70 percent of cardiac arrests outside hospitals happen at home. American Heart Association
3 a.m. Jan. 4, 2016. Lisa Peters of St. Petersburg is awakened by her husband, Rick, making strange gasping sounds. She can't wake him. He feels cold.
Only 46 percent of cardiac arrests outside hospitals get immediate help until professional help
Lisa is unsure, confused, can't understand why her husband won't respond. About a minute elapses. She calls 911. To the young-sounding paramedic on the other end of the phone, it's very familiar. He takes control, sends her downstairs to unlock the front door, secure the dogs and return to her husband. Lisa reports that Rick is no longer making gasping noises. He doesn't seem to be breathing.
90 percent of people who suffer cardiac arrest outside a hospital die. AHA
The 911 operator tells Lisa to get her husband on the floor. "He's a big guy. This is isn't going to be easy," said the now 62-year-old homemaker. "But the operator tells me to do whatever it takes to get him on the floor, to try his feet first." Rick's head hits the nightstand. "That's when I realized it was serious," she remembers. "He didn't react to that."
Then Lisa notices something else. Rick, 67 at the time, is turning blue. The 911 operator tells Lisa she must start CPR. Lisa is at a loss. She never learned CPR.
CPR performed in the first few minutes of cardiac arrest can double or triple
"He was very authoritative," Lisa said of the 911 operator, noting that his language was efficient. "He didn't say a single word he didn't mean. He was taking it very seriously. He knew exactly how to talk to me without ever having met me."
Across the country, 911 operators relay the instructions every day: Place the heel of one hand on the breastbone, in the center of the chest, right between the nipples. Put your other hand on top of that hand. Pump the chest hard and fast 30 times, at least twice per second and 2 inches deep.
"He had me count with him," Lisa recalls. "And I was realizing the severity of what was happening. I heard a rib crack and he told me just don't stop. He kept counting with me and he told me to slow down. He was a hero, this 911 operator. One, two, three, four. One, two, three, four. We went on for several minutes." Then the paramedics arrived.
Most people called on to give CPR in an emergency will be trying to save a loved one —
a spouse, a child, a parent,
a friend. AHA
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Cardiologist Robert Sanchez doesn't like to hear that no bystander CPR was performed before a cardiac arrest patient was rushed to the hospital.
"It's always disappointing," said the director of cardiovascular medicine at Northside Hospital and the Tampa Bay Heart Institute. "The greatest chance we have for survival and neurologic recovery is when CPR has been performed."
CPR, or cardiopulmonary resuscitation, is an often lifesaving technique that involves pushing hard on the chest to force any remaining oxygenated blood through the body of someone who has collapsed, isn't breathing and has no pulse, until an automated external defibrillator, paramedics or doctors can reset the heart and get it back to a normal rhythm.
In cardiac arrest, an electrical problem causes the heart to stop beating rhythmically; instead, it quivers erratically. An electrical shock, the paddles you see in TV shows and movies that jolt a body inches off the bed, can bring the heart back to beating normally. AEDs, now common in airports, shopping centers and other public places, do the same thing if used properly in time. "But early CPR is still the most important step in increasing the chances of survival," Sanchez said. "Most of these (abnormal cardiac) events happen in the home and the lifesaver is going to be a loved one, in the home, almost always."
Of the estimated 350,000 cases of cardiac arrest in the United States each year, almost 90 percent of patients die, mostly because they don't get medical care in time. "For every minute you delay CPR, survival decreases by 10 percent," said Sanchez, who also is president-elect of the American Heart Association's Greater Southeast Affiliate board of directors. "If you do CPR early on, you can double or triple survival chances. That's why I'm so passionate about it. Add AEDs in the community, in addition to CPR, and you have the best chances of survival. That's where we can really make a difference."
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Why don't more people know CPR? The reasons and excuses are many. But learning CPR has never been easier and more accessible. Here's why:
First, Hands-Only CPR, for use on unresponsive teens and adults, is now considered just as effective as conventional CPR. So, you no longer have to give mouth-to-mouth breaths. You can give compressions, hard and fast in the center of the chest, until help arrives. That actually changed in 2008, but word has been slow to get out.
"We taught it the other way, mouth to mouth, for many years," said Tony Cambone, a paramedic, CPR trainer and clinical services coordinator for Sunstar Paramedics. The AHA launched a Hands-Only CPR training campaign in 2008. "Calling it Hands-Only is helping," Cambone said.
Cambone said that community CPR training gets the word out that bystanders can do a lot on their own before paramedics arrive. They learn that the first step is to call 911. If the person who has collapsed isn't responsive, has no pulse and isn't breathing, it's time to start CPR. The 911 operator will confirm that and guide you. By learning CPR, you "help us help you," Cambone said.
