European Restart a Heart Day
This year’s European Restart a Heart Day is on October 16th, 2017.
What is European Restart a Heart Day?
European Restart a Heart Day is a day designated across the whole of Europe to teach the vital life-saving skill Cardio-Pulmonary Resuscitation (CPR) to as many people as possible.
This will be the 4th year of European Restart a Heart Day, with last year’s event seeing 150,581 young people trained to carry out CPR.
Why is European Restart a Heart Day important?
In the UK, regrettably survival rates for casualties who have had a cardiac arrest is as low as just 6%. This is a really sad fact. However, The Resuscitation Council (UK), The European Resuscitation Council (ERC), The Department of Health and Voluntary Aid Societies are recognised as determined to improve this figure.
It is fair to say that all other First Aid organisations, including The Training Fox, are determined to ensure that this survival rate is as high as it can be.
The statistics do look a lot healthier when all the links in the Chain of Survival take place promptly. The survival rate in this instance is 74%.
The Chain of Survival
So, I hear you ask, what is the Chain of Survival? The Chain of Survival has 4 links in the chain as follows:
- Early Identification and Call,
- Early CPR,
- Early Defibrillation,
- Post Resuscitation Care.
When the chain of survival is promptly undertaken, the chances of a casualty surviving greatly increases. Of course, the best way for bystanders and emergency responders to learn the skills behind the Chain of Survival is to attend a course, The Training Fox has a wide range of First Aid courses, which we are confident will meet your requirements.
The next part of our article, will focus on the Chain of Survival, but should not be seen as training!
Early Identification and Call
In order to get the casualty the help and aid that they require, it is imperative that the emergency aider contacts the emergency services on 999/112 as soon as they have identified that the casualty is not breathing. A good way of not delaying the emergency services is to make use of the loudspeaker functionality of a mobile telephone.
It is important that anyone who calls the Emergency operator understands that answering any of the questions that the operator asks will not delay an ambulance, although the operator will have to prioritise cases to ensure the casualty who needs help quickest receives this. A non-breathing casualty is a priority and is referred to as a Code Red 1.
The advantage of using the loudspeaker functionality of the mobile telephone allows the emergency aider to start CPR as soon as possible, having identified the lack of breathing of the casualty. The best position for the mobile telephone to be placed is on the floor next to the head of the casualty, so that the operator is clearly heard by the emergency helper.
How to carry out Cardio-Pulmonary resuscitation (CPR)
Below is a guide to the steps required to carry out CPR:
- Place the casualty on a hard surface,
- Kneel at the side of the casualty, ensuring that you are comfortable,
- Start Chest Compressions –
- Place the heel of one hand in the centre of the casualty’s chest,
- Place your other hand on top, interlocking fingers and lift fingers up,
- Lock your elbows out, to ensure your arms remain straight and vertical,
- Press down on the sternum to a depth of 5 to 6cm (a 1/3 of the chest cavity, or approximately the width of a debit/credit card),
- Release all the pressure, keeping contact with the casualty’s skin,
- Do 30 Chest compressions at the rate of 100-120 per minute.
Avoid pressure over the ribs, base of sternum or the upper abdomen.
- After 30 Chest Compressions, start rescue breaths –
- If you have one available, you should place a resuscitation face shield onto the casualty, as a barrier between you and the casualty,
- Pinch the soft part of the casualty’s nose,
- Allow mouth to open, but maintain the chin lift,
- Take a normal breath,
- Seal your mouth around the casualty’s mouth,
- Blow steadily into the casualty’s mouth, observing the chest to rise, take about one second to do this,
- Keep the airway open, removing your mouth from the casualty,
- Watch the chest fall as air comes out,
- Take another normal breath,
- Seal your mouth, once again around the casualty’s mouth,
- Blow steadily once again into the casualty’s mouth, observing the chest to rise, take about one second to do this,
- Return your hands without delay to the centre of the chest.
Do not interrupt compressions by more than 10 seconds to give 2 rescue breaths
Do not try more than 2 rescue breaths, as the airway may be obstructed
- Continue CPR at a ratio of 30 chest compressions to 2 rescue breaths.
