Feb. 14, 2017 inspired Maurice and Nancy to form a nonprofit called Heartbeat NOLA, which  encourages CPR training among residents, increases awareness about AEDs and raises funds to purchase AEDS for music venues throughout New Orleans.

Maurice, who also has written music for years, turned to music to help him cope with the anxiety and questions that lingered after his cardiac emergency. He said he also wanted to write to see if that part of his brain still functioned properly.

“The first song I wrote is ‘You Are Not Alone,’ because I had fellow survivors on my mind,” he said. “I was feeling what they’re feeling. The lyrics and music were meaningful to me but also the people I was writing for.”

He continued with his songwriting, which spurred his first solo album titled,” Grateful: A Sudden Cardiac Arrest Survivor’s Awakening,” which was released in December.  All proceeds from album sales will benefit Heartbeat NOLA.

Twenty musicians collaborated on the project with Maurice, who said the album is a tribute to people who save lives and conveys the message that tomorrow is not guaranteed.

“When you put together all the songs that came together on this project, it’s a basically a musical thank you note to everyone that not only saved my life but save lives every day,” he said.  “Because this whole experience has opened up my eyes that anybody can save someone’s life. If you have two hands, call 911 and get an AED.”

Maurice encourages the public to become educated about  CPR during CPR and AED Awareness week, which is June 1-7. He said it’s important to learn CPR now more than ever as many people are spending a lot of time at home during the COVID-19 pandemic.

“Where do most cardiac arrests happen? In the home,” he said. “Chances are you’re going to save the life of somebody you love. Our EMS is stretched. We need to become citizen first responders. We need to play our role just  like we are now with social distancing. We need to play our role in the first move in the chain of survival.”

None of us expect the unexpected. With 10,000 cardiac arrests in the workplace every year, you should understand the benefits of CPR training.

By Gina Mayfield

When it comes to ensuring safe and healthful work conditions, we tend to focus on finding and fixing commonly recognized hazards such as clearly preventable injuries and illnesses. While these dangers certainly warrant our attention, what about expecting the unexpected, such as an employee experiencing a cardiac arrest outside the hospital? Is your workplace fully prepared for an incident that requires CPR or even a defibrillator?

June is CPR Awareness Month, with the first few days designated as National CPR and AED Awareness Week. Both occasions were designed to bring attention to the importance of CPR and AED training that organizations can provide to keep their employees safe, prepared to respond and…alive. Trained employees who can properly and quickly respond to an out-of-hospital cardiac arrest before emergency responders arrive can help save a life.

Cardiac arrest—an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia) and disrupts the flow of blood to the brain, lungs and other organs—is a leading cause of death. Each year, more than 350,000 EMS-assessed out-of-hospital cardiac arrests occur in the United States, according to the American Heart Association (AHA).

Be Ready: CPR

When a person has an out-of-hospital cardiac arrest, survival depends on immediately receiving CPR from someone nearby.

According to the AHA, about 90 percent of people who suffer out-of-hospital cardiac arrests die. CPR, especially if performed immediately, can double or triple a cardiac arrest victim’s chance of survival.

But most U.S. employees are not prepared to handle cardiac emergencies at work because they simply lack the training, according to findings from two surveys from AHA as part of its Workplace Safety Training Initiative. Between February and April 2017, researchers surveyed 2,000 employees in various fields such as corporate offices, hospitality, education and industry/labor.

Study findings revealed that most employees do not have access to CPR and first aid training, and half could not locate an automated external defibrillator (AED) at work (helpful hint: place it in the same location as the fire extinguisher). Such training has the potential to save thousands of lives, considering there are 10,000 cardiac arrests in the workplace annually.

The second survey from OSHA and commissioned by AHA included more than 1,000 safety managers in industries regulated by OSHA. The safety managers see a need for more frequent training, but a third of them said first aid, CPR and AED training only become a priority at their workplace after a demonstrated need, meaning after an incident.

