CISD for bystander CPR?

[dzmohr]

I have not been able to find a topic that comes close to a research project I am thinking about doing. I wanted to get some of your thoughts on this. I have not been able to find a study that addresses this in my search either....

We tell people "come take a CPR class and learn to save a life." We do NOT tell them 85-92% will not make it, but CPR gives them the only chance they have.

We tell people practice and get the compressions right, if you do it wrong you will break bones... we do NOT tell them the sternum was not designed to be pushed down that far and you will may well break cartilage or bones even if you do it right...

So when their patient, usually a family member, does not make it, my experience is many feel they "killed" their loved one. They forget they were told the person has to be sick or hurt enough to die to qualify for CPR to begin with.

If we, as professionals, respond to a family member who is critical most of us will get a CISD response. I have found few departments or agencies that track after effects of bystander CPR on the lay provider. A few have chaplains that may or may not be called but at best most will just get a card from the Red Cross or AHA saying thanks for being a hero and trying.

I have done a very unscientific and informal study and found that 7 out of 10 with negative outcomes say they would never do CPR again.

Is anyone aware of a study or do any of you have policies that address this?

I will be most interested in your comments.

[Dustdevil]

Before you get too carried away with this train of thought, I would spend a few minutes researching the current literature on the validity of CISD itself. It's crap. It's worse than useless. It is potentially harmful. And about the only people supporting it anymore are those who have a vested financial interest in it.

I'm sure the supporters of CISD would love your premise, because professionals are dumping CISD right and left. Those whose whole professional identity is attached to CISD now need a new audience to sell their snake oil to. Lay persons would be a prime target for that. There's a sucker born every minute.

And yes, I DO teach my CPR students about ALL of those potential occurrences. Any instructor who does not sucks!

[dzmohr]

I use the term "CISD" generically--- I am not looking to debate the content of our classes nor the value or content of CISD---I am trying to find out if other perceive a concern for the psycho-social issues involved in a lay bystander doing CPR and losing a loved one and not getting any followup counseling, feedback or a chance to deal with his thoughts and if so what others are doing about it, if anything.

[Dustdevil]

Good deal. You do have an excellent point. Most lay persons who take CPR are indeed sent out with very inadequate preparation, both for the performance itself, and for the aftermath. I wholeheartedly agree with you that this is something that we as educators need to seriously consider. My only contention is that CISD as we know it (i.e. routine debriefing of all involved in so-called "critical incidents," even before they complain of problems), is very definitely not a vaid option.

Many professional rescuers recognised this problem a long time ago and, like myself, have made very real efforts to give their students realistic expectations. The last thing I want is for one of my students to hear a crack or get vomited on and freez up wondering WTF just happened. I know that there is only one thing that will suprise any student who learned CPR from me. That is if the victim actually survives.

[Asysin2leads]

I always though giving a healthy does of reality into a CPR class would be a good thing, but who am I to say. Unfortunately, the public's misconception of CPR is extremely skewed, and mass media only makes it worse, take this article from the New York Post for instance:

"I'm starting to believe that I'm always in the right place at the right time," said [Margaret Tarulli], who was at the Sheepshead Bay station with a Post photographer, taking pictures for a story about her nomination for a Community Liberty Medal stemming from her heroics last winter.

(Basically, a woman fell onto some train tracks, what her condition was, what exactly happened is unknown because the newspaper didn't say, but they did say that...)

Two brave men jumped down and lifted the student onto the platform, where Tarulli performed CPR and revived her.

"He kept thanking me, a hundred times over," said Tarulli, who has had no formal medical training except for CPR.

So, apparently, she must have mighty fine CPR skills going on there, apparently performing a succesful traumatic cardiac arrest save with only lay person training. Wow, huh?

[Michael]

http://keepmebusy.com/?p=3&id=674

[BEorP]

I know that the points I am about to make have already been pretty much covered, but I am really disappointed to see someone who has their occupation as "Educator" who either doesn't teach CPR classes well (if you are an instructor) or has never seen a good CPR class taught in your time as an EMT-P.

My "we" below refers to where I recently completed my FA/CPR instructor course...

We tell people "come take a CPR class and learn to save a life." We do NOT tell them 85-92% will not make it, but CPR gives them the only chance they have.

