WEBVTT 1 00:00:16.720 --> 00:00:21.220 Please adjust your sound to the level of this voice, which will be the same as that of the 2 00:00:21.370 --> 00:00:21.870 narrator. 3 00:00:38.010 --> 00:00:39.430 This patient's heart has stopped. 4 00:00:40.090 --> 00:00:44.430 Unless the proper measures are taken within the next four minutes, he will be beyond hope 5 00:00:44.430 --> 00:00:45.450 of resuscitation. 6 00:00:46.290 --> 00:00:50.250 In your hospital, what happens next? 7 00:01:11.170 --> 00:01:15.650 Once cardiopulmonary arrest has taken place, what should happen next? 8 00:01:16.510 --> 00:01:23.090 Someone trained in resuscitation procedures should arrive almost immediately and start to revive the patient. 9 00:01:30.370 --> 00:01:35.770 The recently developed technique of external or closed-chest cardiac compression, used 10 00:01:35.770 --> 00:01:40.490 in conjunction with mouth-to-mouth breathing, has proved to be a simple and effective way 11 00:01:40.490 --> 00:01:45.090 of keeping the patient alive until more elaborate measures can be taken if necessary. 12 00:01:48.210 --> 00:01:52.050 In a small number of hospitals, training in these emergency techniques has been underway 13 00:01:52.050 --> 00:01:53.530 for some time. 14 00:01:54.510 --> 00:01:59.270 Yet, it is in the hospital that cardiopulmonary arrest still claims many of its victims. 15 00:02:01.210 --> 00:02:06.910 One reason for this is that the need for resuscitative measures may not be recognized soon enough. 16 00:02:08.570 --> 00:02:13.730 A second is the lack of hospital-wide training in these emergency and definitive measures. 17 00:02:15.430 --> 00:02:19.570 Still another may be that trained people and equipment are not able to reach the patient 18 00:02:19.570 --> 00:02:20.490 in time. 19 00:02:21.310 --> 00:02:25.050 When arrest occurs, is your hospital ready? 20 00:02:27.410 --> 00:02:32.450 Since the basic resuscitation procedures, external cardiac compression and mouth-to-mouth 21 00:02:32.730 --> 00:02:38.890 breathing, are relatively simple, most hospitals are already adequately staffed and equipped 22 00:02:38.890 --> 00:02:41.030 to cope with cardiopulmonary arrest. 23 00:02:42.630 --> 00:02:47.650 Therefore, the central problem in designing a hospital-wide program is to bring trained 24 00:02:47.650 --> 00:02:50.930 people to the patient quickly, wherever he may be. 25 00:02:53.530 --> 00:02:57.330 Obviously, hospitals differ greatly in size and physical setup. 26 00:02:58.030 --> 00:03:03.270 In a large hospital, one of the difficulties in providing emergency aid to the cardiopulmonary 27 00:03:03.270 --> 00:03:06.330 arrest victim may simply be a matter of geography. 28 00:03:08.490 --> 00:03:12.110 The distance between wards can sometimes seem like miles. 29 00:03:14.370 --> 00:03:19.370 An overtaxed elevator system can also seriously limit the speed with which help can arrive. 30 00:03:22.950 --> 00:03:28.550 In a small hospital, the availability of staff members may be the major consideration. 31 00:03:34.030 --> 00:03:38.890 Experience in hospitals which have set up emergency cardiopulmonary resuscitation programs 32 00:03:38.890 --> 00:03:42.250 has clarified the main steps that must be taken. 33 00:03:42.810 --> 00:03:49.110 By following these, your hospital, regardless of its size, can initiate an effective life-saving 34 00:03:49.110 --> 00:03:50.010 program. 35 00:03:50.230 --> 00:03:54.550 First, of course, someone must take an active interest in setting up the program. 36 00:03:55.290 --> 00:03:58.370 Maybe you can be the one to start things moving at your hospital. 37 00:03:59.130 --> 00:04:03.730 To begin with, a committee should probably be named to coordinate and direct the program. 38 00:04:04.330 --> 00:04:09.850 One of its first jobs will be to evaluate the effectiveness of current procedures, their 39 00:04:09.850 --> 00:04:11.510 strengths and possible weaknesses. 40 00:04:12.490 --> 00:04:18.070 The committee's next task would be to study hospital procedures and layout, to judge the 41 00:04:18.070 --> 00:04:21.670 of trained personnel and equipment at any time. 42 00:04:22.090 --> 00:04:27.790 This will, in most cases, mean taking a hard look at the resuscitation training now underway. 