CPR Discrepancy: Myths vs. Reality.

image contains the title of the blog "CPR on Women - Closing the Gap" Next to the title, illustrates a woman doing CPR to another woman with the logo of LIfe Saving First Aid

Introduction

I want to talk about the CPR discrepancy and closing the gap, one rescue at a time.

Do you know that females in cardiac arrest are less likely to receive out-of-hospital cardiopulmonary compressions (CPR) than males? That is simply because the provision of bystander CPR is less likely to be performed on a female by a member of the public.  This is the CPR discrepancy.

Cardiac arrest:

A cardiac arrest is a life-threatening emergency situation where these casualties require immediate chest compressions to imitate the pumping of the heart, which promotes blood and oxygen delivery to the brain and other vital organs.

Despite the severity and complexity surrounding a cardiac arrest, the initial life-saving treatment simply involves using two hands to administer chest compressions in the centre of the chest, hard and fast. 

However, despite the simplicity of performing CPR, recent literature states that only 39% of women received CPR from bystanders in public compared to 45% of males. (American Heart Association) 

CPR on Women:

So, let’s unpack why the provision of CPR is less likely for Women and why the CPR discrepancy exists: 

Gaining an insight into understanding the public perceptions of why the provision of CPR is less likely in women is an essential measure towards promoting the equitable implementation of CPR. 

Bystanders are less likely to perform CPR on women due to concerns about inappropriate touching, potential accusations of sexual assault, or fear of causing injury.

Although these concerns for privacy and cultural sensitivity are valid, exposing the casualties’ chest must be done to initiate life-saving medical treatment. Using an Automatic External Defibrillator (AED) for example.

Exposing their chest includes removing all upper body clothing, which also includes removing or cutting their bras. This is optimal as it will allow for correct hand placement for compressions and for the AED electrode pads to be properly placed in the correct position. Further, as many bras include metal components, removing them reduces the risk of burns or electrical arcing during defibrillation. 

Remember, exposing the female’s chest is necessary for optimal medical care. In the case of a woman with larger breasts, it might be required to lift the left breast with the back of your hand for accurate positioning of the AED pad. When a bra is removed and a female is lying on their back, it’s likely the breasts will fall to the side and thus allow for correct hand placement in the centre of their chest without the requirement to touch them. This is the correct location to effectively deliver compressions. 

Preserving privacy:

Preserving the privacy of female patients can be achieved by continuing to treat them with dignity and respect at all times. It is important to ensure only those assisting with resuscitation are within sight of their exposed chest and for all other bystanders to maintain at a distance. In addition, capturing photos or videos of the casualty is inappropriate and unnecessary. Additionally, if there is a cloth or towel available, it can be used to cover the chest and preserve modesty, whilst compressions are provided.

CPR on pregnant women:

It is often misperceived that pregnant women who experience a cardiac arrest should not receive resuscitation with CPR and defibrillation. However, the standard protocol for resuscitation remains unchanged and it’s expected that they receive the same quality CPR and AED shocks as anyone else. Therefore, observing the same three life-saving procedures; calling 000, starting CPR, and utilising an AED as soon as possible is vital to attempt resuscitation.

Both compressions and defibrillation should not pose any significant risk to the mother or baby. However, there are some alterations we can practice to further mitigate any risks.

Whilst they are lying flat, place a padding such as a cushion or towel under their right hip to tilt their left side about 15°-30° while leaving their shoulders flat to the ground. This will facilitate blood flow for the pregnant woman and baby.

Finally, as for all patients, if CPR is successful, placing them in the recovery position whilst you wait for the ambulance to arrive is ideal. However, the left side is preferred as it prevents the baby from compressing one of the major blood vessels in the abdomen.

Conclusion:

Remember, if you attempt to resuscitate and save the life of a female casualty with genuine and well-intentioned efforts, you will always be protected under the Good Samaritan Legislation.

I hope this blog encourages strong public education and eliminates the biases surrounding bystander CPR on female casualties so we can make a difference together and save lives, regardless of gender, one rescue at a time.

Thanks for tuning in, see you in the next blog! – Dounia

PS: Click here for more First Aid info

Triage for multiple casualties

Image of someone being injured in a fire being tended by a first aider giving yellow tag triage with the title"Triage for multiple casualties" followed by Life Saving First Aid logo

Introduction

When faced with multiple casualties the process you should follow is called Triage.

