A Cardiac Arrest Is Not the Time to Learn CPR

I’ve been following Rogue Medic’s excellent discussion about how Cardiac Arrest Management is a BLS Skill.  If the role of ALS is defined by advanced procedures, the only benefit of ALS would be from manual defibrillation instead of an AED.  This is only because shocks from a manual defibrillator can be delivered with less of a pause in chest compressions than with an AED.

I am frequently frustrated having to teach other responders, of all levels, the correct way to do CPR on calls.  The person at the head is usually bagging away,  there’s a flurry of activity around the patient,  but no hands on their chest. When compressions are performed, they are often too fast (over 150/min) and  not deep enough.  And then I cringe when I hear “set up in the ambulance, we’re on our way out” over the radio.

A football team would never play a game without practicing together first, but that’s exactly what we do when someone’s life is on the line. Sometimes people’s feelings get hurt during my lesson, and sometimes I get invited to sit down with a supervisor about it after.

Perhaps the real value of ALS for cardiac arrest is a more in depth understanding of how CPR works.  I didn’t appreciate this until I did research for an article I wrote a few years ago.  I was reminded of calls I wish I could have back, during which compressions were stopped for several minutes because I had to get that tube.

Delivering excellent CPR is the primary reason Seattle/King County and Wake County EMS are the best in the world at resuscitation.  Their paramedics understand what is most important and treat it seriously.  As serious as life and death should be treated.




  1. I am an april 2011 cardiac arrest survivor. I was in my office, a retail location, of a fortune 500 bank as a mortgage loan originator. I had two clients at my desk. I have no memory of the following but it has been consistently recanted from coworkers and ems at the scene. I became unresponsive, and one of my clients, went to the tellers in the public area of the bank and one of the employees came back to evaluate me and checked for breathing and pulse. i was gasping and he could find no pulse. NO ONE IN THE BUILDING KNEW CPR & THERE WAS NO AED. The EMTs were in my office in approx 5 min from 911 call. They immediately started manual cpr while getting the AED ready. They had 4 people on the scene with two working on me a driver and a runner. The AED was ineffective through out many shocks and the manual CPR continued. the intubation happened sometime on the way to the hospital. The EMS started drugs as instructed by the hospital and manual breathing continued to the hospital. My cardiologist has repeated that the CPR was instrumental in my being alive. Since I have gone through the experience and recovered, I have been advocating for bystander cpr compression only , AED in all public and workplaces. Cincinnati, Ohio, my home time has an 11% bystander cpr rate and a very high SCA death rate. As I move forward, working to save others like me, i keep hearing the value of compressions from both EMS personel and entities such as the American Heart Assoc and the Red Cross.
    I have also been told by cardiologist and other doctors that the blood holds a fair amount of oxygen and circulation through out the body through the manual compressions is a life saving and brain saving action.
    Bottom line is compressions make a huge difference. AEDs will jump start many, but for those like me, manual compressions make the difference. I am a non traditional SCA patient. I am young, I have no coronary artery disease, no history of heart disease only a left bundle branch block that has been reviewed over the years and determined to have no clinical impact. I was a patient who created a lot of doubt in the EMS crew mind. (one of the rescue squad lives down the street from me and I had done a mortgage for another one.) The EMS crewmember asked a close neighborhood friend, if I was alive because things looked very badly. Now in retrospect, the skill and persistence from the first responders saved my life. I will continue to advocate for compression intervention because it works.

    • emspatientperspective says:

      Regina, thank you so much for your reply. I’ve read several stories similar to yours, and I get chills from each one. I am so happy that you have recovered and are advocating for better resuscitation practices. I recently went on an arrest at a supermarket. No one performed CPR and there was no AED. Codes require buildings to have a certain number of fire extinguishers, and perhaps some day they will require AED’s as well.

      You may be interested in Rogue Medic’s writing about this topic. He recently described the evidence supporting hands-only CPR.

  2. Seattle, King and Wake have good numbers because they teach CPR to school children and have a commendable rate of bystander CPR. ALS is not the problem, its the 4-10 minutes of nothing being done prior to arrival that’s killing people.