We tell them <5% survive. We tell them that CPR only buys time until the pt can be defibed. We tell them that the person will not sit up and thank you and go on with their day even if you do everything right.

We tell people practice and get the compressions right, if you do it wrong you will break bones... we do NOT tell them the sternum was not designed to be pushed down that far and you will may well break cartilage or bones even if you do it right...

We tell them that you can expect to break bones and when you do, just be sure that you are still compressing in the centre of the chest (rather than too much to one side so you are compressing the ribs) and then continue on.

So when their patient, usually a family member, does not make it, my experience is many feel they "killed" their loved one. They forget they were told the person has to be sick or hurt enough to die to qualify for CPR to begin with.

This is probably the part that concerns me most. How can you teach a CPR course without students leaving with a firm understanding that CPR is done on dead people? I know you did not say that they were never taught it, but rather that they forgot what they were taught. Dead people getting CPR is such a key point in teaching CPR that if they forget that within a year then they probably did not have a good instructor or maybe they did but that instructor should not have certified them.

Just as Dust said, any instructor who doesn't cover these points adequately sucks and should not be teaching CPR. And if the instructor is covering these points and students leave the class and have forgotten them all by the time they get out of their chairs then they should never receive a certification. On a side note, any CPR instructor who hasn't failed someone probably sucks too.

But back to the topic... I haven't read enough about CISD to know about how good or bad it is, but I think that if lay rescuers understand that the casualty is dead, the casualty can't get deader, CPR alone will not save the casualty's life, and if everything goes perfectly the casualty will still probably not come back to life then I do not see a need for it.

[geezlaweezy]

I agree with both Dustdevil and BEorP when they say if you don't teach your students that there is a low survival rate, damage to the ribs, etc you are probably not a good realistic instructor, and even worse letting people walk away with a hero complex. I emphasize these points in every class that I teach, BUT more importantly, I emphasize that doing something is always better than doing nothing at all.

One of my former students actually had to perform CPR on a gentleman a few months ago, and needless to say, it was shocking and traumatizing for her to have had to actually apply what she had learned to someone who was, well.. dead. I spoke to her afterwards, assured her that she took appriopriate action and did all she could. Contrary to the informal 'study' dzmohr mentioned, instead of refusing to ever do CPR again, she was even more determined to take another update course so she could get her skills more polished (she messed up a bit due to shock) so she would doubt herself less should it happen again.

I think it's really important for bystanders who perform CPR to seek proper counselling necessary to move on after incidents such as this. From what she told me, the random shrink she saw was completely useless. Why? Because the person had no stories or anecdotes to relate to the situation. When she spoke to me or other people who have gone through similar situations before it was much easier for her to move past it because the advice and words came from people who knew where she was coming from.

[buckeyedoc]

Before you get too carried away with this train of thought, I would spend a few minutes researching the current literature on the validity of CISD itself. It's crap. It's worse than useless. It is potentially harmful. And about the only people supporting it anymore are those who have a vested financial interest in it.

I'm sure the supporters of CISD would love your premise, because professionals are dumping CISD right and left. Those whose whole professional identity is attached to CISD now need a new audience to sell their snake oil to. Lay persons would be a prime target for that. There's a sucker born every minute.

And yes, I DO teach my CPR students about ALL of those potential occurrences. Any instructor who does not sucks!

I could not agree more. I've used to work as a CISD counselor and chaplain. CISD is a bit (and I mean a little) more effective with emergency workers because we accept death and dying more than the lay public.

Oh, by the way, everytime we teach a CPR class, we give them the figures about saves (or the lack thereof) with CPR. We tell them that the outcome is grim and not to expect miracles.

[Ridryder 911]

I agree, when instructing lay people I give out realistic facts. The chances are they are NOT going to make it, and if there was another procedure available, we would abandon CPR due to its poor outcome. Personally, I have never seen anyone have negative outcome from performing CPR, especially family members. In my 30 years experience, I have always seen that they felt they at least "did something", now I have seen those that felt guilty, in not knowing CPR and did nothing later.

I agree CISD is a mythical excuse for federal funding, and unfortunately no one is addressing the problem of what and how to handle these emergency and crisis ... there is still a problem, and CISD does not address it and we found that out.. but, no one wants to change things and fins an appropriate treatment.

R/r 911