Ocean Safety Fall 2017

A magazine oriented towards our Kauai youth may seem like an unlikely place to run an article about CPR, since it’s very unlikely that any of you will need CPR performed on you in the near future.

By Monty Downs, M.D.
Kaua`i Lifeguard Association
However, it’s not nearly so unlikely that you might find yourself in a situation where you performing CPR could save someone’s life. Maybe even a family member’s life. Recognizing this, our Kauai County Fire Department has a program in which they teach 6 graders at all of our schools how to perform CPR. If any of you were 6th graders last year, I’m sure you remember that Firefighters Justin Shinn or Aaron Hawthorne or Jayson Pablo went to your class one day and demonstrated excellent CPR, and had you practice it. (Or maybe it was the ROTC cadets whom they trained up who in turn were your trainers). And any of you who will be 6th graders this year — keep an eye open for these men. I have to tip my hat to Dave Walker, now a retired Fire Captain, who was the visionary for this. Also, a $30,000 supporting grant from HMSA has allowed this program to flourish.

You may or may not know that I myself am an ER doctor and I get to see people who are brought into the ER by ambulance after they collapsed and who get community-CPR. In the last 10-15 years there have been some major developments in CPR technique and I have noticed a very significant increase in what we call “good outcomes” because of these developments, and because of the ever-increasing number of people in our community who are aware of these developments and who know how to perform excellent “high performance” CPR.

I myself won’t undertake in this piece to describe all the elements of excellent CPR. For this you can google “high performance CPR.” Or much better yet take a course. I will, however, point out a few highlights.

The first principle is “push hard and push fast.” “Hard” means pushing the breastbone in 2.4 inches in an adult. (This is 1.5 inches in a child or infant or 1/3 the AP chest diameter). Try and get a measuring tape to measure 2.4 inches. It’s a lot! It often means you break someone’s ribs — which is why you DON’T want to do it until you’re sure that the person doesn’t have a pulse! “Fast” means 100 compressions per minute. If you can get the BeeGee’s song “Stayin’ alive” into your head, that’s the rhythm and pace. Then there’s a term called “recoil”, where you make sure you let the breastbone return all the way to it’s original and normal position after every compression. If you don’t allow for good recoil, the underlying heart doesn’t get a chance to fill up with blood, with the result that the blood you’re trying to pump out (to the victim’s brain) with your compressions won’t be effective,

In the last 10-15 years there have been some major developments in CPR technique and I have noticed a very significant increase in what we call “good outcomes…”

If you’re a 6th grader, you will get tired within a minute or two and your compressions will lose their effectiveness. So that’s another thing you have to know: Namely, assuming there are at least 2 of you there, switch your positions regularly and frequently.

Breaths? This is a bit of a tougher one. Many people are fearful of putting their lips to the collapsed-person’s lips in order to try and deliver a breath. For this reason, breaths have become de-emphasized unless you have a bag-and-mask (such as Lifeguards and Firefighters have) or another such breathing rescue apparatus. Furthermore, performing excellent compressions-only CPR is much more effective than if you interrupt compressions for an attempt at mouth to mouth — unless you have a good 2 person team that’s working well together.
Hey, I’ve already gone into much more detail than I intended to. The way to really learn the details is to take a course. You’ll get a course if you’re going into 6th grade, and otherwise you can call the American Red Cross at 245-2919.

Additionally , our Junior Lifeguard program just purchased a “Resucie Annie” mannequin, and you Junior Lifeguards will have gotten hands-on experience with this by the time this article comes out.
In the last year I have seen an instance where family gave CPR to a parent who collapsed, it was 7 minutes before Firefighters arrived. The Firefighters arrived and applied their defibrillator (and this is a whole other part of the resuscitation story, since there are an ever-increasing number of defibrillators in stores and shopping centers around Kauai, thanks to Hanalei Rotary.). The parent’s heart responded to the defibrillator, and he came back to life and is now leading a normal life with his family. Oh Wow!

You may one day find yourself being part of a scenario like this. In a way I hope not, it’s not a stress-free situation. But if you do, and if you are prepared for it, it may go really well for you and it may be a highlight of YOUR life as well as of course the near-victim’s life.

Have a good school year, whatever grade you’re going into!