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Should Rescuers Be Held Liable for Poor CPR Performance?

Detroit EMTs Fired After Feedback Data Showed Inadequate CPR

In late March, the Detroit Free Press reported that two of the city’s EMTs had been fired after an AED feedback tool indicated they had failed to deliver high-quality CPR. The victim — a 6-foot-3, 280-pound man with a history of pulmonary embolisms — was pronounced dead soon after arriving at the emergency room.  

Here at Cardio Partners, we’re pretty passionate about AEDs and CPR. In fact, we consider it our duty to inform our readers about topics ranging from sudden cardiac arrest to AED legislation to the importance of CPR

The tragic event in Detroit brings up a host of issues and plenty of questions for the industry. Richard Lazar, President of Readiness Systems (which publishes AED Law Center) noted the following in an editorial published on LinkedIn

“If better CPR is the goal of CPR feedback tools, then great, no problem. But in this case, it appears from news accounts that CPR performance data was used as one of the reasons to fire the two EMTs. If the failure to deliver high-quality CPR (however defined) is legally actionable (either administratively as in this case or civilly in a negligence lawsuit), then volunteer bystanders and professional healthcare workers will be placed in legal jeopardy if they use CPR feedback devices that collect and store performance data. This is quite scary and raises a host of questions.

“For ‘bad’ CPR to give rise to a lawsuit or administrative proceeding, ‘bad’ must be adequately defined and enforceable as a legally binding “standard of care.” However, CPR competence is not governed by any existing or binding standards. As far as I am aware, no statute has been passed and no agency regulation adopted in any state requiring strict adherence to CPR performance metrics. Now that the genie is out of the bottle, however, plaintiff’s lawyers may try to use CPR feedback data to prove volunteer bystanders or healthcare professionals are negligent in CPR/AED cases – a messy and nebulous process that leaves standard of care decisions to judges and juries.

“Claiming CPR feedback devices or CPR competence training represents a standard of care is consequential since this very loaded term has more legal than medical meaning. And who, for example, determines what the enforceable standard for CPR quality is? The benchmark – however defined – will undoubtedly change over time as it has consistently since the 1700s. So what standard will apply when? CPR feedback technology will also have to prove itself good enough – and defensible enough – to stand up to the rigors of litigation and advocacy. Finally, makers of CPR feedback technology and CPR competence trainers may find themselves in the litigation/liability target zone alongside those doing the CPR. The potential ramifications hinted at by this case and the notion of CPR quality as a standard of care seem endless.”

We also think it’s worth pointing to a study published by Baylor University Medical Center in 2017. Researchers found that performing successful compressions on obese or morbidly obese manikins (and, based on the aforementioned victim’s BMI of 35, he would have been considered obese) was significantly more difficult than doing so on a manikin with a healthy BMI. In fact, 23 out of 30 compressions on the normal manikin were successful while 0 out of 30 were successful on the obese and morbidly obese manikins.

“High-quality, effective compressions are vital to successful CPR. Results of this study indicate that compression quality is lower when performed on obese and morbidly obese adult simulation manikins…Edelson and associates found that morbid obesity was associated with poor outcomes in comparison to subjects who were not morbidly obese. They also found that morbidly obese patients received shallower chest compressions.”

AEDs and CPR Save Lives

In 2015, the CDC reported that 375,000 people in the US experienced an out-of-hospital cardiac arrest. The American Heart Association estimates that at least 20,000 lives could be saved annually by prompt use of AEDs. The AHA also notes that “communities with AED programs, which include comprehensive CPR and AED training, have achieved survival rates of 40% or higher for cardiac arrest victims.” 

AEDs with automatic feedback are designed to assist rescuers — both professional and untrained bystanders — improve survival outcomes. 

Clearly, more research is needed; however, the Baylor researchers concluded that “CPR training for individuals working in a hospital should be representative of potential situations that they may encounter, and it is likely that health care workers will encounter obese or morbidly obese patients. Implications for healthcare workers include maintaining competency of basic life support skills and being prepared to deliver CPR on obese patients.”

Are EMTs Protected by Good Samaritan Laws?

Given our litigious society, bystanders may feel some reluctance to help out in emergency situations. In fact, some potential rescuers may even choose not to offer assistance to those in need for fear of liability. While proceeding with caution and care is always advised, fortunately, all 50 states and the District of Columbia now include AED usage as part of their Good Samaritan Laws. 

These laws vary by state but they have been enacted to protect organizations and laypersons — and in some cases, first responders — from civil litigation.

Basically, these statutes protect those who help others in a time of crisis or emergency. Often these laws only apply if the rescuer is acting without any expectation of compensation or reward. In other words, if you’re a medical professional getting paid to rescue, then these laws may not apply to you. 

In general, states also extend Good Samaritan protections not only to good faith rescuers but also to AED trainers; to the person responsible for the site where the AED is located (when that person has provided for an AED training program); and to any physician who prescribes an AED. 

