Jean-Francois St-Amour

7/19/98

Hi, I was reading critics about your #49 tip (about 911 calls vs CPR) and decided to back you up on this one. Placing the 911 call is the most important step in an emergency situation, after making sure the scene is safe for the victims and MOST IMPORTANTLY for yourself. Administering CPR is useless if proper emergency personnel is not called upon the scene. CPR will NOT reanimate anyone (less than 2% actually), proper medical attention will. If you were to do CPR for fifteen minutes before calling 911, your victims chance of survival would be minimal at best. Blood is NOT properly oxygenated during CPR, it is only better than no oxygenation at all. About the particular example given in on critic (R.Goukler), it is an exceptionnal case, but should not be considered to be proper procedure, and I'm scared that some CPR instructor actually used it as an example. Also, M. Goukler missed a vital point in the book, and it is that the 911 actually is way BEFORE the primary survey. However, I did find a few points in your article that needed to be clarified. You didn't mention these facts in your article, and I judged them to be of importance. First, in the case of a multiple victims accident, you must call 911 before you start CPR on any victim, even a small child. Second, you should not even perform CPR on a victim, child or not, if multiple victims are present (more victims than people with first aid knowledge). This is known as triage. And last, all bleeding should be stopped BEFORE CPR is performed! I am aware of ABC, and breathing comes before circulation, but if you perform CPR on a victim with severe bleeding, you will only be pumping his blood out! Anyays, thanks for all your helpfull articles! Jean-François St-Amour Motorcyle newbie First Responder

 

Daniel I. Applebaum

12/10/97

Regarding tip #49, I was told in Red Cross CPR class that you cannot cancel a 911 request for aid. This may vary by region. Once they're rolling, they will go to the accident scene. I think the assumption is that if it ever looks like an emergency, the incompetent amateur on the other end can't later decide that it no longer is an emergency. Also, I disagree, with your "1 minute vs. 10 minutes" argument. Lack of even normal air for 1 minute early on is extraordinally critical. The first few minutes of oxygen deprivation are very important. The minute it took you to stop and secure your bike, coupled with the 30 seconds to assess the situation for safety of yourself and others has already cut into half the time it takes for brain damage to start. That's assuming you started the actions immediately on witnessing a coronary arrest. Add another minute for calling 911 brings you to two and a half minutes. At three minutes, brain damage starts. Also, I'm not sure that coronary cessation is the definition of "dead." Anyway, I have been enjoying your articles. Keep up the good the work, and please accept my comments in the spirit of discussion. Dan.

 

Richard S. Goukler

07/30/97

I have been reading your articles and have found them very helpful and informative. I am writing to you today after having read your First Things First article. In the article you propose that placing a 911 call in an emergency should take precedent over performing life saving techniques such as CPR and rescue breathing. I disagree with that and have information from the American Red Cross CPR manual which also contradicts your statements. According to the ARC there are four steps to perform when facing an emergency situation. Breifly these are: 1) Survey the scene:to ensure that it is safe for the responder to approach. You are correct; making yourself a victim from hastiness won't help the injured party. 2)Conduct a primary survey: this survey looks for signs of life-threatening conditions. If the victim is not breathing or the heart has stopped and there is no circulation, you MUST begin to perform life saving techniques immediately. If blood is not circulating, or the viction in not breathing, the victim will die in just a few minutes because the brain is not receiving any oxygen. 3) Summon additional help: more advanced medical personnel should be called to the scene if any of the following situations exist: -unconscious or altered level of consciousness - breathing problems -persistent choest or abdominal pain or pressure -no pulse -severe bleeding -vomiting or passing blood -suspect poisoning -seizures, severe headache or slurred speech -suspected or obvious injuries to head or spine -suspected broken bones -severe burns (this list is taken from the ARC CPR manual) 4) conduct a secondary survey: gathering additional information about other possible injuries, checking vital signs etc.

Once you have begun rescue breathing or CPR you cannot stop until more advanced personnel are on the scene. This means that if you are alone you must perform these techniques until another arrives to call 911. BE SURE to tell that person to return to the scene and confirm that a 911 call has been placed. An example of this procedure was shared with us in CPR class. A woman found her father after a heart attack, she immediately began CPR and performed it for over five hours before another person arrived to place the 911 call. Her efforts were successful and her father lived through the experience.

Safe riding to you!

Rick