All of this data brings to light an important realization: Employees may be relying on untrained peers in the event of an emergency, which creates a false sense of security. Many may wrongly believe there is someone onsite who is qualified and able to respond, but that’s clearly not always the case.

Here’s the good news: The study shows that more than 90 percent of employees would take First Aid and CPR+AED training if employers offered it.

Save Lives: AED Awareness

Use of an AED is the third step in the cardiac arrest chain of survival, with the first two steps being a call to 9-1-1 and beginning immediate CPR.

During a cardiac arrest, the electrical activity in the heart is disrupted. According to the AHA, every second counts because without immediate CPR, the heart, brain and other vital organs aren’t receiving enough oxygenated blood. For every minute without CPR, the chance of death increases by 10 percent.

Survival from cardiac arrest doubles when a bystander applies an AED before emergency responders arrive, according to 2018 research published in AHA’s flagship journal, Circulation.

Unfortunately, less than half (45.7 percent) of cardiac arrest victims get the immediate help they need before emergency responders arrive, in part because medical services take, on average, between four and 10 minutes to reach someone in cardiac arrest.

An international team of researchers looked at 49,555 out-of-hospital cardiac arrests that occurred in major cities in the U.S. and Canada. They analyzed a key subgroup of these arrests: those that occurred in public were witnessed by bystanders, and the patients were shockable. The researchers found that nearly 66 percent of these victims survived to hospital discharge after a shock delivered by a bystander. Their findings emphasized that bystanders—or for our purposes, coworkers—make a critical difference in assisting cardiac arrest victims before emergency responders can get to the scene.

Be the Difference. It’s Simple.

If you want to be a part of a larger culture of safety in the workplace and are interested in getting CPR and AED training at work, it’s not difficult to do. Helpful resources from quality organizations such as AHA provide beneficial training.

For example, AHA’s Heartsaver First Aid CPR AED Training course teaches participants to provide first aid, perform CPR and use an AED in a safe, timely and effective manner. The course is designed for those with little or no medical training who want to be prepared for an emergency in any setting.

The course covers the basics such as first aid as well as medical, injury and environmental emergencies. But it also delves into preventing illness and injury, opioid-associated life-threatening emergencies, Child CPR AED and Infant CPR in addition to Adult CPR and AED use.

You’ll just need to decide what type of training works best for your team. You could go with a blended learning approach, such as AHA’s Blended Learning Heartsaver First Aid CPR AED Online class, which combines online instruction with a hands-on skills session.

Or you could opt for a Classroom Heartsaver First Aid CPR AED class, which is an instructor-led, hands-on class format in either a training center or your place of business. Both video-based, instructor-led courses teach students critical skills needed to respond to and manage an emergency until medical services arrive. The practice-while-watching technique allows instructors to observe the students, provide constructive feedback and guide the students’ learning of skills.

AHA also offers a CPR First Aid Anywhere Training Kit, a video-based kit that can be easily facilitated by anyone to train hundreds of individuals.

Know that in response to the COVID-19 outbreak, AHA has issued optional instructional changes to its training network for its Heartsaver courses.

In the Age of COVID-19: Hands-Only CPR

Hands-Only CPR has been shown to be as effective as conventional CPR for cardiac arrest at home, at work or in public, according to the AHA.

But in the age of COVID-19, rescuers are unlikely to have access to adequate personal protective equipment. Therefore, rescuers are at increased risk of exposure to COVID-19 during CPR, compared to healthcare providers with adequate personal protective equipment.

The AHA has issued interim guidance on how lay rescuers should perform Hands-Only CPR, if they are willing and able, after recognizing an out-of-hospital cardiac arrest in an adult, especially if they are household members who have been exposed to the victim at home. AHA recommends a face mask or cloth covering the mouth and nose of the rescuer and/or victim may reduce the risk of transmission to a non-household bystander, such as a colleague at work.