Protect Yourself From Civil Liability

First and foremost, always act in good faith. Regardless of the laws in your state, it’s wise to protect yourself from possible liability by acting on behalf of the victim. Here are a few tips to protect yourself from liability:

  • Take a nationally-recognized First Aid course
  • Become AED certified
  • Learn CPR
  • Make sure your certifications are up-to-date
  • Use common sense
  • If possible, ask the victim if you can assist them
  • Don’t try to be a hero, but do try to help
  • Don’t do anything you’re not trained to do
  • Seek professional help as soon as possible
  • Never accept cash, gifts, or other awards for your assistance

While Good Samaritan Laws provide some level of protection if a lawsuit is filed, they do not prohibit or prevent a lawsuit from being filed. In fact, some states, such as Rhode Island, only offer Good Samaritan immunity to individuals who hold up-to-date AED certifications. Virginia, by way of contrast, offers extensive protection and goes so far as to urge the public to receive CPR and AED training.

Ready to hone your CPR and AED skills? We have the info you need about CPR or AEDs and CPR and AED Training. To purchase an AED, visit AED.com or call Cardio Partners at 866-349-4362. You can also email us at customerservice@cardiopartners.com.

DISCLAIMER: The information included in this post and on our website is not intended as legal advice. As legislation changes often, this post may inadvertently contain inaccurate or incomplete information. We urge you to contact your state representative should you require more information about current AED, CPR, and Good Samaritan laws in your state.

DISCLAIMER: Information and resources found on the cardiopartners.com and aed.com websites/blogs is intended to educate, inform, and motivate readers to make their health and wellness decisions after consulting with their healthcare provider. The authors are not healthcare providers. NO information on this site should be used to diagnose, treat, prevent, or cure any disease or condition.

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What You Need to Know About Agonal Breathing

What are Agonal Respirations or “Last Gasps”?

Gasping, or agonal respiration, is an indicator of cardiac arrest. When these irregular breathing patterns occur, it’s a sign that the victim’s brain is still alive and that you must begin uninterrupted chest compressions or CPR immediately.

If you do so, the person as a much higher chance of surviving. In fact, bystander-initiated CPR has been proven to be a sudden cardiac arrest (SCA) victim’s best chance of survival. Approximately About 90 percent of people who experience an out-of-hospital cardiac arrest (OHCA) die; however, nearly 45 percent of OHCA victims survived when bystander CPR was administered (American Heart Association).

Often, agonal breathing is seen during cardiac arrest, and in most cases rescuers report observing these so-called “dying breaths” fewer than 10 to 12 times per minute (as opposed to 12-20 inhalations in typical respiration).

Agonal respiration does not provide adequate oxygen to maintain body functions and should not be considered breathing.

Gasping or agonal respirations commonly occur following or during sudden cardiac arrest or stroke. Based on paramedic reports, researchers found that gasping occurred in 56% of patients who suffered an out-of-hospital cardiac arrest. They also found that gasping or agonal breathing is likely more common soon after cardiac arrest and is most common in individuals who receive bystander CPR (Science Direct).

Symptoms of Agonal Breaths

Agonal breathing can last for minutes or up to several hours. Someone who is suffering from agonal breathing may appear to be gasping for air, snorting, gurgling, or moaning, or they may make grunting sounds or display myoclonus — the sudden, uncontrollable jerking of muscle groups.

“The gasping associated with agonal breathing is not true breathing, but rather a brainstem reflex. Agonal breathing often occurs because the heart is no longer circulating oxygen-rich blood. In other cases, it may be due to the lungs not bringing in enough oxygen” (Medical News Today).

Causes of Agonal Breathing

In most cases, patients that suddenly stop breathing without warning and exhibit agonal breaths are likely suffering from cardiac arrest. However, respiratory arrest brought on by severe asthma, choking, stroke, or an opioid or narcotic overdose may also cause agonal breathing.

How to Treat Agonal Breathing

If someone is exhibiting symptoms of agonal breathing, resuscitation efforts should begin immediately and 911 should be called.

“In cases where the patient is not breathing or has agonal respirations but still has a pulse, he or she is considered to be in respiratory arrest rather than cardiac arrest. The 2015 CPR guidelines call for lay rescuers to treat both conditions the same: by starting CPR” (Very Well Health).

The Value of Gasping During Out-of-Hospital Out-of-Hospital Cardiac Arrest

In 2017 a study published in the Journal of the American College of Cardiology found that gasping during CPR was associated with an increased survival rate. The study noted that “These findings underscore the importance of not terminating resuscitation prematurely in gasping patients and the need to routinely recognize, monitor, and record data on gasping in all future cardiac arrest trials and registries.”

