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Captain Chris Strobach, the clinical educator at TCAD, instructing us on how to use AEDs.

On Thursday, Feb. 23, I took a free hands only CPR class, offered by TCAD through the Hollister Chamber of Commerce. 

I had CPR training years ago (when my children were little which means it has been over 20 years) but was taught the ABCs of CPR back then. Traditional CPR, or cardiopulmonary resuscitation is an emergency procedure which provides artificial respiration and blood circulation when normal breathing and circulation have stopped. This is usually caused by a trauma, heart attack or drowning. CPR, when performed correctly, can give victims supplying life-sustaining oxygen to the brain and other vital organs until fully equipped emergency medical personnel arrive on the scene.

I think most of us have seen the television and movie version of the ABCs of CPR, right?

What I remembered about my training was it was called the ABCs but it was actually CAB.. First C for compressions to create circulation. Then A, for clearing the airway. Then B for breathing you know the step which has you breathing into someone’s mouth to push air into their lungs for them.  

We have all seen those dramatic moments on television when someone does CPR, thinking of those Baywatch episodes. (Yes I am that old.) 

The truth is I have never had to use the CPR I learned years ago in a real emergency, which I am grateful for for two reasons. One, I do not want to think about anyone needing me to step in to be the ‘hero’...eek! And two, I was never really sure how I felt I would handle the mouth to mouth part. I was always a bit nervous about that part. 

But I did get training to do it, so why did I decide to take this class now? Well, last year we at the paper talked about taking the class but scheduling conflicts seemed to get in the way. So I got the email with the registration to take the class from the Hollister Area Chamber of Commerce in January, and thought it would be nice to relearn it. 

I am glad I did. 

Captain Chris Strobach, the clinical educator at TCAD, was my instructor.  Strobach is a paramedic with the district and for the last 10 years has served as the instructor. 

Strobach began by explaining this was not one of the American Heart Association certified classes (that is what I took years ago).

 “First off, let me just disclaim this is not a certification course. This is not a full blown American Heart Association three to four hours of education course,” Strobach said. “Quite honestly, folks. You don’t need to save a life. Let me qualify that. I’m not here to bash the American Heart Association. We’re not here to say you shouldn’t get certified in the full blown CPR certification course. In that course you’re gonna get adult, child and infant CPR, choking instruction and all that kind of stuff. But that’s not going to deal with the elephant in the room. The elephant in the room, folks, the reality is the 350,000 Americans who will have gone into cardiac arrest this year. The vast majority of them, 95 plus percent of them go into cardiac arrest because of what we call primary cardiac arrest as opposed to or something called secondary cardiac arrest.”

Strobach explained to me and my fellow students most people who go into cardiac arrest do so because their hearts are sick. When their heart stops beating because of the primary cardiac arrest, everyday people can make a difference and save a life by doing ‘Hands-Only CPR’ versus the ABC CPR.

“Only about 5% of cardiac arrest are what is known as secondary cardiac arrest folks,” Strobach said. “Those are people that go into cardiac arrest because their heart stopped getting oxygen. And it stopped. These people had healthy hearts up until that moment. Examples would be drowning, choking, and opiate overdoses…people die from opioid overdose because among other things. The opiates tell the primitive part of the brain that controls our primitive breathing centers, ‘Hey, you don’t have to breathe anymore. We quit breathing.’ This is what we call secondary cardiac arrest.”

This is when those ABCs come in handy Strobach said. When you are needing to get air into the body. But for 95% of cases the body has air it is just not circulating. So the Hands-Only CPR, can get the air circulating which increases the blood flow to the brain and helps save lives. 

“Does the oxygen in our bloodstream stop when our heart stops beating? Does it magically disappear? No, it’s still there,” Strobach. said “In secondary cardiac arrest any oxygen left in the bloodstream has been consumed. This is why the heart stopped. In drowning you are not breathing anymore. The heart’s using up all the oxygen in the blood. And that’s why the heart stopped. This distinction is necessary, because it helped us to figure out why CPR didn’t seem to be working.”

Strobach told us historically the survival percentage of cardiac arrest patients in the United States is very low. 

“It may be a shock for you to know that it’s about three to 4%,” Strobach said. “Historically, we can’t do any better than three or 4% survival rate from cardiac arrest outside of the hospital. What gives? Doesn’t CPR work with people? Are we wasting our time out here attending these classes and learning the skill? It took some smart doctors about 12 to 13 years ago to finally figure out about understanding the difference between primary and secondary cardiac arrest. This has been for decades and decades, our most sacred and basic dogma of Emergency Medicine. When you get a patient, I don’t care if you’re called for a stubbed toe or for cardiac arrest or anything in between. This is your treatment priority. Airway. You don’t do anything to that patient until you’ve established that they have an open airway? Can I get air and gasses in and out of the lungs? And if not, that is your attention. You don’t do anything else until that is addressed first. And then and only then do you turn your attention to breathing are they breathing adequately? If not, what can we do mechanically or pharmaceutically to help them breathe? If they’re not breathing at all, in cardiac arrest, we have to breathe for them right but the point is, that breathing is your next priority. Then circulation right. So you see you understand there is a hierarchy we follow, an algorithm we follow, and in emergency medicine. When you guys learned CPR, for those of you that have gone through the class, when you learn CPR, you didn’t realize it that’s what you were being taught the ABCs you’ve already bought airway positioning vignette, head tilt, chin lift, jaw thrust maneuvers, be breathing you learn how to mechanically or manually ventilate somebody. Okay, and then see circulation, which in cardiac arrest means compressions.”

