#30: Become CPR/AED certified

My mom is an incredible woman. Among the many very wise things she did as a parent was infuse the spirit of caring, compassion, and volunteerism in my sister and I – through her words and her actions.

Growing up, both my sister and I were expected to donate some amount of time and energy to serving our community – and we did so willingly and happily. (Well, most of the time, anyway. We were kids; I’m certain we had our moments.)  😉  As an adolescent, one of the cool volunteer roles my sister held was a candy striper at the local hospital. She delivered cards and flowers to patients, certainly; but she also had to learn first aid, CPR, and other emergency-response techniques in case something happened and she had to respond to a crisis. As a teenager, I thought that was pretty bad-ass.  😉

As my sister told stories from the hospital about various experiences she had and scenes she witnessed, I thought it would probably be a good idea if I learned CPR, too. I mean, what if I was shopping in the mall and some stranger had a heart attack right in front of me? Or what if I was at the local fast food joint and someone started choking on a french fry at the table next to me? Or what if I was babysitting and one of the kids I was watching slipped in the tub and stopped breathing? (Okay, that wouldn’t make me a very good babysitter…) But you get the idea: What if a crisis occurred, and I had no idea how to respond? I’d feel like an asshole, and I’d be guilt-ridden for the rest of my life.

And yet, despite all of the reasons why I *should* have learned CPR, I never did. Either a class wasn’t offered during a time when I could take it (high school), or I couldn’t afford it when it was offered (college), or I couldn’t find one close to me (my early 20s), or I got busy with grad school and marriage (late 20s)… until I just kinda forgot about it.

Last year when I sat down to make my 101 list, one of the questions I asked myself was, “What are things I’ve been wanting to do, but just haven’t gotten around to doing yet?” – and Learn CPR surfaced quickly. So I kept my eyes open for a chance to take a class – and spied an opportunity a few months ago in the local community education catalog. I immediately registered for an upcoming session – then waited for the class date to arrive.

Last weekend the day finally came; I attended an American Heart Association CPR/AED Heartsaver course.

I arrived at our local community center 10 minutes before the class was scheduled to begin – and only two other people were in the room. I paused in the doorway and asked, “Umm… is this the CPR class?” The seventeen-year-old student who was sitting at a table nodded, so I entered the room and took a seat near him. The other person in the room turned out to be the instructor – but she didn’t say a word to me.

Eight minutes later, a third student entered the room – and was greeted with a hearty, “Hello! Welcome!” from the instructor. These were the first words she said since my arrival. Did you catch that? I sat in a room with her and one other person for nearly 10 minutes, and was not acknowledged once. Seriously? So that’s how this is gonna go down? I so don’t think so…

In the next three minutes, 11 more people arrived to the class session, and we became a group of four men and 10 women. (And yes, the instructor greeted each of these individuals, too.) Then exactly one minute after 1 pm, the instructor began the class. (At least she was prompt.)

Once she officially started the session, the instructor turned out to be rather personable and pretty darn funny. She kept the tone of the class appropriately serious and realistic, but infused a positive spirit into the content. As she explained the various processes and procedures (from performing the Heimlich maneuver, to delivering chest compressions, to using an AED) the instructor repeatedly encouraged us to err on the side of action versus caution; to not worry about being perfect, but to simply do our best. As she explained, “In past CPR classes, people may have expected you to do everything exactly like a trained paramedic would. But none of you are professional paramedics. So anymore, we’re happy if you just engage with the scene. Call 9-1-1, then simply do the best with what you have.”

I can do that.

Over the next two hours, I learned a lot about what to do in a choking or heart-related medical emergency. Here’s a quick summary of new information I received in this course:

• Often times, people collapse not because of a heart issue, but because they are choking. (This is particularly true for young children, and for people who have been eating/drinking/chewing gum.) So before starting to administer CPR, you may want to perform the Heimlich maneuver – that may fully resolve the issue.
• Frequently people will have a mini-seizure before they have a massive heart attack.
• If in doubt about whether someone needs chest compressions or not, go ahead and do them. Delivering “unnecessary” chest compressions can’t hurt anyone. (Apart from maybe giving them a bruise.)
• CPR has to be done on a hard, flat surface. So you can’t do CPR if a person is lying in a bed, or sitting in a car – you have to pull them to the floor, or move them to a section of flat ground.
• In addition to needing to deliver CPR on a flat surface, the recipient must also be lying flat him/herself. (This means that if the victim is wearing a ponytail, or hat, or has a wallet in their back pocket, you need to remove all of these things.)
• There is one exception to the must-be-lying-flat rule: The recipient’s feet can be elevated. Indeed, if it’s at all possible to elevate their feet, it’s ideal to do so. (Some ways to get the feet elevated: Place their legs on a chair, a purse, a rolled-up coat or sweatshirt… Get creative.)
• The song “Stayin’ Alive” offers the perfect beat (tempo) for giving chest compressions.
• When giving compressions, aim to push halfway into the victim’s chest. This will help you determine how much pressure to deliver to a child vs. adult, and a thin person versus a heavy person.
• If you are administering CPR on a hard surface (i.e., pavement, astroturf, tile, wood, even linoleum), take your shoes off and put them underneath your knees. This will provide some cushion, and will let you go longer with less discomfort/pain.
• If the victim throws up, roll them towards you until they are on their side. Once they are done, you can use their shirt to wipe off their mouth, then roll them on their back again.
• If an AED (automated external defibrillator) is available, put it at the head of the victim, and turn it on immediately. The machine will tell you exactly what to do, and will monitor all of the victim’s heart activity (or inactivity) once the device’s pads have been applied to the victim’s chest. This can provide really important information to the professionals when they arrive on-scene. The machine will also continue to coach you on appropriate actions to take – it’s like having an emergency professional right there with you. [Before this class, I had no idea an AED was so easy to use, nor did I understand the incredibly important information it recorded. I am now a lot more conscious of these machines, and see them in all sorts of places I previously ignored {i.e., the grocery store, the library, my parent’s home…}]

In addition to all of this important and broadly-applicable information, I also learned the specific step-by-step process for administering the Heimlich maneuver and for performing CPR. (Which is good, since that was the whole reason why I registered for the class.) Here is the summary for what to do in both situations:

HEIMLICH:

1. Come to the front of the person who is in need of aid, and loudly ask, “Are you choking? Can I help you?” However, stay an arm’s length away from them. If the person is choking, their reaction will be to reach out and grab you – and if they “catch” you, you may be stuck (as they may be stronger than you – especially if they have lots of adrenaline coursing through their body).
2. When the victim silently looks at you like you are an idiot and/or nods “Yes!!” vigorously, walk behind them, and put one fist on their belly button. [Note: You want your hand as close to the victim’s skin as possible. If the person is wearing bulky clothes, lift up the layers until you get to either a thin t-shirt, or bare skin.] Wrap your other hand over your fist, and thrust with powerful gusto (i.e., give it everything you got).
3. Repeat thrusting until the obstruction comes out.

If the person is 1) pregnant, or 2) too big for you to wrap your arms around, don’t thrust against their belly. Instead, stand in front of them, back them up against a wall, and do compressions on their chest. (It will look a little like CPR, but will work to clear a throat obstruction.)

CPR:

1. Before you take any action, make sure the scene is safe – and say it out loud. (Example: In a store, you make sure the crowd is at an appropriate distance, that no liquids/glass/etc. is near the victim, and so on – and then you say something to the effect of, “It’s safe for me to proceed.” Outside, you make sure that the victim is off of a road, out of the way of traffic, away from anything that could spark or flame… and again, you say something like, “It’s safe for us to be here.”)
2. Approach the person who appears to be in need of help, and yell at them/tap on them pretty aggressively. Basically, try your best to annoy them. Yell, “Hey, are you okay? Do you need help?”, and poke at their shoulder with two fingers, or roughly rub the top of their head with your hand. If they are somewhat okay (i.e., just hungover, or stunned), they will respond to you – and then you know you don’t need to launch into CPR. But if you don’t get a response even when you are being super-annoying, you know something is probably wrong.
3. Yell for help. “Everyone, help me! Call 9-1-1, and bring me an AED! If you know CPR, get over here beside me!”
4. Check the victim to see if they are breathing. Roll them on their back if they are not already there (rolling the person towards you, and removing ponytails/hats/wallets/etc.), then watch their face and chest for 1-2 seconds for any signs of movement. If you don’t see anything happening, start CPR.
   [Note: Turn on the AED immediately when it arrives, and follow its directions.]
5. Elevate the victim’s legs if possible, then put your hands in the middle of their chest (removing clothing if you need to [you want to be as close to their skin as possible], and moving zippers, bra straps, buttons, or anything else that is in the way), and start compressions. Don’t worry about doing everything ‘right’ or being ‘perfect’, just get in there, commit, and GO!
6. Deliver 30 compressions to the beat of “Stayin’ Alive”. Count them out loud. (Literally: “One, two, three, four, five…” all the way to 30.)
7. Optional: Give the victim two breaths. (If you don’t want to touch your mouth to theirs, you can put a thin cloth [t-shirt, men’s handkerchief, restaurant napkin, etc.] over their mouth while you deliver the breaths. Then remove the cloth after the two breaths are finished.) You should breathe in enough air so that the victim’s chest rises. (So, if you don’t have good lung capacity yourself [i.e., if you have asthma, or are out of shape, or are winded from the work of giving the 30 compressions], it’s probably just as well to skip this step.)
8. Yell for help again. (“Call 9-1-1 again! Where is the AED? Does anyone else here know CPR?”)
9. Deliver another round of 30 compressions to the beat of “Stayin’ Alive”. Count them out loud.
10. Optional: Give 2 breaths.
11. Yell for help again. (“People, CALL 9. 1. 1.! Get me an AED!”)
12. Repeat steps 9 through 11 until help arrives, or until the victim moves on their own. (If the victim starts moving, pause compressions and watch them. If they stop moving at any point, resume compressions immediately.)
13. Keep track of how many sets of 30 compressions you give. One way to do this: When you deliver the first set of compressions, note the victim’s head. With set #2, note the victim’s left arm. With set #3, note the victim’s left leg. With set #4, note the victim’s right leg. With set #5, note the victim’s right arm. You’ve then made a full circle around the body. If you are still delivering compressions, repeat with the head and go around again. Each body part equals about 1 minute of CPR activity. So when paramedics arrive and ask you, “How long have you been giving CPR?”, you can (internally) note that you were on the right leg, so you can tell the medical professional, “Four minutes.”

After the instructor verbally walked us through the Heimlich and CPR procedures a few times, she showed us how to use an AED – which I discovered is surprisingly simple. Basically, all a person needs to do to use an AED is turn it on, then follow the step-by-step instructions the machine gives. The general instructions will likely be:
1) apply sticky pads to the victim’s chest,
2) briefly stop touching the victim while the machine looks for a heart rhythm,
3a) press the AED button to deliver a shock (this will be indicated if the machine can detect an appropriately shockable heart rhythm), OR
3b) begin/resume CPR.

Prior to this class, I never would have used an AED on a person for fear that I would shock them inappropriately and hurt (or kill) them. But in this session I learned that an AED machine will not deliver a shock unnecessarily (i.e., an AED won’t deliver a shock to a fully beating heart, nor will it deliver a shock to a heart that has zero activity) – so it’s impossible to hurt someone using an AED. I also learned that an AED will only deliver a shock to a victim a pre-set number of times (usually 3) – so it’s also impossible to “go overboard” with the machine and cause harm via overuse. Finally, I learned that even if an AED machine never delivers a single shock to a victim, it is recording all of the person’s internal heart activity (or inactivity) – which is very valuable information for medical professionals to have once they begin treating the victim. So even if the shock button on the AED is never pressed, it’s still incredibly important to use the device (if it’s available) for the rich data it will collect. I had no idea!

At this point in the class session, the instructor gave us a 5 minute break; then she started the hands-on segment of the session. That’s right – we all practiced CPR.

I paired up with another woman who was attending the class alone, and she and I made our way to one of the many “Rescue Annie” dolls scattered around the room.

As I kneeled down next to my legless victim, the instructor gave us this scenario: “You’re out at the park, when suddenly this person collapses right in front of you. What do you do?”

With that, I launched into the CPR sequence:

• I looked at Annie, and at the area around her, and surmised that it was safe for me to approach. I then literally said out loud, “It’s okay for me to be here.”
• I bent over to get close to Annie’s ear, and said very loudly, “Hey, are you okay?” I then rubbed her head rather roughly. She didn’t respond to my words or my actions.
• I then looked at Annie’s face and chest, and watched for breath movement. I didn’t see that either. Crap.
• At this point I called out, “Hey, someone call 9-1-1! Someone else, go find an AED and bring it to me!”
• I then launched into compressions. I put my hands in the middle of Annie’s chest, and went to town pumping while literally humming “Stayin’ Alive.” I found it kind of hard to hum and count at the same time, so after a few bars of the tune I transitioned to internal/mental “humming”, and overt/aloud counting.
• When I hit compression #30 I paused and looked for breath movement – and still didn’t see any. Damn it Annie, don’t do this to me…
• I called out for help again (“Seriously, someone call 9-1-1! And where is the AED?!”), then said, “Round 2 – left arm” – and then delivered 30 more compressions.

At this point the instructor had us all stop. While a few people in the class were a little ‘entertained’ by my literal approach to the task at hand, I know the power of muscle memory. Whatever I practice in an artificial setting is what I will default to should a real emergency surface – this is what makes ‘practice’ so powerful. So I didn’t want to practice some abbreviated version of the CPR process; I wanted to do everything I could to embed the correct steps into my mind – as well as into my hands, arms, eyes, and voice. I know that should a real emergency occur, my mind will be one of the last things to kick into gear; my muscular reflexes will take over from the start, and may not give my mind a chance to enter the picture until after the crisis is over. (Such is the power of adrenaline, anxiety, and fear.) So I absolutely appreciated the opportunity to begin to develop that powerful muscle memory – and I hope that the 10 minutes of practice I experienced will be enough to buoy me should I ever need to deliver CPR to a fellow human.

I also had the opportunity to try compressions on a child-size version of Rescue Annie – and I was genuinely surprised by how light a touch is required for giving CPR to a child. While I had to press on Annie’s chest with some gusto in order to get it to compress (I’m not an overly large or strong person), I had to scale back my efforts by about 75% for Little Annie. Wow. I’m glad I got to experience this adult/child difference in a safe setting (versus crack some poor kid’s ribs).

After we all practiced the CPR process for 20 minutes or so, the instructor asked, “Does anyone have any questions about what to do to effectively and safely deliver CPR?” We all shook our head ‘no’. The instructor then asked, “So, do you think you’ll be able to do this should a real emergency occur?” Everyone was silent. After 20 seconds or so, I responded, “I actually don’t think I can answer that question until I’m put into a real emergency situation. I know how I like to think I’d respond – but until I’m tested, I’ll never really know….” The instructor looked truly pleased with my comment, and said, “That’s exactly right – you’ll never know until the moment comes. So my hope for all of you is that if you are ever faced with a CPR situation, you call for help, then immediately dig in, take action, and just do your best. Anything you do is better than doing nothing at all. A person who isn’t breathing isn’t going to complain that you’re doing something ‘wrong’ – so just do it. Don’t worry if you miss a step, don’t worry about exactly where your hands go or exactly how fast or how hard you should compress; just do what you can. I genuinely feel better knowing that 14 more people in our community know CPR. Thank you all for providing a great service today.”

With that, the instructor distributed official completion cards to each of us stating that we have “successfully completed the objectives and skills evaluations in accordance with the curriculum of the AHA Heartsaver CPR AED Program”. While the little piece of paper is nice, I left the session feeling genuinely empowered to take action. While I hope I never have to use the skills I just learned, I feel really good knowing that if push comes to shove, I can enter a really crappy situation and do my part to help keep someone alive until the cavalry comes. I don’t know that I could ask for much more from a 3-hour community education class.

Stef

P.S. Here is a “Cliff Notes” version of the CPR process. I encourage you to take an additional 30 seconds to read through the steps below, and do what you can to internalize them. One never knows when this information might literally save a life.

1. Make sure the scene is safe. (“It’s safe for me to be here.”)
2. Yell at and tap on the victim. (“Are you okay?” Poke their shoulder and/or rub on their head.)
3. Yell for help. (“Call 9-1-1! Get an AED!”)
4. Roll the victim on their back. Look at their face and chest to see if they are breathing.
   [Turn on and apply the AED as soon as it arrives.]
5. Move the victim’s clothes out of the way, elevate their legs, and start compressions.
6. Deliver 30 compressions to the beat of “Stayin’ Alive”.
7. Pause, check the victim to see if they are breathing. If not, give 2 breaths if you want.
8. Yell for help.
9. Deliver 30 more compressions to the beat of “Stayin’ Alive”.
10. Pause, check breathing. Give 2 breaths if you want. Yell for help.

Repeat steps 9 & 10 until help arrives, or until the victim starts moving on their own. Keep track of how many sets of compressions you give.

Thanks. Now stay safe. 🙂