    • emspatientperspective says:

      Seattle, yes, high rate of bystander CPR. I’m not sure about Wake, but don’t think it’s as high as Seattle’s.

      ALS isn’t a problem unless chest compressions are interrupted during ALS procedures. And if the compressions are done poorly, nothing else will matter. Seattle’s Resuscitation Academy resource page emphasizes “CAB at all times,” and the reason for any off-chest time is documented on their QI form. In Wake, Dr. Myers teaches about “drinking the new CPR Kool Aid” “drill ’em, King ’em, and chill ’em.” The common denominator is good, continuous chest compressions.

  3. all of you speak to the same issue; effective compressions and understanding what keeps the patient alive. I am militant about the CPR issue. I took my first CPR class at age 11 as my mom (a nurse) and my dad (a surgeon) would not let me baby sit unless i took CPR and first aid. What is more ironic about my situation, as i was non responsive, the bank called my son, 23, a trained lifeguard. The caller explained to my son that they had done everything they could and had called 911 and were waiting for the EMS. He was haunted (still is) by the question, why aren’t you doing cpr? I am even more strongly haunted by the question, why did the 911 operator not tell the caller what to do.

    Compressions make all the sense in the world. Physics dictate that if we are to move fluid through out the body, we push the muscle that would normally provide oxygen to the cells. From what I know, no one stopped CPR to intubate me. I know the intubation happened because that’s how I arrived at the hospital. No matter, as first responders, its important to know that the person you are rescuing and or their family may have an idea of correct protocol.

    Even more importantly, all employees, especially of a fortune 500 company should be in a work environment that is safe with at least one cpr trained employee. I paid for my own CPR/First aid courses. I refuse to be the person that stands and watches a SCA victim die. If a company can list on the NSE or NASDAC, they can afford to have AEDs and a trained employee available. The company I work for has AEDs at the corporate office outside of the office of the CEO. In situation of life and death, we are all equal regardless of leadship role or salary.

    thanks for all of your input.

    Regina A. Rosemire
    AED Heart-Starters

  4. I’m with most others on this subject as I believe all schoolkids over 11 should have to learn CPR (unless too disabled or handicapped in another way).

    My first real training was at about age 12 through the Boy (as it was then!) Scouts. We had been shown the technique at school but not trained. Mind you, CPR was in its infancy in those days and mouth-to-mouth was considered sufficient (and it was better than Holger-Nielson which was taught alongside). Chest compressions came along (for us) a little later. I also had to learn the Sylvester method but frankly I can’t see how this would work well enough even with a pulse!

    Getting my First Aid badge with the Scouts ensured I knew CPR. On moving to Venture Scouts at 16, it was necessary to do the St John Adult Certificate in First Aid, or a similar qualification through Red Cross or if in Scotland through St Andrews Ambulance (but thankfully I’m in England ).

    These certificates were recognised for First Aid in the workplace too. This situation has now been replaced by the First Aid at Work (FAW) certificate through the UK though most of the old organisations offer it.

    For most of the time since then (say 40 years!) I’ve been qualified in First Aid. Thankfully I’ve rarely had to use it but would feel I was not being a true citizen if I didn’t feel capable of giving First Aid.

    I believe that everyone with a driving licence should have to learn First Aid to a decent level – not professional or even best amateur, but something to assist until better trained staff arrive – unless there are sound physical/mental reasons why they shouldn’t. Obviously this would include CPR. This would need to be refreshed every three years but should be sponsored by Government to an extent.

    Why should people like you or me die for want of someone (like you or me) having a little basic training?