In about 60% of cases Strobach said the first responders and the hospital can get the heart started again. He said the discrepancy between the 60%, who get their heart started versus the only three to 4% who survive is due to a lack of oxygen to the brain. 

“Our most basic dogma or most sacred and basic treatment algorithm, we got it wrong. When it comes to cardiac arrest, we got it wrong. And this is what some smart doctors in Phoenix figured out about 95% of all cardiac arrest, the oxygen is still there. If the oxygen is there, shouldn’t we prioritize circulation in cardiac arrest? Let’s circulate the oxygen that’s there. Because the reality is that we have several minutes of oxygen still in our bloodstream, and we need to keep the brain alive. Understand this. This is absolutely fundamental to what we’re learning today. When our heart stops beating, we often think of death in terms of associate or from a theological religious standpoint. However, physiologically speaking death is a process and it’s a slow one. At about four to five minutes the brain starts to die without a fresh supply of oxygen. Our challenge as paramedics generally speaking, isn’t getting your heart started in cardiac arrest. We have the tools, the training and the drugs, to do that. The problem, folks, is after no oxygen has been circulating, the patient is brain dead.”

Strobach said Hands-Only CPR changes the outcome and makes a difference because you are keeping the oxygen flowing to the brain with compressions. 

“Folks, there’s an old saying it takes a village to raise a child. I don’t know about that. But I have learned this in 30 years of doing this job. It takes a village to save a life. We can’t do it alone. This is why this class is so important to me. It’s the one class I do get to do on a regular basis with the general public and it’s the most sacred one to me because this is the one where we can truly work together to make a difference. This works. Prioritizing compressions keeping the brain alive. Keep the oxygen going to the brain is the key to giving people the best chance of surviving cardiac arrest being neurologically intact. We’re tired of getting heartbeats back only to see these patients die a couple of days later due to being brain dead. But it all starts with understanding that our most of the basic dogma ABCs for most cardiac arrest is wrong guys, we got to get the C first circulation. This is where you come in. This is why you’re here. And you can make a huge difference. Focus on compressions. By the time somebody in cardiac arrest would need a fresh oxygen supply. Guess who’s going to be there? If not the ambulance, a first responder is going to be there. We’re asking you to let them worry about rescue breathing. For that critical first four or five minutes. All we need you to do, all we’re asking you to do is do compressions and don’t stop.”

During the class we, in attendance, were taught the proper technique and the steps to perform Hands-Only CPR on adults who are not breathing. 

Step one is to call 911 or ask someone else to call. Step two, kneel beside the victim, loosen clothing if practical. Check if the victim is breathing by placing your ear up to their mouth while looking to see if you can see their chest rising. Three, place the heel of one hand in the middle of the victim’s chest. Four, cover first hand with your other hand and lock fingers, Step five, push down hard and fast, try to maintain at least 100 pushes per minute, to the beat of ‘Stayin Alive’ by the BeeGees. When doing compressions lock your elbows and push with all your weight, depressing the chest two inches deep with each pump. Continue to do compressions until help arrives. This technique should not be used on children, infants drowning victims or in cases of drug overdoses.

“Our survival numbers have gone from three or 4% in our county to as high as 40 to 50% since our 911 operators have been instructing callers to focus on compressions,” Strobach said. “Like I said, there is a place for the old traditional CPR. People ask me, ‘Well, what if four to five minutes comes and goes and there’s no help yet and the first responders haven’t shown up?’ What I’m here to tell you is at that time, what will happen is the Emergency Medical Dispatcher on 911, will know it’s time to start rescue breathing, but they’re going to ask you if you’re unwilling to, and folks, this is a personal decision on your part. They’re not going to bully you. They’re not going to coerce you. They’re simply going to ask you if you’re willing and want to help, they will walk you through that process at that time. I want you to erase that concern. I want you to focus on compressions because this is what’s made the difference.” 

As part of our instruction we had the chance to practice doing compressions on a CPR dummy for one minute, trying to get the 100 compressions needed in a minute. Let me say everyone in the class, no matter their age or physical condition, was exhausted after just one minute with the proper technique. Strobach said if you find yourself tiring during CPR see if someone else can switch with you and help. Continue to do this until first responders arrive. Strobach also instructed the class in the use of AEDs, which can be found in public places in Stone and Taney counties, for emergencies.

I learned so much in the hour class and am now comfortable with my knowledge of Hands-Only CPR, and my ability to (if I could keep calm) save a life if needed. 

If you are interested in taking Hands-Only CPR classes contact TCAD or register for the next two free classes on Thursday, March 16 or Thursday April 13, both from 9 to 10 a.m. through the Hollister Area Chamber of Commerce at hollisterchamber.net/events. 

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