Cardiac arrest

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Scene 1 · Opening

21.30, the council sports hall. Volleyball finished ten minutes ago. Three of you are putting the nets away, under floodlights nobody has thought to switch off.

The man at the far end stops in the middle of the court, one hand on his chest. Then he goes down in one piece, without breaking his fall.

Scene 2 · What you find

He is on his back, on the wooden floor. He says nothing.

His throat makes a noise every five or six seconds, like a gasp. His chest does not rise.

What do you do first?

• Right move : I kneel down, I speak to him loudly, I shake his shoulder, and I watch his chest for ten seconds.
  He is not responding and he is not breathing normally : That is all you had to establish, and the guidance even puts a limit on the time: assess breathing for ten seconds at most. Two questions, two answers: does he respond, does his chest rise. From there, everything is decided.
• Mistake : Those gasps mean he is still breathing: I roll him onto his side and wait for him to come round.
  Those gasps are not breathing : Slow, noisy, laboured, useless movements: the guidance calls this agonal breathing, and it says to treat it as a cardiac arrest. It is the most deceptive sign in this whole situation, and the one that costs the most time.
• Not the best choice : I look up “chest compressions” on my phone, there must be a video.
  There are. They run four minutes : You have three. Put it away, except to call: that is the only useful thing your phone can do tonight.

Scene 3 · The alert

The other player has stayed on his feet three metres away, phone already in his hand, watching you.

At the far end of the hall, on the wall, there is a green cabinet.

You have a bystander and ten seconds. What do you do with them?

• Right move : I shout two things at him: “Call 15” and “Go and get the green box off the wall”. And I stay here.
  Two clear orders, to one named person : The Croix-Rouge sets it out in that order: ask someone to call the emergency services and to bring a defibrillator immediately. You do not move from where you are. A bystander with a sharp instruction goes at once; a bystander who has been told nothing just watches.
• Mistake : I call myself, then I cross the hall to fetch the machine: I would rather handle it.
  Meanwhile, nobody is doing compressions : You are the only person kneeling beside him: that is your place, and you do not leave it. The guidance hands both errands to the bystander precisely so that compressions start at once.
• Mistake : I start compressions right away and say nothing: the call can wait.
  You are doing compressions for a crew nobody has called : Compressions buy time, they do not restart a heart on their own. What restarts a heart arrives in a van, and in that box on the wall. One sentence would have set both moving.

Scene 4 · Setting up

The other one has gone, running, phone against his ear. You are alone with him.

Two metres away there is a stack of gym mats.

How do you set him up?

• Right move : I leave him flat on his back on the wooden floor, I kneel right up close, and I bare his chest.
  The wooden floor is exactly what you want : Flat, on his back, on a firm surface: the floor does the job. Kneeling as close as you can, chest bared, and you are ready. There is nothing else to prepare.
• Mistake : I drag him onto the gym mats, he will be better off than on bare floor.
  The mat sinks instead of his chest : A soft surface swallows the compression: you press hard and nothing reaches the heart. The guidance asks for a firm surface, the floor or a table. Comfort is not the question this minute.
• Mistake : I put him in the recovery position while I wait for help.
  The recovery position is for someone who is breathing : It protects the airway of an unconscious person who is breathing normally. He is not breathing: what he needs from you is compressions, and on his back.

Scene 5 · Where the hands go

You are kneeling against him, his chest is clear. Your hands are above it, hesitating by half a centimetre.

Where do you put your hands?

• Right move : The heel of one hand in the middle of the chest, the other hand on top, fingers interlocked, arms straight and elbows locked.
  The heel of one hand, in the middle of the chest : The other hand on top, fingers interlocked and lifted so they do not press on the ribs, arms straight and elbows locked. That build is what carries your weight into the breastbone instead of losing it in your arms.
• Mistake : On the pit of the stomach, a bit lower down: that is where it gives best.
  Too low: you are pressing on the belly : For an adult the landmark is the centre of the chest, on the midline, on the lower half of the breastbone. Any lower and you leave the breastbone, and the pressure no longer reaches the heart.
• Mistake : On the left, over the ribs, where you can hear the heart beating.
  Never on the ribs : The guidance says it twice: press straight down, and do not press on the ribs. The heart is in the middle, behind the breastbone, and it is the breastbone you push down.

Scene 6 · Holding the rhythm

Your hands are in place. There is nothing left to decide: there is a rhythm to hold, and it is faster than you think.

Thirty seconds of compressions. Go.

Press on every beat: with your finger, with the mouse, or with the space bar. The needle has to stay in the pale zone, between 100 and 120 a minute. The sound guide is there if you want it, and it is not compulsory.

Rhythm test: hold between 100 and 120 compressions per minute for 30 seconds, in sets of 30.

Challenge held : You held it, and now you know what it costs : Between 100 and 120 a minute, as long pressing as releasing, and the chest recovering its shape between each press. Thirty seconds was enough to show you why people take turns every two minutes.

Challenge missed : The rhythm did not hold: someone takes over : Too slow and the blood stops moving. Too fast and the chest has no time to come back up, so the heart does not refill. That is why the window is narrow: 100 to 120 a minute, with a full release. Here you hand over: the guidance asks for a change of rescuer every two minutes, interrupting the compressions as little as possible. The compressions carry on without you.

Scene 7 · Taking over

Two minutes. Your shoulder is burning, your back gave out before your arm did.

The other player comes back at a run, the green box in his hands. He has 15 on the line.

What do you do?

• Right move : I do not stop, and I tell him to switch the machine on right now.
  The machine goes on while you press : Compressions stop only when the machine says to stop touching the casualty. Everything else, including setting it up, happens around your hands without stopping them.
• Mistake : I lift my hands off for a second to see whether he is breathing now.
  Every pause puts the pressure back to nothing : You keep going until help arrives or until breathing clearly comes back to normal. Checking every thirty seconds does not bring breathing back: it interrupts the only thing that is moving any blood.
• Mistake : We swap over, but I tell him to put the box to one side: we will deal with it after.
  A machine that is switched off is no use to anyone : Taking turns is right. But the machine is switched on as soon as it is there, not when there is time: you turn it on and you follow its instructions.

Scene 8 · The crew

Blue light through the far door, two sirens stopping one after the other. Four people cross the hall with a bag and a board.

Somebody puts a hand on your shoulder and says “we have got him”. Your hands come away, and your arms shake on their own.

You repaired nothing tonight. You moved blood around for the minutes when nobody else could.