5 Reasons Your CPR & First Aid Technique Is Broken (And How to Fix It)

Cardiopulmonary resuscitation, or CPR, is a medical intervention technique that can save a life when used properly.  While CPR training requirements are becoming more widespread, there still exist some common errors when it comes time for its use.  Here is an overview of 5 reasons your CPR & first aid technique is broken, and guidance on how to fix it.

1. Failing To Call 911

When coming across a scene with an unconscious person, the first step is to survey the area for any safety hazards before approaching.  Immediately followed up by checking the status of the person by trying to rouse them with a shout “are you okay” or shaking to get their attention.  With a lack of response comes the decision to initiate first aid and CPR.  At this point the next crucial step is to call for emergency services.

If calling 911 is so high in the chain of survival, how is it missed sometimes?  In most instances calling 911 first is the right response.  Time counts when it comes to CPR.  With a lack of the heart pumping oxygenated blood to the brain, brain death can occur within 10 minutes.   Calling 911 as early as possible will start the clock on medical response time.  This means they should reach the victim sooner, and hopefully within the short window of opportunity.  In other circumstances, it may be best to conduct 2 minutes of CPR before leaving to make the call to 911.  Such circumstances include: child victims, potential drowning victim, or when no one else is around to help.  In an ideal situation, the emergency call and CPR can happen simultaneously.  That way trained medical responders can be on the way without distracting from valuable time to perform CPR.

When faced with an emergency requiring CPR, it can become scary and uncertain even for the conscious person.  To avoid the mistake of not calling 911, remember when CPR is boiled down to its simplest state, there are only 2 steps:

1. Call 911
2. Begin compressions

2. Gaining Proper Leverage

You’d be hard pressed to find a CPR training source showing the victim in any position but laying down on the ground.  In reality, the victim is not always in such an ideal place.  In order to properly assess and deliver breaths and compressions to the victim, it is important they are on a hard and flat surface.  The ground is best and usually readily available for such use.

The rescuer should set themselves, and their patient, up for success before CPR can begin.  Use the three C’s: Check, Call, Care to prompt the initial assessment.  Check the scene for safety.  Check the victim to see if they can be roused.  If not, check that they are on a hard and flat surface to setup for CPR.  Call 911.  Care for the patient by initiating CPR.  Notice when assessing the victim initially, a check for their placement on a hard and flat surface is included.  Moving the victim to a hard and flat surface is as much for them and it is for the rescuer.  CPR is a very physical activity.  So, the proper leverage is needed for the rescuer to conduct adequate assessment and compressions especially.  It serves additional purpose when the safety of the victim is further considered.  They will not risk falling off a bed, and have a reduced risk of improper compressions depth or placement.

Once the victim is on the hard-flat surface, the rescuer belongs kneeling beside their chest.  Bring your knees close to their body and lean in over top of them.  Extend your arms over their chest placing the heel of one hand in the center of their chest.  The center of the chest is found along the breastbone, or between the nipples.  Place the other hand atop the first, interlacing the fingers.  Lock the arms straight and lean over the chest.  With a rocking motion going back and forth using body weight, compress hard and fast into the chest.  Compress to a depth of 2 inches for teenagers-adults at a rate of 100-120 per minute.

Maintaining straight arms throughout this process is key, and leads to another reason your CPR technique may be broken.

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3. Bending Elbows

As popular as emergency-related shows are, they do the population a disservice by depicting CPR incorrectly.  Unfortunately, most depictions of CPR in television and movies perpetuate this next reason your CPR technique is broken.

Recall, CPR is a physical activity largely focused on chest compressions.  The method for compressions is for the rescuer to use their body weight and rock back and forth.  This means nearly the entire body of the rescuer is moving, and quite quickly.  This is probably an awkward position to film an actor, let alone the fact you really shouldn’t compress a conscious person’s chest (for sake of the patient actor).  Instead, to portray the swiftness of their compressing action, most of the time they resort to bending and straightening their elbows rather quickly.

Hollywood issues aside, bending at the elbows goes against proper CPR procedure.  To put it simply, maintaining straight arms is crucial to effective CPR.  Only a strong and straight arm position can produce adequate compression depth.  Additionally, bending at the elbows is more work for the rescuer and will tire them out more quickly, reducing the achievable timespan for CPR overall.

CPR is physically demanding enough without making it more difficult.  The average rescuer can only carry out CPR for a few minutes.  Make them count.  Do yourself and your patient a favor and keep those elbows from bending.

