Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Tuesday, April 18, 2017

Trauma in Emergency Cardio Events and Among Responders

"We ask a lot of them [bystanders] to respond, and then we just say, 'thanks'. The ambulance comes and takes the patient away and they're [the bystander giving medical aid] sort of left standing there, like, 'What just happened'?"
"[CPR training on mannequins or "Annie", the CPR doll] is nothing, nothing like it is in real life. It can be just a completely chaotic and unpredictable environment [when a medical emergency outside a hospital occurs]."
"It's your husband, your wife, a loved one, it's happening in your home -- maybe you're doing CPR on your bed. That scene may play in your mind for the rest of your life."
"And if you don't react [paralyzed with inaction], then there's the trauma of not reacting."
Katie Dainty, Li Ka Shing Knowledge Institute, St.Michael's Hospital, Toronto

"It doesn't matter how well they [reacting bystanders] do it, or how perfect it is [their technique], just that they're doing something -- pushing that blood around to that heart and that brain and giving that person the chance of surviving."
"It's life or death [for the victim]. It's a highly emotional situation."
"We need to better understand that and better support people that are witnesses to that."
Dr. Farhan Bhanji, professor of pediatrics, McGill University, Montreal

"Tell them [911 operators] he's gasping."
"[I don't know whether he -- man in medical distress whom she responded to by using CPR -- survived] but I hope he did and, if he didn't, I hope his family knew he wasn't alone, that he wasn't not touched, and left on the street until the ambulance came."
"I didn't want to talk to anybody about it. I worried about his family. I was upset with myself and disappointed that I really didn't want to do it [CPR] at first, because I was afraid. But I'm so glad I did, I'm so glad I did."
"I still cry [thinking about it] and I shouldn't, right? I think we have to find new ways of talking about that."
Toronto woman trained in CPR
CPR Lesson at City Hall
Paramedics and members of the Toronto Paramedic Services’ Safe City team demonstrated cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED) to members of the public and City staff members today at Toronto City Hall. The event was part of Toronto Paramedic Services’ 2016 Heart Month activities. Toronto Paramedic Services
Research suggests the experience of a witness to someone suffering a medical emergency, who then intervenes in a desperate attempt to provide some measure of relief until paramedics arrive, suffers consequences as a result of their altruism; the irresistible urge to help someone survive a medical emergency, and to give comfort to someone in dire medical straits. The lay person attempting to administer emergency medical help can find the experience results in strong emotional reactions.

Nightmares, flashbacks and fearful thoughts that one cannot control may plague the volunteer for months and years after the event. One limited study published in BMJ Open last year concluded: "the main concern was whether their actions had led to severe injury, a vegetative state, or death". In other words, whether their amateur reaction turned out to be harmful to the survival of the person in distress, rather than helpful.

Each year in Canada an estimated 40,000 out-of-hospital cardiac arrests occur, and swift bystander CPR intervention can increase the opportunity of survival threefold. Yet, despite studies proving the indisputable value of such intervention, few researchers have undertaken studies to evaluate the outcome for "lay rescuers", onlookers to dire health events who react in the best interests of a positive outcome. And who may experience, while attempting to resuscitate someone, an event unfolding that leads nonetheless to death.

Canadian researchers have now launched a virtual support network (www.bystandernetwork.org) to enable the public to share their first-hand experiences after having responded to, or witnessed a cardiac arrest. This is an effort to examine and try to understand the psychological side-effects of cardio-pulmonary resuscitation. With the best of intentions people do want to do what they can to help others. And public entreaties for people to become familiar with the technique of CPR to enable the public to spring into action if and when needed makes the case for intervention as a public good.

The reality is that bystander CPR rates are low, with many cardiac arrests witnessed, but a mere third receiving bystander CPR. Though people sincerely do want to help, when they're faced with a sudden health emergency many tend to freeze; fear and panic immobilizes reaction; that in contemplating   how they would react, people may confidently visualize themselves doing so, but when the real thing occurs, they are frozen with indecision, polarized between need and fear.

The new guidelines that were publicized and published in 2010 now recommend that untrained bystanders witnessing an adult collapse, set aside the mouth-to-mouth breathing component of CPR and rather, focus simply on deep and rapid chest compressions solely. That simplification appears to have done little to help people feel a little more confident about their ability to do the necessary despite the mental strain they may be suffering. People still fear being the author of harm to others.

Yet, as medical scientist Katie Dainty stresses, it is always best to react and do something rather than stand back and commit to nothing. Doing nothing, the victim will likely die, while chest compressions double or triple the chances of survival through the circulation of oxygenated blood through the body, to ensure the brain and other organs can be kept alive.


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