The above process is designed to be used to administer CPR to an adult casualty who is over the onset of puberty. There are some amendments that should be considered on younger casualties:
Child (1-year-old to the onset of puberty):
- If you are on your own, give 1 minute of CPR before going for help,
- Prior to conducting chest compressions, administer 5 rescue breaths, in the same way as detailed above, then follow the CPR at a rate of 30:2,
- Use 1 or 2 hand(s) to compress the chest,
- Chest should be compressed to about 5 cm.
Baby (Under 1-year old):
- If you are on your own, give 1minute of CPR before going for help,
- Prior to conducting chest compressions, administer 5 rescue breaths, in the same way as detailed above, then follow the CPR at a rate of 30:2,
- Use 2 fingers to compress the chest,
- Chest should be compressed to about 4 cm.
To reduce fatigue of the emergency aider, if you have more than 1 aider, it is good practice to swap over every 2 minutes, whilst minimising the delay of chest compression.
If you are trained and able, you should follow the CPR steps taught on your First Aid course and detailed above. However, should you be untrained or feel unable to provide rescue breaths, providing chest compressions is better than doing nothing at all. This is known as Hands-only CPR. To carry this out, you should provide 100-120 chest compressions per minute continuously. Should there be 2 emergency aiders, they should swap over every 2 minutes.
There is a risk, that your casualty will vomit while you are conducting CPR, this is an involuntary process from the body and not a sign that the casualty is coming round, or going to be ok. As vomiting is a passive action, you are unlikely to see or hear the signs that vomiting is imminent, however vomit in the airway makes gurgling sounds when you give rescue breaths. Should your casualty vomit:
Roll the casualty onto their side,
Tip their head back,
Allow the vomit to run out.
Having done this, you should clean the casualty’s face, and then if possible use a resuscitation face shield, but throughout, minimise the interruption to chest compressions.
So, when do we stop CPR?
Cardio-Pulmonary Resuscitation should not be interrupted and stopped unless:
- A health professional tells you to stop,
- You become exhausted,
- The casualty is definitely waking up, moving, eyes opening and breathing normally.
Early defibrillation is carried out by the emergency aider using a machine called an Automated External Defibrillator, also known as an AED or Defib. The defibrillator can be used by any member of the public, as the machine will talk you through the steps required step by step. There is no way that the defibrillator can be misused or used on someone who is not in actual need of defibrillation.
The AED will guide the user through each of the steps, ensuring they have been completed before carrying on to the next stage. The AED machine can detect if requirements have been done, this is helpful because it means the user just has to focus on following the instructions provided and not have to remember information from a previous course, or find that the particular Public Access Defibrillator (PAD) being used is different to the one that they practised on in training.
You should always send someone else to get the defibrillator, if you are on your own it is much better to start and carry out CPR than it is to not do CPR. Remember CPR will keep oxygenated blood reaching the brain, and if no oxygen is getting to the brain it will start to die.
When the helper returns with an AED, you should encourage them to follow the steps of the AED machine to set up, whilst you maintain CPR. If they are resistant, see if they can maintain CPR while you set up the AED, at all times minimising the interruption to chest compressions.
Step 1 – Remove Clothing
The emergency responder must remove all clothing from the casualty’s chest and torso, this will ensure that the AED pads will adhere to the skin. If necessary use the clothes’ removers to cut away clothing, and remember to remove a female casualty’s underwired bra, to ensure the electricity does not flow through the metal and prevent the machine from working. If you are dealing with a male casualty, pay attention to his chest hair and should there be a lot of hair on his chest, you should use the provided razor to shave the area where you are about to place the pads, thus ensuring the pads are able to adhere properly to the casualty’s body. If the casualty has a wet chest, this will also have to be dried off, there should be a towel/cloth in the AED bag, remember that electricity and water do not mix.
Step 2 – Locate AED Pads
Once you have opened the AED machine, this may have switched the AED on, if not use the standard on/off button that we are all familiar with in order to turn on the machine. (This operation varies from AED to AED make and model).
With the AED open, you now need to identify the AED pads, which are usually in a silver packet that will need to be torn open in order to access the pads. Pull the pads out of the packet and have a look at the diagram on them. The diagram on the pad is designed to illustrate to you, the AED operator, where to place the pads on the casualty.
Correct pad placement:
Pad 1: Upper right-hand side of the chest,
Pad 2: Lower left abdomen.
Pad 1: Centre of the child’s chest (Front),
Pad 2: Centre of the child’s chest (Back).