What You Can Do to Help Someone Suffering from Agonal Breathing

Learn CPR. Without CPR, agonal breathing brought on by cardiac arrest is fatal. If you know someone who is at an increased risk for a stroke or cardiac arrest, you’ll need to be able to quickly identify the symptoms and then respond with high-quality CPR.

Ready to learn CPR? As an Authorized Training Center, Cardio Partners provides high quality and consistent CPR and AED training courses across the United States. Our courses are offered through the American Red Cross and the American Heart Association. For more information about blended or traditional CPR and First Aid training, call our team at 866-349-4362 or email us at customerservice@cardiopartners.com.

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The 2018 Cardio Partners Gift Guide & Holiday Sale

Looking for the perfect gift for the life-saver in your family? You’ve come to the right place.

 

Happy Holidays from all of us here at Cardio Partners and AED.com! To celebrate, we’ve come up with a few unique gift ideas for the heart- and safety-conscious souls in your family.

Use the discount code HOLIDAY2018 at checkout to get 10% off your entire AED.com or Cardio Partners purchase.

For the On-the-Go Professional: Curaplex Pocket Mask with O2 Inlet

The Curaplex Pocket Mask with O2 Inlet is the perfect stocking stuffer for teachers, office managers, consultants, fitness instructors, and facilities managers, or just about anyone who is CPR-certified! This affordable, compact mask is suitable for use on adults, children, and infants and features a disposable one-way valve with a 3M Filtrete hydrophobic filter to help prevent the transmission of liquids and other secretions. The oxygen inlet facilitates the delivery of oxygen to breathing and non-breathing individuals. The pre-inflated cuff makes for quick and easy application and the compact carrying case keeps your mask in perfect working condition.

For the Always Prepared: Curaplex Stop the Bleed Kits

Earlier this year, our good friends at the Brentwood Fire and Rescue Department led a hands-on Stop the Bleed training at our offices just outside of Nashville. Since then, we’ve been huge proponents of these supplemental training programs, and we are pleased to offer Curaplex Stop the Bleed kits start at just $59.99. These compact kits are designed to provide a rescuer (whether a  civilian bystander or a first responder) with immediate access to life-saving products that can control bleeding and traumatic hemorrhaging.


These vacuum-packed and tamper-proof kits include:

  • 2 rolls of primed, compressed gauze dressing
  • 1 C-A-T® tourniquet
  • 1 emergency bandage
  • 1 permanent marker
  • 2 pairs of gloves, latex-free, large
  • Pair of trauma shears, 7.5”
  • Detailed and easy-to-follow directions

Advanced kits also include 1 Pack of HALO seals and QuikClot combat gauze.

For the Life-Long Learner: CPR and First Aid Training

If you’ve always wondered what you’d learn in a CPR class, CPR and First Aid training may be the perfect gift to give to yourself! It’s also the ideal gift for all the babysitters, new parents, high school students, and teachers on your list. Need some more convincing? Read our post, 10 Reasons Why You Should Learn CPR — and then sign up for a class near you!

For the Newly First Aid Certified: A Brand-New First Aid Kit

We carry a wide range of first aid kits. Our entry-level Curaplex First Aid Kit comes in a compact metal case. The case is portable or can be mounted for easy access. The kit includes one of each of the following:

  • Bandage, latex-free, 2”
  • Triangular bandage, with two pins, 36” x 51”
  • Box of adhesive bandages
  • Box of knuckle bandages
  • Gauze bandage, large, 24” x 72”
  • Roll of tape, waterproof, ½”
  • Roll of stretch gauze, 2” x 4 yd
  • Bottle of burn spray, 3 oz
  • Pair of scissors, 4-1/2”
  • Bottle of eye wash, 4 oz
  • Box of antiseptic wipes
  • Box of ammonia inhalants
  • Cold pack
  • Metal case

For the New Recruit: The Curaplex Officer Down Kit

The Curaplex Officer Down Individual First Aid Kits (IFAK) are designed for law enforcement officers, first responders, or members of the military. These highly portable individual trauma kits contain the essential supplies needed to treat life-threatening traumatic injuries — such as gunshot wounds or stab wounds — that occur in the field or in a combat environment.

For the Cardiac Arrest Survivor: An AED for the Home

If you’re looking a unique gift for your loved one, an automated external defibrillator is just the ticket. There are a lot of things to consider when purchasing an AED, so we recommend reading our post, Which AED is Right for You, or downloading our AED Starter’s Guide before making a decision. As of publication, our recertified Cardiac Science Powerheart G3 Plus was listed at $599, and we invite you to call us for pricing on our recertified HeartSine Samaritan PAD 300P (supplies are limited).

For our full line up of AEDs, CPR and AED Training, AED Accessories & Storage, and AED Services, call Cardio Partners at 866-349-4362. You can also email us at customerservice@cardiopartners.com.

Don’t forget to enter the discount code HOLIDAY2018 and save 10% off your entire order! Offer expires on December 31, 2018.

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