It turned out that people were watching a civilian banging away at the chest of a man who was unconscious and supine on the floor. I was immediately alarmed. Chest banging was eliminated from CPR protocol quite a few years ago. This civilian was out of date, or he was completely uninformed and imitating something he saw on television. So, I interceded.
“You’ve got to give the man an airway,” I said. “Are you a doctor?” a police officer asked me from behind. He must have just entered the scene.
“No,” I responded, “but I have First Responder training, I’m a volunteer for the fire department in my hometown.” Those must have been magic words because the officer immediately made way for me to get to the patient.
No one had seen what happened. In the few seconds I’d been watching, though, it appeared that the man was not breathing. So I used a jaw-thrust maneuver to open the airway. The effect was immediate. I could see hie respiration resume. I checked the patient’s pulse and found it to be strong and regular. I assigned the civilian who had attempted CPR the job of stabilizing the patient’s head to protect the cervical spine. I did a quick body sweep and found ne apparent evidence of injury. We continued to monitor the patient until the ambulance came.
After the police officer had radioed our exact location to the dispatcher, he did his best to keep the crowd away from us and in control. The ambulance showed up in what seemed like no time at all, and the crew transported the patient to a local hospital.
The incident wasn’t really very dramatic, but it did show me the importance of the ABCs of emergency care. All I did was provide the basics. The rest fell into place.
BASIC LIFE SUPPORT ASSESSMENT
The Basic life support sequence for adults established by the American Heart Association is:
- Assess the patient
- Activate the EMS system
- Begin resuscitation
As the American Heart Association explains: “The assessment phases of Basic Life Support are crucial. No victim should undergo the more intrusive procedures of cardiopulmonary resuscitation until the need has been established by appropriate assessment.”
Assessment is more than the initial ABCs. It is a subtle, ongoing process of watching the patient throughout the entire time you care for him/her. It requires constant observation, not just a one-time check of vital signs. The initial steps in patient assessment for the basic life support are:
- Determine unresponsiveness. Gently shake the patient’s shoulder. Loudly ask several times: “Are you OK?”
- Determine breathlessness. Use the “Look, listen, and feel” assessment method.
- Determine pulselessness. Palpate the carotid artery.
There are two maneuvers commonly used to open the airway. These are known as the head-tilt/chin-lift maneuver and the jaw-thrust maneuver. Both techniques move the tongue from the back of the throat and allow air to pass into the lungs.
If you suspect cervical-spine injury, do the jaw-thrust maneuver. Do not attempt the head-tilt/chin-lift maneuver.
- Put one hand on the patient’s forehead and apply firm backward pressure to tilt the head back. Continue to press as you lift the chin.
- Place the fingers of your other hand under the bony part of the patient’s lower jaw near the chin. Lift the chin to bring it forward, supporting the jaw and tilting the head back. Do not press deeply enough to compress the soft tissues underneath the chin. They might obstruct the airway. Do not use your thumb to lift the chin.
- Lift the chin so that the teeth are nearly brought together. Avoid closing the mouth completely unless you need to perform mouth-to-nose ventilation.
- If the patient has loose dentures, hold them in position. If rescue breathing is needed, the mouth-to-mouth seal is easier when dentures are in place. However, if the dentures are difficult to manage, remove them.
If the head-tilt/chin-lift maneuver is unsuccessful, or if you suspect a cervical-spine injury, bring the jaw forward with the jaw-thrust maneuver.
- Kneel aside the patient’s head. Place your elbows on the surface below the patient. Put your hands at each side of the patient’s head.
- Grasp the jawbone on both sides where it angles up toward the patient’s ears. Lift with both hands in place. Move the jaw forward.
- Retract the lower lip with your thumb if the lips close.
As you can see, this isn’t so complicated that any Health Guardian couldn’t do it, but it does require some training and practice. These maneuvers are typically followed up with additional procedures such as resuscitation, which also requires additional training and practice.