CPR and Defibrillator Myths
Shining some light on CPR and busting the myths surrounding defibrillators
"I have heard that I will break the casualty's ribs if I perform chest compressions"
There is a chance that you may fracture a rib or two (you definitely will not break them in half) and you will probably break the cartilage between the ribs and sternum, however these are all minor soft tissue injuries that will heal in about 6 weeks which is the least of their worries. Remember why you are doing this, their heart has stopped and you are keeping vital organs oxygenated until a defibrillator arrives. Initial out-of-hospital bystander CPR has been shown to double and in some cases even quadruple survival rates alone. To perform chest compressions: Place the heel of one hand in the centre of the casualty’s chest on the lower half of their sternum, place your other hand on top and interlock your fingers. Lock your elbows so that your arms are straight and lean forwards so your shoulders are positioned directly over your hands. Push down 5-6cm (2 inches) which is approximately a third of the depth of an average adult’s chest, at a rate of 100-120 beats per minute.
"I might get it wrong and start doing CPR on someone who is breathing but I thought they were not"
Do not worry too much about this, it is far better to start chest compressions on someone than not at all. You are only going to be attempting this on someone who you do not think is breathing, therefore they will also be unresponsive; you would have already tried everything you can think of to try to get some kind of response out of them. Even if they are breathing, you just could not tell, you are not going to stop their heart by performing chest compressions (they will soon tell you to stop if they are actually breathing) you will cause them far more harm by not starting when you should have. The threshold for starting cardiopulmonary resuscitation (CPR) is lower than most people believe, if you are in any doubt that the casualty is breathing, or even if their breathing is not effective (agonal breathing) then start chest compressions immediately.
"I am not a trained first aider so surely it is better to wait for the ambulance service, as they will resuscitate them when they arrive"
You do not have to be trained in order to attempt chest compressions on someone who is not breathing. Out-of-hospital cardiac arrest survival rates are currently less than 10% in the UK with bystander CPR rates sitting at around 40-50%. When you compare these figures to other places in the world, it is no surprise that there is a direct link between higher instances of bystander CPR and higher survival rates. Of course it is highly recommended to take a basic life support course in order to become confident.
"You have to be trained in order to be able to use a defibrillator"
Defibrillators are designed to be used by untrained people; any labelling that you may find on a defibrillator’s cabinet stating any different is out dated and should be removed. Automated external defibrillators (AEDs) are extremely sophisticated pieces of equipment, they analyse the electrical activity within the heart and then decide if the heart will benefit from a shock or not. They do this all themselves and constantly talk to you; prompting you what to do next if you are unsure. All you need to do is place the pads onto the casualty’s bare chest and stand back, oh and do not forget to press the flashing button if it tells you to.
"Defibrillators will shock a heart that is 'flatlining' like they do in the movies"
Guess what? TV and movies have lied to you! Defibrillators DO NOT shock a heart that is 'flatlining' otherwise known as asystole. When a defibrillator is analysing a heart’s rhythm it is actually looking for one of two rhythms: Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (VT) these are the only two rhythms that will benefit from a shock and the machine is clever enough to spot them. A heart in one of these rhythms is either quivering (fibrillating) or going so fast that the heart isn’t refilling with blood so in effect there is no pulse. What these hearts need is to be stunned and to metaphorically ‘pull itself together’. That is what the defibrillator is trying to do, it does not send a jolt of electricity into a heart to jump start it back into life; it is trying to defibrillate it. These rhythms do not last for very long though, with effective chest compressions they will last longer than if you did nothing at all, so as soon as the defibrillator arrives you need to use it and ideally within 3 minutes of their heart stopping if you can. Studies have shown that chances of survival can be around 70% if a defibrillator is used within 3 minutes, with chances dropping by 10% for every minute that goes by without one.