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Lessons from last night

Having now experienced someone having cardiac arrest in a restaurant, here’s what they don’t tell you in the training:

  • You will forget your training (you aren’t a professional) so just do compressions and don’t worry about the rest
  • The crowd will be an obstacle. Managing the crowd is as important as managing the victim. If you have a leadership skillset and can issue instructions instead of doing the CPR yourself, focus on managing the crowd. Get them to shut up so the caregivers can focus on the victim.
  • If you aren’t doing the CPR, the caregiver giving the CPR is probably having a lot of self-doubt. Reassure them that they are doing it correctly. And by correctly, I mean doing compressions.
  • No one knows what an AED is (see also). And despite your training, you will forget to ask for one but that’s okay because it turns out most restaurants and businesses do not have one (which is not okay).

Get trained in CPR (see also) and review your training regularly. Remember, it is the victim’s emergency and not yours. Stay calm and take action.

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Last night a man died

[n.b. This is the event as I remember it. I tried not to add embellishments. I have no idea how others saw this play out.]

Cathy had a beginning of a migraine and our Saturday go to place, Stirfry Cafe, had a private event for another hour. I took Cathy to Surin. It’s a quiet restaurant with a large Budda and a fountain in the main seating area and is generally serene. I was under-dressed which may or may not have been the reason we were seated in the lounge area. In hindsight, their seating was unbalanced so the tshirt and jeans probably had little to do with the seating location.

We joked with the waiter. Our food came. Then there was a commotion which we presumed was the wait staff singing happy birthday to a patron. Then a waitress ran into the back yelling, "does anyone know CPR?"

I was on my feet before thinking. As I raced through the lounge to the main room, my first thought was "what about liability?" I know about the good Samaritan law and the thought almost didn’t complete as it was interrupted with a rush of memories of my CPR training. Then I exited the lounge and entered the main dining area and the scene made me freeze. The victim, a larger man probably in his mid-60s, lay on the floor pale white. Eight to a dozen people surrounded the victim. A person on the phone, apparently with 9-1-1, tried yelling instructions. Someone pumped on the victim’s chest while others cried, "is he breathing?" A relative cried hysterically and was eventually carried away by the wait staff. There were too many people. I blanked. Surely someone more knowledgeable than me would take control. I’m an authoritarian leader with a loud voice but I could not get myself to utter the words, "I’m trained. Everyone be quiet and let me help." The person giving compressions walked away. I recognized my gloves and breathing mask were in the car. I failed to ask the manager if they had an AED. The victim made a noise and someone declared, "He’s breathing." He wasn’t. His mouth foamed with a sticky white grossness. I recognized another man going through my same hesitation. He and I both knew what to do and were hesitating. A man yelled, "move, I’m with the sheriff’s department." He was as uncertain as the other guy and me. He kneeled beside the victim and I could see him going through the steps we’ve all been taught but not doing compressions. I started to push him aside to begin compressions myself but he finally began pumping the victims chest. The crowd continued to scream mixed instructions like the audience at a boxing match.

I heard instructions of CPR trainings that the Red Cross had altered for so many years. I heard "he’s choking" "clear his airway" "Roll him on his side" "Turn his head" "Push on his stomach" To that one I loudly refuted, "No! Do not push on his stomach. Keep your compressions on his sternum." I felt like I was screaming at the ocean and my words were quashed by the crowd. I should have announced, "if you aren’t giving CPR, please back up and be quiet so we can save this man." I couldn’t. My mind was too busy trying to figure out what I should be doing to help. I considered giving the victim mouth to mouth but I didn’t have protection and my last trainer really implored us to always use a mouth guard and gloves. Plus I know that the current philosophy is that breathing for the victim does little to help and that chest compressions move oxygen to the brain and dislodge blocked airways. Compressions. Compressions. Compressions. Besides, in my heart of hearts, I knew this guy was gone. He’d died before he hit the floor. I chose not to do mouth to mouth.

The guy from the sheriff’s department stopped compressions. I could read in his face that he was questioning whether or not he was forgetting something. I shouted, "Keep doing compressions. Staying alive!" Anyone with recent CPR training has been taught that the Bee Gees song Staying Alive is the correct tempo for chest compressions. Coincidentally, I was reminded of this fact this morning while reading Life Pro Tips on Reddit.

LPT: If you have to do CPR, keep the beat by singing “Stayin’ Alive” (exact rhythm of CPR) (self.LifeProTips) by drdeteck

[Source, Reddit, Life Pro Tips]

I felt my shout was unheard but the guy doing compressions returned to doing compressions. Someone asked for gloves. I ran to the car for mine forgetting that a restaurant probably had boxes and boxes of gloves and sure enough when I returned he was gloved but it was a new guy doing the compressions and the guy from the sheriff’s department had moved to the head of the victim. I said, "let me know if you need help with compressions" but I doubted myself. The guy from the sheriff’s department said, "Tell me if you are tired." While I was getting my gloves, I could hear the ambulance coming. The restaurant propped the doors. The crowd screamed, "Get out of the way. The paramedics are here." I shouted back, "Keep doing compressions until the paramedics tell you to stop." My voice trailed into the abyss. The paramedics rolled a gurney into the restaurant and the crowd said in unison, "Get out of the way." I spoke back, "Keep doing compressions." Or did I think it? As the paramedic got beside the man doing compressions, he stood up to get out of the way and without a word, the paramedic gently placed a hand on his shoulder and pushed him back down to the victim to keep doing compressions. I turned back to the lounge to see my wife standing there. We returned to our table. Forced down our final bites of food. Paid the bill and drove solemnly home.

My parting thought was that I need to schedule a refresher on my CPR training and that this experience has made me better prepared for the next time this happens.

See also: Lessons from last night and Cathy’s perspective.

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We are all one breath away from the end

Today I saw a man dying on the side of the road
He lay within sight of trained paramedics, a mere 325 feet
As I came to the scene, parked cars lined the side road dangerously close to the speeding traffic
I criticized whoever allowed their party guests to park so carelessly
I did not know they celebrated a life
As the distance narrowed, my irritation turned to concern
This looked more like a car accident than party
A footfall field away, sirens roared and lights flashed, help was on the way
I pulled the side to clear a path, to my right my worry turned to fight
There in grass, lay a man surrounded by people and one pumped his chest
I do not know what happened to that man
I drove away, I could not help, I’d just be in the way
I did not see his face, he could be someone I knew well, a neighbor, or a stranger
I do not if he breathed again or had his last day
He left my mind as quickly as he entered it
I had no emotional or philosophical response
I did not think of his family nor mine
I simply noted that my CPR training is out of date.