43 00:04:28.750 --> 00:04:30.610 Are enough people being trained? 44 00:04:31.830 --> 00:04:33.950 Are their responsibilities clearly defined? 45 00:04:34.990 --> 00:04:39.650 What are the chances that the nurse who finds a victim of cardiopulmonary arrest will recognize 46 00:04:39.650 --> 00:04:42.310 it and be able to start resuscitation? 47 00:04:44.450 --> 00:04:49.490 Second, a continuing training program in the techniques of external cardiac compression 48 00:04:49.490 --> 00:04:52.730 and mouth-to-mouth breathing should be organized. 49 00:04:54.090 --> 00:04:59.050 This training should eventually be given to all staff positions, residents, interns, nurses, 50 00:04:59.690 --> 00:05:00.990 and paramedical personnel. 51 00:05:04.030 --> 00:05:08.570 In the community at large, these techniques are now recognized as emergency life-saving 52 00:05:08.570 --> 00:05:13.810 procedures to be followed by any trained person when cardiopulmonary arrest is discovered. 53 00:05:24.090 --> 00:05:32.250 Third, an emergency program should be in effect at all times, day or night. 54 00:05:33.090 --> 00:05:38.750 Since a team to initiate resuscitation must be drawn from on-duty staff, detailed scheduling 55 00:05:38.750 --> 00:05:44.210 will be required to ensure that trained personnel are always available when a cardiopulmonary 56 00:05:44.210 --> 00:05:45.230 emergency arises. 57 00:05:45.870 --> 00:05:50.850 This includes not only trained nurses and paramedical people, but physicians who must 58 00:05:50.850 --> 00:05:53.590 carry out the definitive steps in resuscitation. 59 00:05:55.950 --> 00:06:00.510 Fourth, supportive drugs and equipment, such as a squeeze bag and mask. 60 00:06:01.410 --> 00:06:06.990 A cardioscope and a defibrillator should be made readily available to the resuscitation team. 61 00:06:09.010 --> 00:06:13.490 These supplies should be placed at strategic locations where they can be obtained immediately. 62 00:06:15.850 --> 00:06:20.730 Some hospitals may find it practical to have special carts for cardiopulmonary emergencies. 63 00:06:22.650 --> 00:06:26.430 Others may rely on a resuscitation kit at each nursing station. 64 00:06:27.230 --> 00:06:32.890 Whether the equipment provided is simple or elaborate simply depends on your hospital's resources. 65 00:06:34.110 --> 00:06:39.510 Fifth, an emergency notification system should be adopted so that the nurse does not have 66 00:06:39.510 --> 00:06:42.270 to leave the patient in order to find trained help. 67 00:06:42.690 --> 00:06:45.590 Code 4, room 341. 68 00:06:46.090 --> 00:06:48.850 Code 4, room 341. 69 00:06:49.230 --> 00:06:54.670 The alarm can be given in a coded announcement over the public address system by a signal 70 00:06:54.670 --> 00:06:58.070 to a receiver carried by selected on-duty staff members. 71 00:06:58.250 --> 00:07:00.970 Code 4, room 341. 72 00:07:01.710 --> 00:07:04.830 Or, as shown here, by a more traditional method. 73 00:07:05.270 --> 00:07:07.070 Help, somebody, 334. 74 00:07:08.890 --> 00:07:13.750 Sixth, and very important, these emergency procedures should be rehearsed and reviewed 75 00:07:13.750 --> 00:07:19.370 three or four times a year to make sure that changes in personnel and hospital layout haven't 76 00:07:19.370 --> 00:07:21.030 lessened the efficiency of the system. 77 00:07:22.350 --> 00:07:27.610 Here it must be kept in mind that because of the high rate of personnel turnover prevalent 78 00:07:27.610 --> 00:07:34.250 today, new employees and staff members should be trained as soon as possible after joining 79 00:07:34.250 --> 00:07:35.010 the hospital. 80 00:07:36.750 --> 00:07:41.470 One illustration of how a resuscitation program functions can be found at the Hoover Pavilion, 81 00:07:42.170 --> 00:07:48.890 a 160-bed hospital in Palo Alto, California, which serves a community of some 60,000 people. 82 00:07:49.530 --> 00:07:54.510 To give us a clear idea of the results of their program, the staff agreed to let us 83 00:07:54.510 --> 00:07:57.890 film a dramatized incident of cardiopulmonary arrest. 84 00:08:09.150 --> 00:08:14.570 If a nurse at the Hoover Pavilion discovers that a patient has gone into cardiopulmonary arrest, 85 00:08:14.570 --> 00:08:19.310 she immediately turns on an emergency light and buzzer. 