May 16, 2003, 7:50 AM.
My wife and I enter the quad at a Midwestern university. There are orderly rows of white chairs on the lawn, and on each one is a bottle of water labeled with the university logo, and a program for the commencement ceremony. Scores of people are hurrying to the seats, streaming in from all sides of the quad with the graduates penned off to the side. I am looking forward to witnessing the first of my three daughters graduate from college, and to hearing the commencement speaker, Madeleine Albright. Suddenly my wife notices people gathered around a woman on the ground. My wife encourages me to see if I can be of assistance. I identify myself as an internist to the woman and she responds with halting, labored breathing that she is having chest pain. I grab her wrist and realize her skin is cold and clammy, and find her pulse weak and fairly rapid. It was immediately apparent that she is having a heart attack, and her condition is critical. I ask the bystanders and the security guard if paramedics had been summoned, and they assure me this was the case. Another physician is at the scene too, a pediatric endocrinologist, and she informs me that she too had requested paramedics.
The woman’s pulse becomes weaker, her breathing shallow, and she loses consciousness. Her acute heart attack has led to cardiac arrest. I start CPR.
According to a recent New England of Journal Medicine study of June, 2015, there are 420,000 cases of out of hospital cardiac arrests each year in the U.S, which corresponds to 38 people experiencing one every hour. Odds are that you know a friend or family member who has had one. Survival chances decrease about 10% for every minute following a cardiac arrest, but less than half of persons with a cardiac arrest receive bystander CPR. When CPR is performed before paramedic arrival the thirty day survival improves from 4% to 10.5%.
Many people assume that cardiac arrests take place outside the home where there will be a willing bystander to initiate CPR. Surprisingly, 88% of cardiac arrests occur in the home, so if you are called upon to initiate CPR at home, the life you save could be a spouse, parent, child or friend. Since 2008, the American Heart Association has offered hands-only CPR for adult cardiac arrest as an alternative to chest compressions plus breaths because the outcomes are similar. Although, a CPR course is advised, the instructions are simple: call 9-1-1, and push hard and fast in the center of the chest to the tune of “Stayin Alive.” Here is the link: http://www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/Hands-Only-CPR_UCM_440559_SubHomePage.jsp
The San Francisco Unified School District has a reason to be proud. Starting this school year, SF is the largest school district in the country to add hands-only CPR to its ninth grade health curriculum. Improvement in rates of bystander initiated CPR is a critical public health issue and it is encouraging to see this initiative.
Paramedics have not arrived yet. I continue chest compressions, and the pediatric endocrinologist administers mouth to mouth breaths. Oxygen and an AED, or automated external defibrillator, are unavailable.
Paramedics finally arrive! They had trouble navigating through narrow crowded roads into a congested space. Initial evaluation by them reveals the woman has a heart rate but absent blood pressure.
When I returned home, I wrote the chancellor of the university expressing my dismay over the lack of emergency medical support for this large gathering of people. Four years later, when we returned for my youngest daughter’s graduation from the same university, it was gratifying to see a paramedic vehicle right on site.
Sadly, as I learned later, the woman who we tried to resuscitate died at a nearby hospital. She was the grandmother of a graduating classmate of my daughter. If resuscitation had been successful, the grandmother could have been expected to continue to live a normal life. Although bystander CPR improves the odds of survival by more than 2.5 times, probably too much time elapsed before advanced paramedic resuscitation was begun. One never knows when you may need to perform CPR so I “heartily” encourage you to take a CPR course near you: http://www.heart.org/HEARTORG/CPRAndECC/FindaCourse/Find-a-Course_UCM_303220_SubHomePage.jsp
Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.
Editing acknowledgement: Ellen Saliman
Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.