[Press release] Distrust of police is top reason Latinos don’t call 911 for cardiac arrest

Distrust of police is top reason Latinos don’t call 911 for cardiac arrest.

From the 4 December 2014 EurkAlert

WASHINGTON – Fear of police, language barriers, lack of knowledge of cardiac arrest symptoms and financial concerns prevent Latinos – particularly those of lower socioeconomic status – from seeking emergency medical help and performing cardiopulmonary resuscitation (CPR), according to a study published online yesterday in Annals of Emergency Medicine (“Barriers to Calling 911 and Learning and Performing Cardiopulmonary Resuscitation (CPR) for Residents of Primarily Latino, High-Risk Neighborhoods in Denver, Colorado”).

English: CPR training (Photo credit: Wikipedia)

“Residents of low-income, minority neighborhoods have two strikes against them: the incidence of out-of-hospital cardiac arrest is much higher than average and rates of bystander CPR are below average,” said lead study author Comilla Sasson, MD, PhD, FACEP of the American Heart Association and the University of Colorado School of Medicine in Aurora, Colo. “We need to do a better job of overcoming the significant barriers to timely medical care for Latinos suffering cardiac arrest. Culturally sensitive public education about cardiac arrest and CPR is a key first step.”

Researchers conducted focus groups and interviews with residents of primarily lower-income Latino neighborhoods in Denver to determine why they underutilize 9-1-1 emergency services and how to increase knowledge and performance of CPR on people suffering cardiac arrest. General distrust of law enforcement, of which 9-1-1 services are bundled, was cited as a top reason for not calling 9-1-1 by most participants.

Many subjects also believed – incorrectly – that they would not be able to ride an ambulance to the hospital without first paying for it, as that is the practice in Mexico where many participants came from. Subjects also expressed a lack of understanding about the symptoms of cardiac arrest and how CPR can save a life. Strong reticence about touching a stranger for fear that it might be misconstrued was a unique cultural barrier to performing CPR. Language barriers – either with 9-1-1 dispatchers or first responders – also inhibited subjects from getting involved with someone experiencing cardiac arrest.

In the interest of educating more people on how to perform CPR, participants widely supported policy changes that would make CPR either a high school graduation requirement or a pre-requisite for receiving a driver’s license.

“Future research will need to be conducted to better understand how targeted, culturally-sensitive public education campaigns may improve the provision of bystander CPR and cardiac arrest survival rates in high-risk neighborhoods,” said Dr. Sasson.

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Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

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[Press release] Results of study of the human mind and consciousness at the time of death available

Artist’s depiction of the separation stage of an out-of-body experience, which often precedes free movement. (Photo credit: Wikipedia)

http://www.eurekalert.org/pub_releases/2014-10/e-ros100714.php

From the 7 October 2014 EurkAlert!

he results of a four-year international study of 2060 cardiac arrest cases across 15 hospitals published and available now on ScienceDirect. The study concludes:

• The themes relating to the experience of death appear far broader than what has been understood so far, or what has been described as so called near-death experiences.
• In some cases of cardiac arrest, memories of visual awareness compatible with so called out-of-body experiences may correspond with actual events.
• A higher proportion of people may have vivid death experiences, but do not recall them due to the effects of brain injury or sedative drugs on memory circuits.
• Widely used yet scientifically imprecise terms such as near-death and out-of-body experiences may not be sufficient to describe the actual experience of death. Future studies should focus on cardiac arrest, which is biologically synonymous with death, rather than ill-defined medical states sometimes referred to as ‘near-death’.
• The recalled experience surrounding death merits a genuine investigation without prejudice.

Recollections in relation to death, so-called out-of-body experiences (OBEs) or near-death experiences (NDEs), are an often spoken about phenomenon which have frequently been considered hallucinatory or illusory in nature; however, objective studies on these experiences are limited.