Hands-Only CPR has two easy steps:

1. Call 911 if you see a teen or adult suddenly collapse.
2. Push hard and fast in the center of the chest to the beat of a familiar song that has 100 to 120 beats per minute.

Song examples include “Stayin’ Alive” by the Bee Gees, “Crazy in Love” by Beyoncé featuring Jay-Z, “Hips Don’t Lie” by Shakira or “Walk the Line” by Johnny Cash. People feel more confident performing Hands-Only CPR and are more likely to remember the correct rate when trained to the beat of a familiar song. When performing CPR, the beat of the song examples above corresponds to pushing on the chest at a rate of 100 to 120 compressions per minute.

Note that AHA still recommends CPR with compressions and breaths for infants and children and victims of drowning, drug overdose or people who collapse due to breathing problems.

To get a better sense of Hands-Only CPR, which is a natural introduction to CPR, you can watch a 90-section instructional video at heart.org/handsonlycpr. Then find a CPR class near you at heart.org/findacourse.

One last thing to keep in mind: In one year alone, 475,000 people die from cardiac arrest in the United States. While that’s a big number, it also presents a big opportunity. Consider being an organization that commits to proactively fostering a safe environment and empowers its people to take on a small social responsibility that can have a big impact at work, home and in the community as a whole.

Please note: The article was originally published in the June issue of Occupational Health & Safety magazine.

By Gina Mayfield

It was late August 2019, and Saturday morning in the Walenga household was off to its typical All-American start. Kristen Walenga sent her husband off to work and geared up for her team mom duties as she made breakfast for her four children. Her daughter Rose, 14, got ready upstairs for cheerleading pictures and her youngest sons, Sam, 11, and Nate, 9, ran around outside to burn some energy before their youth football game.

The family’s eldest child, Eddie, 15, was in the basement playing video games when he heard a loud crash coming from the kitchen above him, followed by screams for help from his younger brothers who had just come inside. Then the family pet, a certified therapy dog, started howling. That’s when Eddie realized this wasn’t a typical Saturday at all.

He raced up the basement stairs to find his mom in a heap on the floor, and his two little brothers standing there in disbelief. At first, they thought their mother was just playing around.

Eddie, who had taken a Hands-Only CPR class a few years earlier in middle school, quickly realized his mom wasn’t breathing and had no pulse.

His training immediately kicked in and he began chest compressions while little Nate ran to get help from a neighbor. The neighbor’s son, who happened to be visiting, was a former Army medic and ran straight for the Walenga’s kitchen where he found Eddie performing CPR like a champ.

In the midst of the chaos, Sam had the presence of mind to call 911. Paramedics arrived, continued CPR and administered four AED shocks. They got a pulse and transported Kristen to the hospital where, a couple of days later, they removed her from a ventilator. She woke up from a medically-induced coma with an internal defibrillator firmly implanted in her heart at the age of 45.

“So I had a sudden cardiac arrest,” Kristen says. “They were not able to find any reason for it. It’s ‘idiopathic,’ or unexplained. Their best guess is that it was stress induced. I was a full-time teacher, the school year had just started. We’re a very busy family, and I had been working a ton that week.”

Later, one of the paramedics told Kristen that she was very fortunate. “He said that I had so many good things fall into place. Of course, one being a ‘witnessed’ cardiac arrest. Two, having someone at home who could start CPR within a minute or two.”

After some time went by, Kristen sat down with Eddie and said, “How did you know this was the right thing to do? How did you react so quickly and know to start CPR?” Eddie said that even after a couple of years, a few things stuck in his head from that middle school health class, including that he couldn’t do more harm than what was already happening to his mother. Secondly, he recognized that Kristen wasn’t breathing normally, so he knew that meant to start CPR.

Since her cardiac arrest, Kristen has taken what she describes as a serious interest in CPR by taking classes, going through an instructor course and getting certified. As is the case with so many survivors, Kristen immediately felt that it was no accident she was left on this earth.

