No No Go

I want to congratulate all of you for the life saving efforts you've made with our no, no go criteria. We have really seen an increase in not only return of spontaneous circulation but also neurologically intact survivors. And that is all basically from your recognizing cardiac arrest early and getting those callers to start cpr. So I want to go briefly over our no, no go criteria, why it's so important and how we're going to if we get roadblocks, how we're going to deal with those roadblocks. So first, the no, no go criteria obviously go along with those questions. The first question, is the patient awake? And if not, can you wake them up? If the answer is no, then you immediately go to the next question. The next question for our no, no go criteria has to do with breathing. Is the patient breathing? And the question is normally. So that criteria is really important because folks who have just gone into cardiac arrest are often gasping they and gasping to a lay rescuer looks like breathing. We're not looking for any type of breathing. We want to know are they breathing normally? Because abnormal breathing is certainly a sign of cardiac arrest, as is lack of breathing. So either lack of breathing or not breathing normally are both cardiac arrest symptoms. So now you've got no, you can't wake them up. No, they're not breathing normally. The next criteria is go. We're going to start pushing on the chest and don't be afraid to tell folks to push on the chest. Again, it's harmless in alive folks. So if you just have someone who's unconscious for a different reason, you're not going to do any harm. But for someone who's truly in cardiac arrest, this maneuver can be life saving because it's super time dependent and you getting to the start has really. We've already seen lots of lives saved by that. But let's talk about you've got someone who's on the bed or somebody's crunched in the corner of the bathroom and either you've got a caller who's too weak to roll them over or too weak to get them off the bed onto a hard surface or too weak to get them out of the corner of the bathroom. Give it 20, 30 seconds maximum. If it's clear they're not going to be able to get them on the ideal surface. Don't let perfect be the enemy of good enough. Good enough is start some kind of compression. However they lay, if they're on their belly and you can't roll them over, do compressions right on their back. That still helps. If they're in a corner and you can't get them to lay flat, do compressions sitting right up, just like they're at. So understand that we're not going to let a delay of more than 20 or 30 seconds go by before it's obvious to us that we're not going to get him in the ideal position before we start doing compressions, even if it's not in the ideal position, because that also will help save lives. So let's talk about another roadblock. When you're speaking to somebody on the phone, but they're not actually at the patient's side, it's critical that you have the phone and the communication be right at the patient's side so you can hear in the background what's going on. Have them put it on speakerphone so everybody in the room, if there's more than one rescuer, can listen to what you're saying. And you really want to take control of the situation. Control of the situation is a critical thing. You really have to be a little bit forceful here. Obviously polite and respectful, but a little forceful, because that will help get them organized and get them to do what needs to be done. And if there's more than one person there, obviously use all the resources you've got and let them work together. Now, keep in mind, one of the things that we do is we have people unlock doors and we have them do other things. None of those steps are critical. All of those things can be done later on. You've got to concentrate on getting the compressions going and the compressions going in a good.

Coordinated fashion before you do anything else, whether it be unlock a door, anything, whatever the other step is that you want to do, make sure your compressions are going first and then you can watch the rescue come along. And when you see rescues showing up, if you haven't already gotten the door unlocked by that time, that's the time to do it. But tell the folks, go unlock the door and then go immediately back to doing compressions again. Let's talk about the question about AEDs. Now, certainly AEDs, if they're available, is super life saving, but let's not get stuck on that one. The fact is, only a tiny minority of the calls for cardiac arrest is there going to be an AED on scene. And not everybody's even going to know, especially if there's a language barrier, what you're talking about if you ask for an aed. So if there is immediate recognition of what an AED is, and they know there's one. Yes. Go for it. Go get them to get that thing. But if they don't have immediate recognition of what you're talking about, skip that step and move on to chest compressions.