CPR—The Lifesaving Technique Everyone Should Know

CPR—The Lifesaving Technique Everyone Should Know

By WARREN R. YOUNG
“Help!  The man needs help!”  The frantic cry shattered the Sunday afternoon serenity on Seattle’s Jackson park golf course.  Form the elevated fifth tee, four started hi school boys saw two youngsters hovering over the crumpled form of a man on a nearby fairway.

“Let’s go!” shouted 18-year –old Craig Larson.  Sprinting downhill to the stricken victim, the four boys saw that he had turned dark blue—obviously from lack of air.  One of those who had shouted—year-old Neil Ratty, a boy scout—was already trying to tip the man’s head back to open a clear mouth-to-lungs airway.  Craig flopped to the ground and shoved his forearms beneath the base of the man’s neck so that the others could tilt his head far enough back to assure an open air passageway past the tongue.  Mike Merkley, 17, quickly but carefully looked at the man’s chest and felt the air in front of his nose and mouth for any signs of breath -   none!  The man was then given four quick breaths.  Pressing fingers gently to the side of the man’s neck, Mike sought any indication of a pulse.  Again, none!  Technically, the man was ‘dead.’

But the boys knew that only about a minute had passed since his collapse, and that the human brain can usually survive about four to six minutes without the oxygen that the heart normally pumps to it through the blood stream.  So they set to work.  Neal helped hold the head there while 17-year-old Dan Fagan prepared to puff lungful of air into the man’s mouth.

Meanwhile, Ross Venema felt the chest to locate the lower tip of the breast bone.  Moving his hands two fingers up from there, Ross placed the heel of one hand on the lower breastbone, and the heel of the other palm a top the first, and began a rhythmic, strong compression of the chest, about once per second.  Each time he pressed down, the man’s heart was squeezed, forcing blood out to his body.  With Craig calling the count, Dan inflated the victim’s lungs once every five times that Ross pressed down on his heart.

Ross was literally substituting for the victim’s heart beat; Dan was literally breathing for him.  Almost magically, the man’s terrible blue color began to fade away.  He was alive again—although only for as long as the youths continued their successful cardio-pulmonary resuscitation [CPR].

Meanwhile, another golfer had run to the clubhouse to call professional help.  About eight minutes after the man’s collapse, an Aid Car from a nearby firehouse slithered across the damp fairways.  Two firemen took over the CPR efforts, substituting an air-bag device for the mouth-to mouth breathing.

Ten minutes after that, an elaborately equipped hospital rescue van arrived.  Using an electrocardiography oscilloscope to monitor the victim’s heart activity, electric paddles to shock his heart back into normal rhythm, plus various medications, two of Seattle’s specially trained firemen-paramedics worked for 27 minutes until they achieved a slow but stable heartbeat and spontaneous breathing in the still-unconscious victim.  Finally, they were able to transport him in the rescue van to the nearest hospital where a fully monitored coronary-care unit was available.

Three weeks later, the victim, a 54-year-old airline executive, walked cheerfully out of the hospital—with no trace at all of any permanent damage to brain of heart!  A group of schoolboys, using only their own hands and exhaled breath, had brought him back from ‘clinical death’ and safety maintained his life until more sophisticated help could come.  Without their application of CPR—that combination of carefully controlled hand pressure on the chest, originated in 1960 by a Johns Hopkins University medical team, and of mouth-mouth breathing, developed in the late 1950s—there is no question at all hut that the man’s brain cells would have been irreparably destroyed.

Strangely, however, the achievement of bringing the man back to life was noted only briefly in Seattle newspapers.  Shy?  Because that city was on the handful of foresighted communities across the country—Jacksonville, Florida and Grand Rapids, Michigan, were others—which had undertaken to program to make such lifesaving daring-do by ordinary citizens a matter of routine.

