DiversityNursing Blog

By Maureen Salamon

Talking bystanders through CPR methods for a cardiac emergency during a 911 call can significantly boost survival rates, a new study suggests.

State researchers in Arizona examined the aggressive use of so-called pre-arrival telephone CPR guidelines -- step-by-step dispatcher instructions on administering cardiopulmonary resuscitation before trained rescuers arrive -- and found that it bumped survival of cardiac arrest patients from about 8 percent to more than 11 percent.

Cardiac arrest occurs when the heart's normal rhythm abruptly stops, and the organ can no longer pump blood and oxygen to the body. It can be triggered by a heart attack, but the two conditions are different.

Lead researcher Dr. Ben Bobrow said the type of focused intervention studied in his home state -- not only training telephone dispatchers but measuring bystander CPR outcomes and circling back to 911 centers with feedback -- is not done uniformly on a national basis, despite American Heart Association (AHA) guidelines.

But he hopes the results of his study, scheduled to be presented Saturday at the AHA meeting in Chicago, will promote that ideal.

"We believe strongly that this may be the best, and most efficient, way to improve survival rates across the country," said Bobrow, the medical director of the Bureau of EMS and Trauma System for the Arizona Department of Health Services. "Cardiac arrest is one of the leading causes of death, and as a country, despite tons of efforts ... this has not improved."

About 359,000 people in the United States suffered sudden cardiac arrest outside of a hospital setting in 2013, and more than 90 percent of them died, according to the AHA.

The heart association also has reported that 70 percent of Americans feel helpless to act during a cardiac arrest emergency because they don't know CPR or their training had lapsed.

Bobrow and his colleagues analyzed more than 4,000 audio recordings from 911 calls over three years from eight Arizona dispatch centers. That information, paired with emergency medical services (EMS) and hospital outcome data, showed that providing telephone CPR instructions prompted a jump in the number of bystanders implementing CPR, from 44 percent to 62 percent.

With the guidelines in place, the average amount of time elapsing between a bystander's call to 911 and the first chest compression in CPR dropped by 23 seconds, to 155 seconds.

"This research shows . . . that even the simplest of interventions, like having someone on the other end of a phone guide you [in CPR], can result in a remarkable difference of outcome," said Dr. Vinay Nadkarni, a spokesperson for the AHA, who wasn't involved in the study.

"That change is possible with a cellphone and our own two hands," added Nadkarni, an associate professor of anesthesiology and critical care at the University of Pennsylvania School of Medicine. "It's within our grasp."

Nadkarni said that Bobrow and his team had done an "excellent job" in helping 911 dispatchers in Arizona use certain phrases to prompt quick action among bystanders who witness a cardiac arrest.

For example, before the intervention, dispatchers typically asked 911 callers if anyone was available to perform CPR, or if they would be willing to. After the Web-based and live training, the revised script emphasized the importance of dispatchers directing callers to start CPR, saying something like, "You need to do chest compressions and I'm going to help you. Let's start."

With the apparent success of this approach, Bobrow said he and his team have asked the U.S. Centers for Disease Control and Prevention to consider implementing it on a national scale. Funding for such a program is needed, he said.

"It would be an incredibly inexpensive intervention for how many lives it would save," he said. "We estimate conservatively that it would save several thousand lives per year. It's not complicated stuff . . . and the beauty of the 911 system is that it already exists."

Research presented at scientific conferences typically has not been peer-reviewed or published and results are considered preliminary.

Source: www.medicinenet.com

By Jen Christensen

Cancer is plaguing a growing number of first responders and rescuers who worked at ground zero after the terrorist attack on the World Trade Center on September 11, 2001. These are cancers the federal government says are thought to be directly related to that effort -- cancers like leukemia, myeloma, thyroid and prostate cancers.

There are at least 1,646 certified cancer cases that have been documented by Mount Sinai Selikoff Centers for Occupational Health. There are some additional 863 cancer cases among both fire and EMS personnel, according to FDNY, which keeps a separate database for its members.

That's a total of 2,509 cases. The center has screened more than 37,000 World Trade Center rescue and recovery workers since 2002. It will continue to monitor those workers and volunteers for any new cases.

Some reports suggest the number of cancer cases in this group has doubled since last year. While that may be mathematically true, cancer experts caution that we can't draw any significant conclusions from the increase.

"For every decade of life, if you look at a population ... cancer rates go up the older you are," said Dr. Otis Brawley, the chief medical and scientific officer and executive vice president of the American Cancer Society. "Looking at an increase from one year to the next is a nonscientific way of making an assessment that is incredibly biased to find a link between the activity and the cancer."

To be scientifically accurate, Brawley said someone would have to look at all the cancer records for the people in the 9/11 group and compare them to a group that had the same age makeup, same gender, and other demographic data. There would also have to be a significant portion of firefighters in that sample, because as a profession they tend to have higher cancer rates than the general population, Brawley said.

A deep scientific analysis of available medical data through 2010 showed a 20% increase in the rate of cancer cases for 9/11 rescue and recovery workers when compared to the general population, according to Mount Sinai.

Government reports suggest workers at the World Trade Center were exposed to a number of chemicals that were known to be carcinogens, or agents that may cause cancer.

Many people who worked at the site are struggling with devastating cancers they may not otherwise have had, had they not responded to the tragedy. That much is clear, according to the U.S. government, which set up a special World Trade Center Health Program.

The program provides medical monitoring and treatment services for 9/11 responders and survivors. Nearly 65,000 people are enrolled. Enrollees are qualified to get health care treatment through several reputable medical centers that keep experts on staff who are qualified to treat and identify illnesses related to the terrorist attacks. The program plans to continue to monitor those workers.

"I think all of us are open to the possibility that these brave folks were exposed to things that caused further illness," Brawley said. "What's most important is that someone has cancer and needs help and we should continue to provide them with the good care they truly deserve."

Source: www.cnn.com