In 2008, a large-scale study involving 2060 patients from 15 hospitals in the United Kingdom, United States and Austria was launched. The AWARE (AWAreness during REsuscitation) study, sponsored by the University of Southampton in the UK, examined the broad range of mental experiences in relation to death. Researchers also tested the validity of conscious experiences using objective markers for the first time in a large study to determine whether claims of awareness compatible with out-of-body experiences correspond with real or hallucinatory events.

Results of the study have been published in the journal Resuscitation and are now available online on ScienceDirect.

Dr Sam Parnia, Assistant Professor of Critical Care Medicine and Director of Resuscitation Research at The State University of New York at Stony Brook, USA, and the study’s lead author, explained: “Contrary to perception, death is not a specific moment but a potentially reversible process that occurs after any severe illness or accident causes the heart, lungs and brain to cease functioning. If attempts are made to reverse this process, it is referred to as ‘cardiac arrest’; however, if these attempts do not succeed it is called ‘death’. In this study we wanted to go beyond the emotionally charged yet poorly defined term of NDEs to explore objectively what happens when we die.”

Thirty-nine per cent of patients who survived cardiac arrest and were able to undergo structured interviews described a perception of awareness, but interestingly did not have any explicit recall of events.

“This suggests more people may have mental activity initially but then lose their memories after recovery, either due to the effects of brain injury or sedative drugs on memory recall”, explained Dr Parnia, who was an Honorary Research Fellow at the University of Southampton when he started the AWARE study.

Among those who reported a perception of awareness and completed further interviews, 46 per cent experienced a broad range of mental recollections in relation to death that were not compatible with the commonly used term of NDE’s. These included fearful and persecutory experiences. Only 9 per cent had experiences compatible with NDEs and 2 per cent exhibited full awareness compatible with OBE’s with explicit recall of ‘seeing’ and ‘hearing’ events.

One case was validated and timed using auditory stimuli during cardiac arrest. Dr Parnia concluded: “This is significant, since it has often been assumed that experiences in relation to death are likely hallucinations or illusions, occurring either before the heart stops or after the heart has been successfully restarted, but not an experience corresponding with ‘real’ events when the heart isn’t beating. In this case, consciousness and awareness appeared to occur during a three-minute period when there was no heartbeat. This is paradoxical, since the brain typically ceases functioning within 20-30 seconds of the heart stopping and doesn’t resume again until the heart has been restarted. Furthermore, the detailed recollections of visual awareness in this case were consistent with verified events.

“Thus, while it was not possible to absolutely prove the reality or meaning of patients’ experiences and claims of awareness, (due to the very low incidence (2 per cent) of explicit recall of visual awareness or so called OBE’s), it was impossible to disclaim them either and more work is needed in this area. Clearly, the recalled experience surrounding death now merits further genuine investigation without prejudice.”

Further studies are also needed to explore whether awareness (explicit or implicit) may lead to long term adverse psychological outcomes including post-traumatic stress disorder.

Dr Jerry Nolan, Editor-in-Chief of Resuscitation, stated: “The AWARE study researchers are to be congratulated on the completion of a fascinating study that will open the door to more extensive research into what happens when we die.”

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Notes to editors:

The paper is, “AWARE—AWAreness during REsuscitation—A prospective study” (http://dx.doi.org/10.1016/j.resuscitation.2014.09.004), Resuscitation, published by Elsevier. Available on ScienceDirect: http://www.sciencedirect.com/science/article/pii/S0300957214007394

[Full text of this article may be available at your local public, academic, or hospital library. Call ahead and ask for a reference librarian. Many academic and hospital libraries have at least some services for the public]

 

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• Results of study of the human mind and consciousness at the time of death available
• Near-Death and Out-Of-Body Experiences Could be Real

Social Media Discussion On Cardiac Arrest Reveals New Avenues For Public Health Education

From the 15 November 2011 Medical News Today article

Discussion about cardiac arrest on Twitter is common and represents a new opportunity to provide lifesaving information to the public, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The Penn investigators presented two studies (ReSS Abstracts #52 and #53) examining cardiac arrest-information exchange on the social media site today at the American Heart Association‘s annual Scientific Sessions.