You will need to peel the pad off the protective carrier plastic, and without touching the sticky side of the pad, place it down in the right position of the casualty’s body. Press firmly on the pad to ensure that it has adhered well to the casualty’s body. With this pad in place, repeat the process to ensure that pad 2 goes into the correct position on the body.
Step 3 – Analyse Rhythm
With the AED pads in place, the AED machine will now take over control of the situation and will continue to tell the emergency aider what to do and when to do it. This is usually reassuring for the emergency aider as they now have support in following the procedure through, even if it is a mechanical voice, it can reassure that you are doing the right thing.
The AED machine will now state that people should not touch the casualty, as it is analysing the heart rhythm of the casualty. If a normal rhythm person is touching the casualty the AED could pick up this and then decide that the casualty has a normal rhythm and therefore no shock is required.
The emergency aider’s role here is to declare loudly:
Step 4: Shock is…
The AED machine has now analysed the rhythm and has decided if a shock is necessary or otherwise.
If a shock is advised, the AED will state that this is the case and then also say that it is charging. All the emergency aider can do at this point is wait, it will feel like you are waiting a long time, however in truth it is really only a few seconds.
The AED, once charged, will then display a button which is flashing: this is the button to deliver the shock to the casualty. The AED will give the voice command, ‘Press flashing shock button’ The emergency aider must then press the button to deliver the electric shock to the casualty, ensuring that no-one is touching the casualty as the button is pressed.
On pressing the button, the AED will deliver the shock to the casualty. As the shock is delivered through the casualty’s body it will ‘jump’, this is normal and you should not panic or be worried by this, you have probably seen this effect on the television.
Shock not Advised:
Should a shock not be advised the AED will inform the emergency aider of this, it will then move the emergency aider onto Step 5.
Some First Aiders will worry if the AED says no shock advised that they have made a mistake in starting CPR and applying the AED and actually the casualty didn’t need this level of support. In this situation, however, the emergency aider, shouldn’t feel this way, because they have used their first aid training to decide that the casualty was and is in need of help, and this is the better than the First Aider walking on by and doing nothing.
The other reason why an AED decides that the casualty does not need a shock, is because the casualty’s heart is in a non-shockable rhythm, for example, there is no heart rhythm or the casualty’s heart rhythm is as normal as fully responsive persons would be.
None of the reasons above are to be considered as a bad thing or a bad decision, because, as we say many times, doing something is better than doing nothing at all to try to save a casualty’s life.
Do Not Remove the Pads
Step 5: Start CPR
Once the AED has allowed a shock to be delivered OR has decided that no shock is advised, the AED will announce for the emergency aider to start CPR.
Some AEDs will use a beep tone to help you keep time to conduct appropriate and effective CPR, or even a light may be used for this process, some AEDs do not do this however.
CPR is now expected to be carried out for a period of 2 minutes, before the AED will then state that it is ready to reanalyse the casualty’s heart rhythm and repeat steps 3, 4, and 5.
At this point in the process, just simply follow the steps and vocal instructions by the AED machine.
Post Resuscitation Care
Successful return of spontaneous circulation (ROSC) is the first step towards the goal of complete recovery from cardiac arrest. As First Aiders, we are not expected, nor are we trained, to be able to support a casualty who has got spontaneous circulation back following on from a sudden cardiac arrest (SCA). This is why it is important the emergency services are called and are en route to your situation as soon as they possibly can be.
Should you be successful in getting return of spontaneous circulation to your casualty, you will need to look after and care for them in the intervening time of the arrival of an ambulance or better qualified medical practitioner than yourself. Invariably this would consist of maintaining the airway, using the recovery position, or if you are concerned about the spine, then using the Manual Inline Stabilisation manoeuvre, as taught on our First Aid courses.
Did you know:
- Every year in the UK, there are approximately 60,000 out of hospital cardiac arrests.
- If a defibrillator is used and effective CPR is performed within 3-5 minutes of cardiac arrest, survival chances increase from 6% to 74%.
- The brain starts to deteriorate after 3 minutes with no access to oxygen, and then loses 10% every minute thereafter.
This European Restart a Heart Day, if you are not on a First Aid course, but going about your everyday lives, and let’s be honest lives are incredibly busy, why not just stop for a few minutes and think, would I know what to do in order to Restart a Heart? Or why not take a walk on your lunch break, how many AEDs can you find in your local area?
Let’s all celebrate Restart a Heart Day even if we are only thinking about doing so.