  5. Thank every one who responded to my comments. To wrap this up, I want to emphasize that my sudden cardiac arrest was not an event where an AED brought me back. My arrival at the emergency room was by no means an assurance of being healed. I spent 3 days in hypothermic therapy with a body tempature of 89 degrees. I was kept in a coma for these three days and I had bilateral LVAD (impella) devices in both femoral arteries. There were serious questions about long term heart pumps the viability of a heart transplant and the availability of a donor. My family was given NO promises nor statistical estimates of survival. In the end, we would not have had any of these options without EMS compressions. Sophistocated medical technology can not exist without the basic manual compression and the willingness of those around the victim to act. Mostly, I cannot beleive it happened but I know it did. The huge ICD in my chest, the long recovery fromy body being traumatized to be kept alive made it clear we were dealing with big medicine. I cannot imagine what my body has gone through but i can tell it was big due to the difficult recovery. Living is definitely worth the difficulties tied to recovery. We cannot recover or live with out having the guy next to us being educated and willing to give each of us who collapse a shot at rebirth. I would appreciate each person who is part of this and has responded or at least considered the content of the article, support my efforts and those around me to support, educate and encourage everyone to act to save a life. I don’t expect the average person to diagonose my problem, I expect them to act.

    thanks for your support.

    Regina A. Rosemire

    • emspatientperspective says:

      Thank you so much for your comments, Regina. One reason I started this blog is because sometimes we EMS people forget who we really work for, and you’ve given us a huge reminder.

  6. I fully agree with you Regina, and I’m happy to know that you are being an advocate for By Stander CPR and installation of AEDs in all public places.

    Regina, as you are aware that I’m also a SCA survivor and I’m passionate about being the poster boy and advocate for “Saving Lives from SCA”, by helping riase SCA awareness through Education, CPR/AED Training, Deployment of AEDs in all public places and Implementation of Public Access Defibrillation (PAD) Programs.

    I am an active Field Hockey Coach in Cincinnati, coaching kids of a local prominent high school and experienced no problem coaching from Monday through Friday. On Saturday, September 18th,2004, my wife and I attended our Church, Immaculate Heart of Mary’s 60th Anniversary dinner/dance and collapsed all of sudden on the dance floor that we just stepped onto and was dead for 6.5 minutes. I was so Blessed and fortunate to have the Asst Fire Chief, Tom Reimar of our Township be present, and also some nurses who were also present. These folks jumped into CPR mode, while others were calling 911. Tom and the nurses took turns performing CPR when all of a sudden a parishioner, who worked for the church noticed Tom and wanted to know what was going on when she saw the crowd around me . Tom told her that I was in Sudden Cardiac Arrest and he and the nurses were performing CPR to buy some time for the Life Squads arrival (The Life Squad is only 5 buildings away from the Church). She was the only one who knew that the church was just given an AED. She then raced to the next building, retrived it and gave it to Tom. Tom, was able to shock my heart and brought me around before the Life Squad who were on another run arrived. They told me that if it wasn’t for the CPR and the AED present, I would not have made it. I was taken to the hospital and was told that I had to have a double bypass surgery and also have an ICD implanted.

    This SCA event has prompted me to talk about the effectiveness of by stander CPR and the use of AEDs. I am working with Regina as a SCA survivor and Volunteer, together with some passionate Volunteers of the newly formed 501c3 Non Profit Organization called AED Heart-Savers in the Cincinnati area to help “Raise Sudden Cardiac Arrest Awareness”. Too many of our kids are loosing their lives to SCA and we have to get involved and help save these young lives…. the future of our great country. We need to raise money to Educate, provide CPR/AED Training and Deploy AEDs in our community.

    I urge folks reading these articles to take a stand in your own communities to help make a difference and save lives from SCA. So please join me and donate to the AED Heart-Savers and help “Save lives from SCA”.

    I want to thank Regina for taking a stand and advocating by stadner CPR/AED Training, which is so vital in a life and death situation (SCA). It does make a difference and will reduce the SCA death rate, which is presently only about 8%. SCA is the number one killer in the US, claiming nearly 300,000 lives each year. It’s greater than Cancer, Diabetes, Stroke, HIV etc.

    Keith White (SCA Survivor)
    AED Heart-Savers
    454 Gabblefield Ct
    Cincinnati, Ohio 45255

    “SCA Takes Lives”
    “AEDs & CPR Save Lives”

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