Hands Only CPR and Termination of Care

Hello everyone! We wanted to pass along some valuable life saving information that affects each and everyone of you.

The leadership of the Maryland Institute for Emergency Medical Services System (MIEMSS) constantly updates the protocols followed by Emergency Medical Services (EMS) providers to incorporate the latest medical skills to allow them to provide the best patient care based on the latest medical information. 

This year, one critical update involves the treatment of adult victims of cardiac arrest, a condition in which a person’s heart suddenly stops beating.

In July 2013, MIEMSS began to educate EMS providers on the importance of a new technique, High Performance CPR, for victims of cardiac arrest. High performance CPR, and its equivalent for the lay public, Hands-Only CPR, are endorsed by the American Heart Association. 

With aid from bystanders immediately performing Hands-Only CPR and EMS providers focused on compressions at the site of collapse, the chance of survival from cardiac arrest increases dramatically.

The King County Resuscitation Academy in Seattle, Washington has shown that when CPR is performed with the new guidelines, the chances of survival from a sudden cardiac arrest increase from the current national average of 6-10% to upward of 50% survival.  

Hands-Only CPR and AED use can more than double a person’s chances of survival. The High-Performance CPR effort begins with bystanders calling 911 quickly and initiating chest compressions (Hands-Only CPR) on the victim. If necessary, 911 dispatchers will provide Hands -Only CPR instructions to the caller.  

To perform Hands-Only CPR the bystander should push hard and fast in the center of the chest to the beat of the classic disco song “Stayin’ Alive.” which translates to about 100 compressions per minute. 

There is no longer a need for the bystander to provide mouth-to-mouth breathing which in the past deterred many bystanders from attempting CPR, especially on strangers.   

If available, the bystander should also attempt to use an Automated External Defibrillator (AED) to revive the patient.  AED’s are available in many public places, such as schools, malls, and government buildings and feature voice prompts that guide a person trying to help the victim. 

The AED will tell you how to attach it to a victim and if the victim would benefit from a shock.  There is a narrow time window, about 5-10 minutes after collapse from cardiac arrest, during which time a shock is “useful” for a person.   

When EMS arrives, the providers will focus on providing high quality chest compressions with minimal interruptions.   In many cases, EMS will also use a device called a defibrillator, to try to shock the heart back into rhythm. 

EMS may also provide other advanced life support treatments such as IV medications and airway management to attempt resuscitation.  The advanced care provided by EMS now involves the same treatments that would be provided by a hospital emergency department staff.  In Harford County and throughout Maryland, we have been vigorously training our EMS providers in this new High-Performance CPR procedure. 

In some cases, even the best quality CPR will not guarantee a person’s survival.  Even in “model cities” such as Seattle, survival from a cardiac arrest is still about 50%. 

In recognition of this fact, we now also enable our EMS providers to make a critical decision and that is to pronounce the victim deceased if extensive efforts have not restored the heart-beat. 

EMS providers are permitted to make pronouncement of death under narrow guidelines, which involve a minimum of 15 minutes of high performance CPR along with additional efforts including IV medicine administration and airway management.   

Previously, nearly all patients were transported to the hospital unless they were obviously deceased or other extenuating circumstances were involved.  In 2013, we know that the person’s best chance to survive is if CPR and advanced care are provided on the scene, without delay. We train our EMS providers rigorously, and equip all of our ambulances with the necessary resuscitation equipment found in hospital emergency departments.

The next time you have the chance to take a CPR/AED class sign up. The class is basically free and it only takes a few hours. In fact sign up the entire family. You never know when you will need to act fast to help save a life, including the life of a loved one. Don't be the one standing around, be the one taking action. 

Remember it's all about "Stayin Alive"....

Rich Gardiner/Jen Chenworth-Price

Spokespersons/PIOs

Harford County Vol Fire/EMS Association