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Publish at September 06 2022 Updated September 06 2022

Rester en vie - Staying alive [Thesis]

Testing first aid education

Flat electrocardiogram taking the form of a disco dancer before returning to normal (normal cardiac activity) with two hands providing cardiac massage in the background.

"When arms are needed, help in words is useless."

Aesop - Fabulist (7th - 6th century BC)


Cardiac arrest is a critical situation for both the victim and witnesses. In the movies, it is possible for a victim in cardiac arrest to :

  • run nearly a mile;
  • make a phone call;
  • get a defibrillator;
  • get an intravenous injection;
  • have a complete cardiac arrest and finally be saved by his or her partner and get on with his or her life as if nothing had happened.

Now, not everyone is James Bond.

Cardiac arrest is a loss of consciousness in conjunction with a disappearing pulse (heartbeat) resulting from the heart's sudden inability to propel blood to the brain and the rest of the body. Without treatment, three minutes of abolished blood flow is enough to cause irreparable sequelae and a few more minutes to cause irreversible death.

Cardiac arrest results in a substantial number of deaths or severe sequelae in survivors. In order to limit these consequences, a rapid and organized management program has been established: the chain of survival.

The chain of survival consists of six links from the first witness to the victim's hospital rehabilitation care:

  1. Witness - Recognition of cardiac arrest and alerting the emergency call center
  2. Implementation of life-saving procedures with emphasis on cardiac massage 
  3. Setting up the defibrillator by the first witnesses or first aid team
  4. Resuscitation by pre-hospital medical aid.
  5. Stage of hospital care in resuscitation unit
  6. Victim recovery
     

Chain of Survival for the Management of Cardiac Arrest  ( adapted from American Heart Association, 2020).

Composed primarily of professional caregivers trained in the management of life-threatening emergencies, the chain of survival depends on the first link, who is most often a novice and facing such a situation for the first time.

What to do when faced with a victim of cardiac arrest

Cardiac arrest should be assumed when a person is unconscious, unresponsive, and appears to be not breathing or having difficulty breathing. Cardiac massage should then be initiated as quickly as possible with the sequence Protect, Alert, Rescue.

  • Protect : protect yourself by inspecting the victim and checking to see if the scene is safe  

  • Alerter : seek help from those around you and/or by calling an emergency number

  • Rescue : It is best for a novice bystander to perform cardiac massage without mouth-to-mouth. This is because cardiac massage creates sufficient blood and respiratory flow to keep the victim going until help arrives by supplying oxygen to major organs and avoiding some irreversible after-effects.

A lot of online content such as blogs, videos or even training programs, such as those of the red cross and the red crescent, are available to get information or training in first aid. The French youtuber Primum non nocere offers a popular video dedicated to this topic: PAPL 2 - Staying Alive or the art of CPR on Disco!

In France, public health programs for first aid training are based on generalized awareness, initiation and training in order to potentiate the action of first witnesses. The objective being to allow as many people as possible to intervene in the face of a cardiac arrest and to quickly trigger the vital chain of survival for the victim by having the right reflexes.

Are these public health strategies optimal?

Are the available trainings sufficient to respond and provide first aid?

Do their durations make a real difference on the performance of the first aider?

This is what we propose to explore Cédric Dammin his thesis "First aid teaching in France: towards a better consideration of human factors and learning strategies".

Why read this thesis

From the very first pages, we become aware or re-aware of our ability to save lives by having the right reflexes as a bystander when faced with a victim of cardiac arrest. Throughout the reading we are indirectly invited to reconsider our knowledge of life-saving gestures, even if it means considering taking the initiative to update them ourselves.

Cédric Damm offers the reader a text that is both rich and accessible thanks to his multiple experiences as an emergency physician, first aid trainer, and researcher in educational sciences.

This aside, both intimate and clear, combined with the reader's introspection induced by the theme, allows the author to lay the groundwork for his subject, while creating a form of appetence for his problematic. Appetence to which the author responds with a narrative framework with an explicit and precise style that allows for a smooth understanding of the subject at different scales.

Excerpt - The Heart of the Matter

 "The management of unexpected cardiac arrest has been compared to a chain in which each link is equivalent to an action essential to the patient's survival. However, the first links, those that allow the initiation of the intervention of the specialized rescue services, rely on witnesses who face this type of situation most often for the first time. Any specialized resuscitation, no matter how good, becomes futile if the rescue chain has not been initiated quickly.

Given the high incidence of cardiac arrest and the human stakes involved, this condition is the subject of intense research. The majority of the themes developed by physiologists and clinicians are focused on technical (artificial ventilation, mechanical cardiac massage, defibrillator...) or pharmacological topics. There are relatively few data in the literature focusing on the behavior of bystanders faced with an emergency situation.

Better understanding of the reasons why bystanders do not intervene to render aid or do not perform the appropriate actions would, in our opinion, be a major asset to improve the overall effectiveness of the chain of survival with, ultimately, an increase in survival rates. "

A training arrhythmia

Among the many findings and emerging trends from Cedric Damm's research work, the most striking results from the study of training history on bystander performance and feelings in crisis situations.

In this experiment, the author compares the performance and feelings of three groups confronted with a cardiac arrest scenario on a mannequin: the first with no first aid training; the second with a two-hour first aid training; and the third with a seven-hour diploma training in first aid.

The observations of this study show that all the subjects overestimate their actual performance, which in fact is relatively low. Furthermore, the data collected appear to show no significant differences between groups. Thus, the measured performance between individuals remained similar, despite the absence, presence, or even duration of first aid training.

"The best is the mortal enemy of the good"

This quote from Montesquieu chosen by Cedric Damm for the opening of his thesis is perfectly in line with his findings. Indeed, we discover that the main obstacles to first aid training are linked to a desire to do better. Long training courses and restrictive selection criteria of trainers give contents that are not very adapted and limit both the generalization and the updating of these trainings to the basics of first aid for the greatest number.

By setting up simple, short and accessible training courses, Cedric Damm aims to transmit and maintain a sufficient base of knowledge on a national scale to avoid many deaths.

We can all embody the first link of the survival chain by assisting a victim; our ability to intervene and rescue remains our responsibility.

What about you? What will your program be to stay ready to rescue?

Happy reading!

This work was defended on December 12, 2021 in Rouen, as part of the PhD degree of the University of Rouen Normandy at the doctoral school Man, Societies, Risks, Territory (HSRT) : ED 556 (Caen - France)

Sources

Cédric Damm. Teaching first aid in France: towards a better consideration of human factors and learning strategies. Education. Normandie University, 2021. French. ⟨NNT: 2021NORMR109⟩. ⟨tel-03635145⟩

Thesis: https://tel.archives-ouvertes.en/tel-03635145/

PDF : https://tel.archives-ouvertes.fr/tel-03635145/document

Images 

Panchal, A. R et al. (2020). Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.  https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines


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