The model Seattle plan, jointly implemented in March 1970 by Dr. Leonard A. Cobb, chief of cardiology at Harbor view Medical Center, and the then fire chief, Gordon F. Vickery, combined the city’s once catch-as-catch-can rescue and emergency ambulance services into an  efficient Fire Department function.  A fleet of so-called Aid Cars—swift, rugged, one ton trucks outfitted to transport patients—were readied and manned by firemen, all of whom had been trained in advanced first aid and CPR.  More than 50 firemen who volunteered for 1800-hour special courses were trained as paramedical technicians at Harborview.  Now these experts, in two-man teams, are poised round-the-clock to hurry to the scene of any heart attack, drowning, electrocution of sudden-death emergency in one of the five mobile intensive-care units that have been acquired.

When a rescued patient arrives at the hospital in a mobile unit, he is moved immediately to a bed in a fully monitored coronary-care of care-care unit.  During the first ten years in which Seattle firemen ran rescue missions, about 3000 sudden-death victims were treated.  More than 800 of the victims were successfully received and subsequently discharged from the hospital.  “And it isn't only these clinically dead who have been saved,” Dr. Cobb points out. ‘thousands of other people suffering less severe forms of heart attack also got rapid assistance, thanks to the same rescue team.

Furthermore, over 200,000 Seattle adults and teen-agers have been taught to perform CPR in three-hour training courses at schools, offices, shopping centers, theaters and homes.  Firemen-paramedics carefully explain how to recognize cardiac arrest and how to perform CPR.  Then each trainee practices CPR on mannequins engineered to respond just like a human body.  Today, two out of every five Seattle citizens have been trained in the CPR technique as the teen-age golf-course heroes were.

The index of teaching the public victims of sudden death back to life by using methods which even doctors didn't know about until 1960 was clearly a dramatic, even a daring, concept.  There can be pitfalls in performing CPR.  For instance, if a great deal of air is blown into the stomach, it can cause trouble—even a state of near-shock.  Even when done exactly right, CPR may carouse cracked ribs.  And when not done right the arrow-shaped tip of the breastbone or a broken rib can puncture the liver of a lung.

The answer to these worries is proper training, followed by periodic refresher courses.  After all, if nothing is done for a person whose heart and lungs have really stopped, death is sure.

Trained rescue squads and prepared coronary-care hospital units are essential prerequisites if citizen training in CPR is to reach its full potential for saving lives.  Dr. Archer S. Gordon, former chairman of the American Heart Association’s committee on CPR and emergency cardiac care, which has developed the accepted standards for the technique, warns: “any person who requires CPR should also have follow-up medical care.”  But quickness in starting CPR is equally indispensable, and even fireman cannot reach every ‘clinically dead’ victim within minutes.  If no citizen trained in CPR is at hand, a grain damaged human being or a corpse is then the only prospect.

Hence the prestigious 50,000 member American College of Physicians recommended that a nationwide educational program be launched to teach CPR to the general public.  Special emphasis was given to training doctors, nurses, medical students, firemen, policemen, ambulance personnel and lifeguards.  In addition, these specialists argue, CPR should be taught to Scouts, airline stewardesses, ski patrolmen, electric utility workers, members of the armed forces, relatives of anybody with previous heart trouble—and also, in fact, to as many adults and teen-agers as can be reached.  (The American Red Cross, the American Heart Association and other groups are currently conducting a nationwide CPR training program.)

Occasions to use CPR are not likely to be rare.  It is estimated that one in every six deaths in America—or about 350,000 each year—is sudden.  Most of these are caused by heart attacks.  Some involve drowning, electrocutions and other accidents.  Autopsies of the victims in all of these categories have revealed large numbers who surely would have lived on for many years if only they had been helped past their immediate crises.

“I get a funny feeling sometimes,” says one of the high school boys who save the Seattle golfer, “when I think how helpless we would have been if we hadn't been taught CPR.”  Some experts predict that, when and if CPR training spreads across America, the number of people who will actually be brought back to life could be in the thousands every year!