Safety First for Triage

Even if you are faced with a multiple casualty triage situation, your starting point is always DRSABCD and first on the list is Danger.

Conduct a rapid risk assessment for your safety and the safety of those around you. Check for hazards – Physical, Chemical, Biological, Electrical, Mechanical and Psychological and try to minimise the risks.

Body fluids from the casualty present a biological hazard. The risk, you could become infected. Minimise the risk by wearing PPE – Gloves, eyewear, mask etc. Or, if traffic is the hazard, being hit by a car is the risk. Therefore, move to a safer location, put up warning signs or have someone direct and control the traffic to minimise this risk.

Your hazard and risk assessment may even lead you to the conclusion that for your own safety you need to leave the area and contact a specialist emergency service to make the area safe before you can help the casualty.

Your safety is the priority.

What is Triage?

If there are multiple casualties, CALL 000, then you will need to undertake basic triage. Check out this link for more info on 000 calls: https://www.triplezero.gov.au/Documents/TripleZeroFactSheet.pdf

There are also some apps available which can assist. You can find them here: https://lifesavingfirstaid.com.au/blog/todays-first-aid-apps-and-gadgets/

Basic triage is the sorting of multiple casualties by the severity of their injury or illness – from those in most need of assistance to those who require little or no assistance using these categories:

Red Tag

 Immediate – use a red tag

Casualties that belong to this category have life-threatening but treatable injuries. Anyone assigned with a red tag requires immediate medical attention. They are also the first to be transported to the hospital when medical help arrives.

Yellow Tag

Urgent – use a yellow tag

These are casualties who sustain serious injuries but can wait for a short time before receiving treatment.

Green Tag

 Delayed – use a green tag

Green tag casualties can wait hours to days before treatment. These ‘minor casualties’ are usually separated from the more serious injury by asking them to move to a specific area OR you can ask them to give you some assistance if they are able.

Black Tag

 Deceased – use a black tag

The final group in which they categorize as the deceased group or white group. Unfortunately, these are casualties you cannot help, and they cannot be resuscitated.

Conducting Triage

While conducting triage it is important that you only commit to treating someone with catastrophic bleeding. For example a severed limb. Try and stop the bleeding then move on.

OR,

If a casualty is unconscious but breathing, place them in the recovery position and move on.

As a rule of thumb, you can follow this action plan when conducting triage:

1.      Stop catastrophic bleeding. Or Place in recovery position if appropriate

2.      Are they Walking? YES, then GREEN TAG DELAYED. You can get them to assist you if they are able. Are they walking NO – check their breathing

3.      Are they breathing? NO then BLACK/WHITE TAG DECEASED

4.      Are they breathing, YES, is it normal? YES, then ORANGE/YELLOW TAG URGENT. NOT normal breathing RED TAG IMMEDIATE.

Remember that triage is an ongoing process so when you have categorised the injured you need to start again. Some of the Urgent may become Immediate, Immediate to the Deceased and even some in the Delayed may need to be reclassified as well.

When you have completed the Triage process, you need to start again. Why? Because the condition of the casualties can change. Some Yellows may become Red, some Reds may become Blacks and so on. Continual reassessment contributes to effective Triage.

Handover to Ambulance

You have already called 000 so when the ambulance arrives you will need to conduct a handover/takeover with the ambulance officer or paramedic.

The details of the incident, as you understand them, the numbers involved, the actions you have taken so far, any relevant timings and the injuries of the casualties can now be relayed to the attending emergency services. Be as clear and concise as you can. State only the facts. There is no need to embellish or add your thoughts unless asked.

Taking control

Don’t panic! If you are first on the scene initially, or the only first aider, you will need to take control. You may need to delegate tasks to others. Locating an AED, CALLING 000 dealing with walking wounded and assisting with CPR. keeping notes etc.

You will need to lead and direct with confidence, making good decisions, acting quickly and in the best interest of your casualty or casualties. Remain calm and focused on the task at hand. You may have to adapt quickly as the situation changes and communicate effectively to others involved. Remember to keep within your own skill level.

Good judgement is essential in directing others such as bystanders, other first aiders, or other resources on the scene to assist as needed.

Main points

Lets’ recap the main points:

•            Make sure the area is safe and use PPE

•            Use DRSABCD

•            Triage the casualties if more than one

•            Conduct a secondary assessment

•            Be aware of post-incident stress and seek professional help

Well, that’s that. Until next time… Stay safe.

Adrian