Being a teacher herself, she questioned why educators weren’t being trained in CPR. “It just seems like a no-brainer. CPR should be a basic skill that everybody has in their pocket.” But it isn’t … yet. “We have several in-service classes that we have to do at the beginning of every school year. We have to know how to administer an EpiPen, manage diabetes and ADHD – all of these really important things. But I can’t think of anything more important than just being able to administer Hands-Only CPR.”

So Kristen discovered her calling: Creating awareness around the American Heart Association’s CPR in Schools program. Schools often don’t know how time- and cost-effective the program can be, and it’s the mission of her foundation, Kristen’s Heart Beats, to change that.

In the end, Kristen went back to those middle school health teachers who made the Hands- Only CPR class happen after writing a grant to the American Heart Association for the CPR in Schools training. They now teach the class at the sixth, seventh and eighth grade levels, but they shared that they initially had some reservations about applying for the grant and teaching the course: How receptive would middle schoolers be? Were they too young? Would they remember it? Is this worthwhile, is it going to work?

But Kristen was living proof they made the right decision. She simply replied, “If you hadn’t written that grant, I wouldn’t be here today.”

This week is National CPR and AED Awareness Week, spotlighting how lives can be saved if more Americans know CPR and how to use an AED. Did you know about 70 percent of out-of-hospital cardiac arrests happen in homes? Learn more about how you could save the life of a loved one by learning CPR today.

 

Paramedic Kevin Thomas was close to ending his overnight shift in the early morning of February 2016  when he received one last emergency call for the day: a pediatric cardiac respiratory arrest in Pearl River, a New Orleans suburb.

The emergency involved a newborn baby named Sophia Ruth Smith, who was only six hours old and suffered a cardiac arrest after a home birth delivery.

As the ambulance sped to the scene 13 miles away, Kevin’s thoughts raced in his mind as he reviewed the steps he’d need to take to treat Sophia. It was his first pediatric cardiac arrest call.

“I don’t remember the drive to the house,” said Kevin, who works for Acadian Ambulance. “All I remember is being nauseated. Just that feeling of you’re going to have a child’s life in your hands. You just feel sick to your stomach.”

When the ambulance arrived at the home, the fire department was already on the scene. Sarah, Sophia’s mother, said her husband had been doing CPR on his daughter whose skin had turned blue. Kevin immediately provided aid to Sophia.

“He was on it from the moment he came into the house and took over the chest compressions and took over the CPR,” Sarah said about Kevin’s assistance. “He didn’t skip a beat.”

Sophia had a pulse, but she was having problems breathing. Kevin and his EMT immediately put a bag-valve mask on Sophia to deliver oxygen to her lungs to help her breathe and started an IV.

A helicopter ambulance had already been called to transport Sophia to the hospital, but Kevin realized that there was no time to wait for the helicopter. Sophia needed to get to the hospital immediately.

Sarah remembered how Kevin advocated for Sophia to be taken to a nearby hospital by an ambulance ride instead of a helicopter.

“He knew there was not time to get her to the helicopter and transfer her to the hospital,” she said.  “I remember he was on the phone with different hospitals because they didn’t want to take her. He fought and fought to get her to one close by.”

Sophia was rushed to a hospital via ambulance ride. Her prognosis was bleak. Sarah said Sophia suffered major organ failure and brain damage. The doctors told Sarah and her husband to let Sophia go, as she would be in a vegetative state and have no quality of life.

Fortunately, Sophia defied the odds and survived. She is now four years old.

“I look at her today and thank goodness that we followed our faith and that we didn’t make that choice,” Sarah said. “That we didn’t make the decision. That we left it up to God and his will and his way.”

Sarah describes her daughter as an outgoing, loving child who has a smile that lights up a room. Sarah said Sophia is nonverbal, but she communicates so well just who she is.

“She’ll let you know what she wants,” Sarah said.  “She is extremely independent. We have nine kids. We treat her like the other kids. I think that has helped with her development and her getting to the point she is today.”

