The sales pitch came fast and loud.
“Sixty-second CPR! Sixty-second CPR!”
Robin Green shouted from behind a small table at a health fair in the atrium of the U.S. Department of Housing and Urban Development headquarters.
The veteran Washington, D.C., paramedic soon had government contractors, office managers and budget analysts hunched over dummies, their interlocked hands compressing plastic chests.
Elvie Thompson, a HUD employee who learned CPR years ago when she was in the Army, quickly picked up the rhythm of the new technique, called “Hands-Only CPR,” humming along to the song’s 100-plus beats per minute – the ideal pace for chest compressions.
Thompson is now among the more than 6,200 District residents trained in this updated version of CPR, which eliminates mouth-to-mouth resuscitation and emphasizes chest compressions to quickly pump blood to an oxygen-deprived brain.
“I might need to use it, you never know,” said Thompson, 58, who works in the housing agency’s information technology division and worries about being along with her grandchildren. Like others, she felt more comfortable with the hands-only version of CPR.
“I like that I don’t have to put my mouth on a stranger’s,” she said.
Hands-Only CPR is the new, streamlined version of the lifesaving technique that was developed in the 1960s. While the old version requires an oft-forgotten series of steps that need to be timed, the new way is simpler. It doesn’t require checking for a pulse, using a finger to clear an airway, making contact with the patient’s mouth or even watching to see if his chest rises and falls.
The instructions are simple: “Pump the chest until we get there,” Green told Thompson at the HUD health fair, one of 157 training events the fire department has attended in recent months. Press down two inches, she implores, and don’t obsesses over the ribs. “If you live, what’s a broken bone?” Green said.
Next to the dummy was a brochure proclaiming “two steps to staying alive.”
Efforts to train ordinary citizens in Hands-Only CPR have taken off across the country.
Texas Tech University and several partners this year hosted “Texas Two Step: How to Save a Life” and trained about 4,000 people across the state in CPR. In Philadelphia, a coalition of government, health-care and other groups is bringing training to community centers, public libraries, faith organizations and other venues. And Maryland’s emergency workers have already taught tens of thousands of residents.
Howard County, one of the leaders in Maryland’s training, has taught 45,000 people – about 15 percent of its population – and boasts a survival rate of 50 percent for people who suffer heart attacks and are given CPR by bystanders. Survival chances drop to about 10 percent when help is not immediately provided.
“If someone isn’t doing something to pump blood into the brain until emergency crews get there, the probability of having a good outcome is very low,” said Matthew Levy, the medical director for the Howard County Department of Fire and Rescue Services.
With the new method, the training can be quick and convenient. In Montgomery County, Maryland, firefighters are teaching hands-only in “pop-up” fashion at various events, such as impromptu appearances at malls and, more recently, at the Bethesda, Maryland, farmer’s market. There, they taught the technique to 400 people.
Prince George’s County, Maryland, plans to launch training next month. Officials there also say they plan to join Howard County in using a smartphone app called “Pulse Point” that alerts users who are trained in CPR whenever 911 is called for a heart attack within a quarter-mile radius. The app provides both the location of the person in distress and the nearest automatic external defibrillator, a device that is becoming more common in public areas.
Jennifer Abele, the medical director and chair of the Department of Emergency Medicine at Sibley Memorial Hospital in D.C., said the hands-only approach simplifies the process for people who might freeze when faced with a real emergency.
“This is a great advance in the evolution of how we treat patients who go into sudden cardiac arrest,” Abele said. “Panic is one of the major obstacles to performing CPR. If you have something very simple for them to do – call 911, start compressions – they might overcome that panic or hesitation.”
The Hands-Only approach, the doctor said, “is easy to teach, easy to remember and the majority of the population can do it.”
The impetus behind the expanded CPR training began in the 1970s in Seattle, where D.C.’s fire chief, Gregory Dean, spent 44 years before coming to the District in May 2015.
The training of thousands of residents there and in surrounding King County is attributed to the city’s Medic One program, a pioneer in the concept of advanced life support. Seattle and its environs still rank among the top cities for surviving heart attacks.
The District’s chief, who said firefighters in the city respond to about 600 heart attacks each year, wants to see the odds of survival similarly improve here. “We are trying to enhance the number of people in the District who can take care of each other,” Dean said.
There already are some promising signs, but there is work to do, the chief said. In the first half of 2013, the department responded to 251 heart attacks, 103 of which were witnessed by bystanders. Officials said bystanders performed CPR in 32 of those cases, about 13 percent of the overall total. Dean said that during the same period this year, bystanders gave CPR in 52 of the total 323 heart attack cases, about 16 percent.
In Howard County, fire officials said that about 50 percent of the 125 to 150 people who suffer heart attacks witnessed by others each year received CPR from a bystander. About half of those people survived. “Not everybody in cardiac arrest will survive,” said Levy, the fire department’s medical director. “But we want to give people the best chance.”
D.C. fire officials said the same day the District’s 911 operators were taught the hands-only approach in January, calltaker Sheldon Thorne coached a woman through eight minutes of chest compressions to help an 82-year-old man who collapsed at a senior center.
Thorne spent nearly 15 minutes on the phone with her, calmly giving instructions even as she cried. “We’re sending help to you as we’re on the phone,” he told her. He instructed the woman to get the man flat on his back and “place the heal of your hand on the breastbone in the center of his chest. Pump the chest hard and fast. We’re going to do this until help takes over.”
When the woman faltered, Thorne said: “I want you to count aloud so I can do this with you. … One, two, three four. … Keep going. You’re doing great. Don’t stop. Keep it up. This is what he needs right now. You’re helping him out.” The man was taken to the hospital, but he did not survive.
On June 18, Dylan Mehri put the advanced CPR training he learned as an Eagle Scout and in scuba diving to work at the Folger Theatre during a play called “District Merchants.” The 20-year-old resident of Northwest Washington, who recently completed his sophomore year at Oberlin College, was near the back row with his mother and sister when a patron collapsed near the stage.
As people shouted for help, Mehri rushed to the stage while a nurse technician went to grab a defibrillator. “I realized, OK, I need to see if I can do something,” he said. The play stopped as Mehri started CPR.
Mehri has been trained in both advance and Hands-Only CPR, but said he could see the man was breathing and the audible instructions on the defibrillator only mentioned chest compressions, which he did for about eight minutes until firefighters arrived. The man survived and has asked through his doctors to meet Mehri.
“CPR is not the most difficult thing to learn,” the Spanish and politics major said. “But to be honest, I was a little bit anxious about using it. I wasn’t sure if I was doing the right thing the whole time. I was in a weird zone, completely focused on keeping this person alive. I just knew that I had to do all that was in my power to keep him alive, and that’s what we did.”
(c) 2016, The Washington Post · Peter Hermann