Second, if you think you don't have time to learn CPR, you're pretty much out of excuses. The AHA has kiosks in seven U.S. airports that teach Hands-Only CPR in five minutes. Each kiosk has a touch screen, short video and practice mannequin so you get the hand placement and compressions right. The nearest one to us is at Orlando International Airport.
Don't have five minutes? Watch an American Heart Association video online (cpr.heart.org). Most are under three minutes. If that's the only CPR training you get, most experts agree, something is better than nothing.
Even better? Attend a community training session provided by the AHA, the American Red Cross or your city or county fire-rescue services. Classes are inexpensive or free and often take just a half-hour. Mannequins give feedback, clicking sounds, when your chest compressions are deep and hard enough.
Think you can't learn CPR? It's too complicated, you're too old, too young, not smart enough. None of that washes anymore either.
Eleven-year-old Elly Berube of Hudson recently completed an AHA-sponsored Hands-Only CPR class at Regional Medical Center Bayonet Point. The sixth-grader, whose parents work in health care, took it in preparation for a Girl Scout CPR course and because she wants to become a babysitter. She now feels prepared to perform CPR.
Devin Lamperski, a 14-year-old from Hudson, was also trained that day, along with his mother and his 16-year-old brother.
"I thought it would be smart if I knew how to do it," said Devin, a ninth-grader at Fivay High, "because if something were to happen, I would know how to help."
Both Elly and Devin said the only difficult part is keeping the compressions going when your arms get tired. In the class, you're asked to push for 10 minutes while listening to the Bee Gees disco tune Stayin' Alive. The beat of that '70s hit is just how fast chest compressions need to be delivered. So you push down hard on the chest with each "Ah, ah, ah, ah, stayin' alive." (Achy Breaky Heart works, too, Sanchez said.)
"My arms did start to hurt," Elly said. But she learned that's when you ask a friend to take over. (Paramedics change out every two minutes when possible.) If no one else is around, take a momentary break and start compressions again.
Only half of Americans can be counted on to perform CPR in an emergency.
Sixty-one percent worry they could injure the victim. AHA 2016 Hands-Only CPR Survey
"When someone is unresponsive, there's nothing you can do that can make him worse." Dr. G. E. Flores of San Juan, Puerto Rico, a longtime CPR instructor
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Paramedics arrived within about 10 minutes of Lisa Peters' call to 911. They took over performing CPR. They gave Rick adrenaline. They couldn't revive him. She heard a paramedic say, "Call it." Lisa yelled "No!" Then she heard someone say, "I have a pulse." Then they lost the pulse. Someone said, "Call it." Lisa, frantic, threw herself across Rick's body on the gurney so he could hear her say, "You're not done. You're not leaving yet." She heard someone say they had a pulse. They got Rick into the ambulance, to the hospital. But his struggle wasn't over. His heart stopped eight more times. He was in a coma for six days.
For those six days, Lisa was in agony, fearing her husband may not recover, knowing he didn't want to be kept alive by machines. The "what-ifs" haunted her. What if she had known CPR, known how to do it right, had done it faster, had done it sooner. "If you have anyone you care about, it's so worth it to get the training, so you don't put yourself through that," she said.
Pinellas County Fire and EMS receives about 650 to 700 calls to its 911 call center daily. Operators talk four to six callers through CPR every day.
According to Jeremy Tinter, director of clinical services for Sunstar Paramedics, the 911 operators don't expect callers to be trained in CPR. The operators are prepared and trained to deliver instructions so anyone can potentially save a life, even a child.
"(Lisa's) right: The operator she talked to on the phone is a hero, but kudos to her, too, to not have a medical background, to listen and to go through it," Tinter, a 15-year veteran paramedic, said. "That took a lot of courage to go through and to follow through and to do it."
Early, high-quality CPR saves lives. "It's the most important link to survival." Jeremy Tinter of Sunstar Paramedics
Rick Peters survived his ordeal. He returned to work at Power Design Inc. in St. Petersburg three weeks later. He remembers nothing about the early-morning Jan. 4, 2016, episode and suffered only chest pain from the compressions and some short-term memory loss, which eventually improved. Doctors implanted an ICD in his chest, a device that will automatically deliver an electrical shock and normalize his heartbeat if this ever happens to him again.
Doctors aren't sure why the electrical system in Rick's heart failed that night. But they do know this: Most people don't have a cardiac event of that sort and live long enough to get to a hospital without CPR.
Contact Irene Maher at firstname.lastname@example.org.