A crowd has gathered around Edward and his wife. Fiona is becoming increasingly hysterical, but nobody comes forward to help. Sean, the security guard, arrives. He assesses Edward and recognises that he has had a cardiac arrest.
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Slide 1:
Sean starts CPR.
Security Guard speech bubble: “Alison, go and get the AED from the ground floor, beside the Fire Exit, on the left hand side of the tills!”
It is important that people know where to access an AED (or Public Access Defibrillator (PAD)) when an out of hospital cardiac arrest occurs. The Scottish Ambulance Service is currently compiling a register of known PAD sites in Scotland. This will allow those SAS Call Handlers taking a 999 call to inform the caller where the nearest defibrillator is located.
Slide 2:
Fiona is distraught.
Fiona speech bubble: “Is he dead? He’s dead, isn”t he? Oh my god! Help him!”
Although there is continuing debate about whether families should be encouraged to witness cardiac resuscitation taking place in hospital or in the home setting, it is generally accepted that families should be offered the choice of whether to attend or not.
Guidance for nursing staff:
- Royal College of Nursing: Witnessing resuscitation
- Nursing Times: Nursing Practice: Evidence in brief Resuscitation: Family presence at resuscitation attempts
Evidence suggests that family members who choose to attend are less likely to experience psychological problems. OCHAs which occur out with these environments, such as Edward”s, often mean that family members have little choice but to witness resuscitation attempts, with the implications for psychological wellbeing that this entails.
Slide 3:
What are the bystanders thinking?
Bystander 1 thought bubble: “Poor man…he looks like a goner. I”ve never seen anybody that colour before.”
Bystander 2 thought bubble: “I wish I knew how to help but I”m scared to. What if I do something wrong?”
Although Edward’s arrest occurs in a busy shopping area, nobody volunteers to help when he collapses. A study carried out for Scottish Government (2016) Scottish Government: Exploring the knowledge, attitudes, and behaviour of the general public to responding to out-of-hospital cardiac arrest found that the most commonly noted reasons why someone would not administer CPR were:
- fear of causing injury/making things worse
- visible signs of vomit/blood
- lack of skills
- lack of confidence
- concern that person might be a drug user
Slide 4
The security guard attaches AED.
Security Guard speech bubble 1: “Stand back, please and give me some room.”
Security Guard speech bubble 2: “I”m going to give him a shock. Please stand well away.”
The AED advises that Edward is in shockable arrhythmia and one shock is administered.
Slide 5:
Fiona is worried what Edward might think with his chest exposed.
Fiona thought bubble: “Why has he opened his shirt like that? Edward would be horrified if he knew all these people are looking at him while he is half-dressed.”
In an emergency situation, such as a cardiac arrest, resuscitation of the collapsed individual is obviously a priority. When someone has a cardiac arrest in a public place their privacy and dignity may be compromised in order to administer chest compressions and to defibrillate. Whilst emergency service staff will do everything possible to maintain privacy and dignity, it is important to explain to family and friends witnessing resuscitation attempts what is being done and why.
Slide 6:
The security guard follows the instructions from the AED.
Security Guard thought bubble 1: “I hope I”m doing this right. It all seemed much easier in the classroom.”
Security Guard thought bubble 2: “Please let him come round! Please let the ambulance arrive soon!”
Even members of the public, such as Craig, who have been trained to do CPR may lack confidence in their ability to perform it properly. A study by Hansen et al (2017) Journal of the American Heart Association: Lay Bystanders” Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests found that a number of factors can increase confidence in CPR-trained bystanders.
Slide 7:
Edward is trying to sit up and looking very dazed. There is the sound of sirens in the background.
Return of spontaneous circulation (ROSC) is achieved and Edward regains consciousness.
Security Guard thought bubble: “Thank goodness. And here’s the ambulance staff – I can hand over to them now”.
Fiona speech bubble: “Edward! Are you all right? What a fright you gave me – I thought you were dead!”
Although ROSC has been established, Edward will require to be continuously monitored and transferred to hospital as an emergency. Not all patients achieving ROSC survive to hospital arrival or discharge. Re-arrest following OHCA is not uncommon.
Pulse point
The Resuscitation Council (UK) has produced a useful guide to AEDs:
