Wednesday, April 2, 2008

More on CPR...This just in:

It is my strict policy not to republish private conversations or emails on my blog, I post this because the email from a listserv ended with a "feel free to forward" note.

I honestly don't know how to take this. Part of me feels that the bystander acting as taught by their AHA course/instructor according to national consensus provides some serious footing. The chances of survival for the patient are pretty slim to begin with. And Lord knows that AHA has published things before with less than solid science behind it.

I recall a session in Orlando some years back when the "between the nipples" hand position was rolled out. The presenters said this was based on "looking at the nipple levels of 'several' dead, recumbent people, some of which had pendulous breasts."

Hmmmm. Maybe I could do research after all...

In any case here is an email from an attorney with EMS experience who proposes a poor legal prognosis for the new CPR guidelines:

Hi all,

I've discussed this issue on this list before, but given the current situation feel the need to mention it again.

The overall standard of emergency care/first aid/CPR and so forth is "reasonable care under the circumstances."

In particular, complying with a standard of care does NOT insulate someone from a negligence lawsuit if the standard itself is found to be unreasonably low. They teach this in law school by pointing out that on the day the Titanic sailed it complied with (and even exceeded) all maritime standards in place at the time, but still had lifeboats for only about half of the people involved -- so therefore the standard itself was substandard and people who complied with it (here, the Titanic's owners) were vulnerable to a negligence lawsuit.

We may very well have a comparable situation with compression-only CPR. Pardon me for saying so, but I'm something of an expert in the law of emergency care (among other things, I'm a part-time law school professor), and as such an expert I am gravely concerned that a jury could find that giving compression-only CPR was substandard care and therefore negligence (with resultant liability) *even if* that's how the rescuer were taught to do it. This would particularly apply in situations were the Good Samaritan law likely did not apply, such as in the workplace.

(Actually, what would likely happen in the event of litigation was that not only would the rescuer be sued -- along with their employer, if any -- but also the instructor who taught them this technique and the organization that the instructor worked for.)

From a liability point of view, this new supposed "standard" scares the hell out of me. I am going to be in Absolutely No Rush to teach it, and will discourage it if it is mentioned by any of my students.

Please feel free to forward this.

Most sincerely,

Jay Wiseman, JD

I'll end this post as I did my last: Keep doing good things for people. It is never wrong.


Ray said...

I think the point here is that Compression Only CPR is for LAY Rescuers only. So they will be covered by Good Samaratin laws. It is better than nothing and in a Urban setting, you are hoping for a fast response from a professional rescuer. All EMS personel should continue to do ventilations with their compressions.

Kenneth J Searcy, RN said...

I know Jay Wiseman well from my subscribed blogs. He is a very knowledgeable and highly intelligent gentleman.

However, the AHA has stated that "compression-only" CPR is meant for those who either lack the confidence (lack of barrier device) or competence (lack of recent training) AND is nearly as effective, if not equally as effective, as conventional CPR.

My "knee-jerk" reaction with change isn't the greatest all of the time so I have to sit, stew and eventually rationalize what IS best despite my initial thoughts. So, I wasn't totally thrilled about "compression-only" CPR trials even before any AHA press release, but on the other hand, I wasn't totally thrilled about the elimination of any pulse check by lay rescuers before CPR either.

We ALL have to look at the evidence-based medicine and learn what is best for all beyond the influence of any personal bias, usual tradition or past education.

Kenneth J Searcy, RN