Sarah said Kevin’s experience the day that he responded to the emergency call and provided treatment to Sophia made a difference.

“His experience was what we needed for her to be here today,” she said.  “When we left the hospital, her doctor over at Ochsner Baptist, the head doctor of the NICU, said there is no scientific reason why your daughter should be alive today. She was that bad. She was that sick. It was their (emergency responders) quick response and everything he did.”

Sarah will not forget how Kevin called the hospital after the incident to talk to the nurse to make sure that Sophia survived.

“God put the right people right where they needed to be,” she said. “Kevin will always have a huge place in our hearts forever.”

Kevin keeps in touch with Sarah and sees Sophia’s progress through a Facebook group that her mother started.

“l look at her Facebook page all the time because her mom posts a lot of things on the page because of her progression,” he said.  “She had a low chance of survival. And here she is four years old.”

Kevin began his career as an EMT with Acadian in 2004. He later earned his paramedic certification and now serves as a Critical Care Paramedic. His EMT training was based on American Heart Association guidelines. He was recognized as a finalist for Acadian Ambulance Paramedic of the Year for the Northshore region of the New Orleans area in 2018.

Kevin said he feels like he’s a savior for his community of Slidell, as he works to protect safety and health. He said EMS personnel provide pre-hospital care and can be the difference between life and death.

“They are special people who always put themselves in danger to help the ones in need,” Kevin said.

School nurse Haley Pepper was about to snack on a donut in her office the morning of Sept. 20, 2019 when she heard a plea for help at Gateway Science Academy South, the elementary school where she worked in St. Louis.

“I’m hearing somebody scream, ‘Nurse! Nurse! Nurse!” she recalled.

When she stepped out in the hallway, she saw the school’s vice principal of operations, Mehmet Okay,  who yelled to follow him. She tossed the donut through the doorway toward her desk,  ran after Mehmet and followed him downstairs to his  office.

The school’s custodian was lying motionless on the sofa in Mehmet’s office. He was not breathing. The custodian had been eating an apple while chatting with Mehmet when his head suddenly drooped. Haley would later learn that he had suffered a heart attack.

Haley shook the custodian and checked his pulse. Erkan Bayer, who is the school’s technology teacher, had also just walked into the office. Haley immediately started giving out orders to get assistance.

Erkan ran to get the AED equipment while Mehmet called 911. Haley, who has a bad back, also quickly realized she would need a stronger person to lift the custodian from the sofa and lay him flat on his back on the floor.

“I remembered the gym was nearby,” she said. “ I ran to the gym, scanned the room and got the P.E. teacher. I said ‘I need help. Follow me.’

P.E. teacher, Kenyon Klousia, and two other staff members had moved the custodian onto the floor just as the AED arrived. CPR was soon started while Erkan was on the phone with dispatchers who were also giving instructions on the emergency response.

As they performed CPR, Haley said she had no idea if the custodian had choked on his apple or something else had stopped his heart and breathing.

“We had to check carefully if our breaths were going in, and a few times there was apple pieces in his mouth that had to be cleared away,” she said.  “So, we were constantly reassessing to make sure we were doing the right thing.”

Only three-and-half-minutes had passed by the time they started to use the AED and administered the first of two shocks. When paramedics arrived, the custodian was breathing and his pulse had returned.

“It was probably 15 minutes all around from the time we called 911 and by the time he was carried out to the hospital,” Haley recalled.

A week later, the custodian called the school to say hello as he recovered. Haley said she isn’t a runner, but she bolted to greet the custodian when he returned to the school weeks later to visit.

“I sprinted to go give him a hug when he came back to visit that day,” she said. “He started crying. I apologized for his sore ribs.”

As Haley reflects on the turn of events on Sept. 20, she said it was easy to make those decisions such as to call 911 and to get the custodian flat on his back. She said the hardest decision was realizing that she would need to do CPR on her friend.