4. Effective Compressions

CPR compressions serve to pump the blood throughout the body where the heart has stopped doing so on its own.  This manual pumping of the blood sustains life by keeping oxygen provided to key organs such as the brain.  The proper rate of compressions is 100-120 beats per minute.  This rate is much higher than the normal beat rate of the heart (around 70 per minute) because even a proper compression is not as good as the heart pumping naturally.  Due to the critical nature of pumping blood through compressions, there is a specific science to it.

Key points to note for proper compressions are best summarized as hard and fast.  Hard so that the depth is adequately reaching 2 inches for children through adults.  Fast so that the rate can more closely match that of the heart pumping naturally.  Ineffective compressions can manifest by not achieving either of these goals, or both.

To bolster proper CPR compression technique, aim for proper positioning first as already discussed above.  Next, have a system in place for supporting the proper rate of 100-120 beats per minute.  Many hit songs you probably already have committed to memory can assist here.  Find one you’re familiar with that has a tempo of 100-120 beats per minute and commit it to memory with the pretense it will be your go-to if the need to give CPR arises.  Having the tune ready in your toolbox is a great accountability measure to prepare with.  The most popular song when it comes to this is the Bee Gee’s Stayin Alive.  It carries some positive reinforcement with it too for added critical motivation.

Refresher Training

Practice.  Practice.  Practice.

It is often said that the best action is having a reaction.  Jumping in when a time of need arises is better than doing nothing at all.  What is even better, is jumping into the situation prepared and ready to give a proper response.

There are reasons annual training in CPR is suggested, and even mandatory in some places.  Keeping the skillset fresh is best when the time comes to use it.  CPR works to sustain life in a multitude of ways from initial recognition of the emergency, to successful completion of saving a life.  With the vast majority of sudden cardiac arrests taking place outside a medical setting, it is more likely to be encountered out in the world, in your home, neighborhood, school, etc.  With no control over the sudden need for CPR arising, you can control your awareness and skill level to respond.  With repeated training, CPR becomes more and more familiar.  With familiarity comes a level of comfort and ease.  When someone is well educated, and comfortable on a subject, they stand to make the best use of the skill and can truly save a life.

The more you learn, the better you get.  CPR courses take only a few hours to complete.  Talk about a sure return on an investment to have the ability to save a life with just a little time invested.  The better you are knowing the proper techniques and administration of CPR, the better equipped you will be to use it in time of need.

In the spirit of proper practice, here are the most common acronyms to help keep your CPR skills refreshed.

• C.C.
  • Check the scene for safety
  • Call 911
  • Care for the person by beginning CPR
• A.B.
  • Compressions—conduct 30 compressions hard and fast to the center of the chest
    • Kneel alongside the victim
    • Extend arms with elbows locked
    • Place heel of one hand in center of the chest interlocking fingers with the other hand on top
    • For infants: use 2-3 fingers instead of the hand
    • Use body weight to rock back and forth compressing the chest
      • For 8+ years old: 2 inches deep and at a rate of 100-120 beats per minute (BPM)
      • For infants and small children: 1 ½ inches deep and a rate of 100 BPM
    • Airway—open the airway by tilting the head and lifting the chin
    • Breathing—deliver 2 rescue breaths
      • Pinch the nose closed and seal over the mouth to avoid any air escaping
      • Breathe into the person’s mouth
      • Breaths should last 1 second each and result in the chest rising
      • If the chest does not rise, open the airway again
      • If the chest still does not rise, return to cycle of compressions
    • E.D.
      • Automated External Defibrillator—an electronic tool used in CPR that can shock the heart into rhythm
        • Many public safety communications centers (911) can direct a caller to the closest location of an AED if available
        • If an AED is available, bring it to the victim
        • Open the case, prepare it for use, and follow its prompts
      • 30:2 Ratio
        • Pattern of compressions to rescue breaths delivered by those trained in CPR
          • Compression only CPR can be done by those untrained, or those rusty on their CPR skills

Reviewing these 5 reasons your CPR technique may be broken, and how to fix it is a great step toward tuning up your CPR abilities.  Annual refresher training in CPR is strongly supported to keep up to date on these and more techniques.

References:
https://www.kidsinthehouse.com/all-parents/health-and-wellness/first-aid-and-cpr/should-i-call-911-or-start-cpr-first
https://www.health.harvard.edu/newsletter_article/cpr-are-we-doing-it-wrong
https://www.tvovermind.com/movies-tv-shows-always-demonstrate-cpr-wrong/