Posted by The Atlantic - BRIAN ANDERSON FEBRUARY 26, 2021 on Apr 26th 2021
The Conversation That Can Change the Course of a Cardiac Arrest
The Conversation That Can Change the Course of a Cardiac Arrest
Telephone CPR saved my father-in-law’s life. Why don’t all 911 services provide that?
The call came in at 7:42:02 p.m. on March 21, 2019.
A man in his early 60s had just sat down to dinner with his daughter and her boyfriend at an otherwise empty North Brooklyn restaurant, when he suddenly slumped in his chair. The daughter shouted at a hostess to call 911. Within seconds—by precisely 7:42:16, according to my review of the incident—a New York City Fire Department emergency-response unit had acknowledged the assignment, and would arrive on the scene some two and a half minutes later. In the meantime, a dispatcher stayed on the line.
“Is this for you, or someone else?” the dispatcher asked the hostess.
“For someone else,” the hostess replied.
“Is the person breathing?” the dispatcher asked.
Confusion. Was the man having a seizure? Before long, it was established that he was not seizing and was unconscious. He had no discernible pulse. The dispatcher instructed the daughter and boyfriend, both in their 30s, to ease the man down to the hardwood floor, belly-up, and expose his chest.
The event was one of the more than 350,000 out-of-hospital cardiac arrests that occur annually in the United States. They are a leading cause of death, and only about one in 10 victims survives. Without early 911 access and cardiopulmonary resuscitation (CPR)—the first two links, followed by early defibrillation, in the out-of-hospital “chain of survival”—death is certain.
Over-the-phone CPR instruction by a dispatcher, also known as telephone CPR or T-CPR, can enable a caller to become a lay rescuer, and by doing so make the difference between life and death. Early CPR performed by a lay rescuer is associated with a roughly twofold increase in the chances of survival.
However, T-CPR is not as widespread as most 911 callers might expect. I would know. The boyfriend in this story? That’s me. The man was my girlfriend’s dad, Todd. For him to have a shot at survival, either my partner or I would need to intervene.
I was about to perform CPR on my future father-in-law.
Many dispatchers are trained to recognize signs of cardiac arrest from an oral description and then direct callers to begin CPR—even callers who might be in shock, as my partner and I were. But there is no universal requirement for dispatchers to do this. Few of the dispatch centers that have implemented T-CPR protocols deliver instructions consistently, and fewer still have strict quality-improvement measures in place. On the night of Todd’s cardiac arrest, I was fortunate that my hands were guided by the right dispatcher.
According to Robert Fazzino, a paramedic and the FDNY medical-affairs representative who procured our incident report, the hostess handed the cordless phone to my partner, Lex, who then handed it to me. Kneeling over Todd’s tensed body, I wedged the receiver between my right ear and shoulder. The dispatcher told me to interlock my hands—one atop the other, at the midpoint of the nipple line—and get ready to start pumping up and down, hard and fast.
The clock was ticking.
This wasn’t the first time I’d been involved in an emergency that required CPR. When I was a teenage pool lifeguard, a 74-year-old swimmer fell unconscious one summer afternoon. After I pulled her out of the water, five other guards and I performed CPR on her for several long minutes until paramedics arrived. She died days later.
Now here I was again, face-to-face with someone clinging to life—only this time, it was a loved one, and my training was rusty.
In my lifeguarding days, I was regularly drilled on the CPR procedures for infants, children, and adults. Was it 15 compressions to two breaths for an adult? Or 30 to two? I was blanking. “What are the ratios?” I blurted out.
The dispatcher, realizing I was at least somewhat CPR conversant, seized the moment. No breaths necessary, he said. “Just stay on my count.”
That’s exactly what I did, according to the call audio. I counted aloud with the dispatcher, using my upper-body weight to press down on Todd’s sternum, before releasing: down and release, down and release. One and two and three and four and five and six …
Time slowed. I closed my eyes. Don’t stop, I thought. After what felt like an eternity, I heard sirens approaching.
“The public assumes that if they call 911 and someone’s in cardiac arrest that they’re going to get [CPR] instructions,” says Michael Kurz, an emergency-medicine physician at the University of Alabama at Birmingham and the volunteer chair of the American Heart Association’s T-CPR Task Force. “That’s not the case. It is the minority of cardiac arrests that receive that instruction.”
If I’ve learned anything in the weeks and months I’ve spent reconstructing the events of that evening, and researching the availability of T-CPR nationwide, it’s that we were very, very lucky. Dial 911 to report a cardiac arrest, and depending on where you are—a big city, a rural town, or somewhere in between—you may be told to wait until help arrives, to stand idle as your loved one’s fate hangs in the balance. Why didn’t that happen to us?
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