The Penn researchers evaluated cardiac arrest- and resuscitation-related Tweets during a month-long period in the spring of 2011 and discovered that users frequently share information about CPR and automated external defibrillators (AEDs) and discuss resuscitation topics in the news. Although their findings indicate that use of the platform to ask questions about cardiac arrest appears to be only in its infancy, the authors suggest that Twitter represents a unique, promising avenue to respond to queries from the public and disseminate information about this leading killer – particularly in the areas of CPR training and lifesaving interventions like therapeutichypothermia. …

Read the article

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• Members of the public lack skills, confidence necessary to save lives with CPR, Penn research shows (eurekalert.org)
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Beware whenever you hear a story about a simple blood test

From KevinMD.com,  Mon Aug 22, 2011 10:00 , by Gary Schwitzer

After seeing the NBC Nightly News last night, a physician urged me to write about what he saw: a story about a “simple blood test that could save women’s lives.”

Readers – and maybe especially TV viewers – beware whenever you hear a story about “a simple blood test.”

And this is a good case in point.
Read the rest of Beware whenever you hear a story about a simple blood test on KevinMD.com.

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A New Order for CPR, named CAB (Compression-Airway- Breathing)

A link to information about the new CPR guidelines (Compression – Airway- Breathing) may be found here.
A presskit with media materials, statements from experts, and real life stories may be found here.

Excerpt from the American Heart Association Oct 18, 2010 news release

Statement Highlights:

• The 2010 AHA Guidelines for CPR and ECC update the 2005 guidelines.
• When administering CPR, immediate chest compressions should be done first.
• Untrained lay people are urged to administer Hands-Only CPR (chest compressions only).

DALLAS, Oct. 18, 2010 — The American Heart Association is re-arranging the ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in Circulation: Journal of the American Heart Association.

Recommending that chest compressions be the first step for lay and professional rescuers to revive victims of sudden cardiac arrest, the association said the A-B-Cs (Airway-Breathing-Compressions) of CPR should now be changed to C-A-B (Compressions-Airway-Breathing).[Editor Flahiff’s emphasis]

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” said Michael Sayre, M.D., co-author of the guidelines and chairman of the American Heart Association’s Emergency Cardiovascular Care (ECC) Committee. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away.”

In previous guidelines, the association recommended looking, listening and feeling for normal breathing before starting CPR. Now, compressions should be started immediately on anyone who is unresponsive and not breathing normally.

All victims in cardiac arrest need chest compressions. In the first few minutes of a cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so starting CPR with chest compressions can pump that blood to the victim’s brain and heart sooner. Research shows that rescuers who started CPR with opening the airway took 30 critical seconds longer to begin chest compressions than rescuers who began CPR with chest compressions.

The change in the CPR sequence applies to adults, children and infants, but excludes newborns.

Other recommendations, based mainly on research published since the last AHA resuscitation guidelines in 2005:

• During CPR, rescuers should give chest compressions a little faster, at a rate of at least 100 times a minute.
• Rescuers should push deeper on the chest, compressing at least two inches in adults and children and 1.5 inches in infants.
• Between each compression, rescuers should avoid leaning on the chest to allow it to return to its starting position.
• Rescuers should avoid stopping chest compressions and avoid excessive ventilation.
• All 9-1-1 centers should assertively provide instructions over the telephone to get chest compressions started when cardiac arrest is suspected.

Related Links

[Video]

Vinnie Jones’ hard and fast Hands-only CPR  (British Heart Foundation)

[Vide0]

Learn Sarver Heart Center’s Continuous Chest Compression CPR

• Brief Video Training Dramatically Boosts Hands-Only CPR Attempts

ScienceDaily (Mar. 8, 2011) — Study participants who viewed a brief hands-only cardiopulmonary resuscitation (CPR) video were more likely to attempt CPR, and perform better quality CPR in an emergency than participants who did not view the short videos, according to research reported in Circulation: Cardiovascular Quality and Outcomes.

Related Articles

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