“This isn’t something where I’m just putting a band-aid on someone,” she said. “This is serious…This just happened to my friend. Coming to grips with the fact that this is the  problem was a hard decision.”

She is grateful that Kenyon was nearby to assist. They both had participated in CPR and AED training together that was developed by the American Heart Association (AHA) and provided by CPR Plus, an AHA Community Training Center.

“I couldn’t have grabbed a better person than the P.E. teacher,” she said.  “I just thought I needed somebody strong to lift him off the couch.  He was amazing. We both remembered our steps from training. We both remembered what each other would be doing.”

Haley has performed CPR before. But she never expected that she’d need to perform the life-saving skill that September morning as she took a break to eat a snack when there were no children in the clinic.

“It was the last thing on my mind that one of my staff members was going to have an emergency at work,” she said.

Article Contribution: Dr. Takahiro Matsumoto is head of a home-visit clinic in Ena City in Japan. He is an active volunteer and is the representative director of the non-profit organization JPSOCLS (Japan Patient Safety Foundation for Organizational Culture and Learning System).

 

Global Impact: Understanding the AHA Education Statement in Japan

In 2018, the American Heart Association (AHA) published a statement on cardiopulmonary resuscitation education in Circulation titled Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest. The statement was developed to promote the construction of learning content based on science and the application of instructional design, which is an area of educational engineering to promote education, training and implementation.

The statement says “Although millions of lay providers and healthcare providers are trained in resuscitation every year, major gaps exist in the delivery of optimal clinical care (ie, poor-quality CPR or no CPR in the out-of-hospital setting) for individuals with cardiac arrest” and that “enhancing instructional design in these contexts can improve educational outcomes (ie, provider knowledge, skills, and attitudes), which will ultimately translate to improved patient outcomes and survival after cardiac arrest.” [1] The application of instructional design was recommended.

In Japan, the Japanese Society for Instruction Systems in Healthcare (JSISH), an academic organization that promotes patient safety by applying instructional design to healthcare, has established an international training center (JSISH-ITC) for AHA Emergency Cardiovascular Care (AHA ECC) program. Instructional Design (ID) theory has been implemented in various educational activities within their programs. This statement recommends the application of ID to improve cardiopulmonary resuscitation education, but for many healthcare professionals, it may not be so simple to understand and apply to practice. We translated the AHA Education Statement to Japanese and published it. In addition, we published the article  “To apply the AHA proposals for resuscitation science education” in the Japan Journal of Health Professional Development (JJHPD), which is the JSISH’s academic journal for the exposition of the statement and proposal of the application in practice.[2]

Furthermore, to spread awareness and knowledge about the above, we held a symposium on June 15, 2019, about “Understanding the AHA statement for Cardiopulmonary Resuscitation Education.” During the symposium, instructional design experts, JSISH representative directors, and practitioners who apply ID to healthcare education presented exposition, proposals and real case studies of ID application in healthcare. These were recorded and will be distributed on DVD.[3]

The efforts continue after the symposium and there are new practice examples. One of them is a cardiopulmonary resuscitation course focused on the learning content for appropriate competence in clinical environment. Another example is a seminar for faculty development that CPR instructors to play active role as ‘change agent’ in their has to improve its performance.

If understood deeply and widely in Japan, this AHA statement has high possibility to support improvement and implementation of CPR but also to improve patient safety in Japan.

 

[1]https://cpr.heart.org/en/resuscitation-science/education-statement

[2] http://idportal.gsis.kumamoto-u.ac.jp/wp-content/uploads/sites/3/2019/04/JSISH_matsumotosuzuki.pdf

[3] https://www.zenkanan.info/dvd

Japan Patient Safety Foundation for Organizational Culture and Learning System (JPSOCLS)、https://www.zenkanan.com/

 

Matsumoto Takahiro, M.D., Ph.D

Okamoto Hanae, RN, MSN.

Shingo Kuroyanagi, CE.