86 00:08:26.590 --> 00:08:30.190 Next, she flattens the bed and starts mouth-to-mouth breathing. 87 00:08:33.050 --> 00:08:37.670 Meanwhile, the nurse at the desk notifies the switchboard operator to page the resuscitation 88 00:08:37.670 --> 00:08:43.030 team by announcing code 66, followed by the location of the arrest. 89 00:08:44.570 --> 00:08:48.510 Code 66, room 214, Dr. Smith. 90 00:08:48.690 --> 00:08:53.650 The page is repeated three times every 20 seconds until a physician acknowledges. 91 00:08:53.690 --> 00:08:55.490 Code 66, room 214, Dr. Smith. 92 00:08:57.970 --> 00:09:02.670 The operator will also telephone the patient's personal physician if he is not in the hospital. 93 00:09:03.390 --> 00:09:08.630 When help arrives at the arrest scene, a bedboard or a meal tray is inserted to support the 94 00:09:08.630 --> 00:09:12.070 patient, and external cardiac compression is continued. 95 00:09:12.070 --> 00:09:17.070 Naturally, until help came, the first person there would have performed both ventilation 96 00:09:17.070 --> 00:09:18.630 and compression alternately. 97 00:09:19.250 --> 00:09:24.190 When the warning light goes on and the emergency page begins, one of the senior registered 98 00:09:24.190 --> 00:09:28.490 nurses sends for a resuscitation cart to be brought to the patient's room. 99 00:09:31.190 --> 00:09:36.370 One of these inexpensive handyman's carts, stocked with drugs and instruments, is kept 100 00:09:36.370 --> 00:09:37.770 near each nursing station. 101 00:09:39.730 --> 00:09:45.190 In addition, a cart with cardioscope and defibrillator is located on every floor. 102 00:09:46.270 --> 00:09:50.690 The first physician to arrive at the patient's bedside automatically takes charge until the 103 00:09:50.690 --> 00:09:52.670 personal physician can get there. 104 00:09:53.830 --> 00:09:59.330 Otherwise, he will continue to supervise resuscitation activities until the patient is revived or 105 00:09:59.330 --> 00:10:00.530 is pronounced dead. 106 00:10:11.270 --> 00:10:15.930 If resuscitation efforts are successful, the physician in charge determines whether 107 00:10:15.930 --> 00:10:18.790 the patient should be transferred to the intensive care unit. 108 00:10:19.150 --> 00:10:23.550 Of course, he will stay with the patient until present danger is thought to be over, whether 109 00:10:23.550 --> 00:10:25.410 or not the patient is to be moved. 110 00:10:26.550 --> 00:10:31.430 As soon as the emergency has been dealt with, the nursing supervisor sees to it that all 111 00:10:31.430 --> 00:10:36.670 equipment is cleaned, that drugs and other disposable supplies are replaced, and that 112 00:10:36.670 --> 00:10:39.250 the resuscitation cart is returned to its station. 113 00:10:40.230 --> 00:10:45.350 She then starts to fill out a special form which describes in detail the course of the 114 00:10:45.350 --> 00:10:48.450 arrest from the time of discovery until the final outcome. 115 00:10:49.850 --> 00:10:54.090 The physician in charge completes the form and adds his comments regarding the case. 116 00:10:54.590 --> 00:10:59.210 These forms are essential to a continuous review of the resuscitation program. 117 00:11:00.810 --> 00:11:05.990 As you can see, the resuscitation team at the Hoover Pavilion is actually formed on 118 00:11:05.990 --> 00:11:09.890 the spot from personnel on duty when cardiopulmonary arrest occurs. 119 00:11:11.430 --> 00:11:15.930 The physician in charge of the resuscitation program at the Hoover Pavilion is Dr. Grant 120 00:11:15.930 --> 00:11:21.270 Fletcher, an anesthesiologist who is also director of the respiratory unit at the Palo 121 00:11:21.270 --> 00:11:22.870 Alto Stanford Hospital Center. 122 00:11:23.770 --> 00:11:28.130 What you've just seen is our hospital's resuscitation program in action. 123 00:11:28.770 --> 00:11:34.310 We feel strongly that having such a program gives any patient who suffers a cardiopulmonary 124 00:11:34.310 --> 00:11:37.730 arrest in the hospital a better chance of survival. 125 00:11:38.570 --> 00:11:45.230 We also feel that with the knowledge of resuscitation techniques becoming more widespread, hospitals 126 00:11:45.230 --> 00:11:50.570 not having organized programs may be losing patients who might otherwise survive. 127 00:11:51.550 --> 00:11:57.910 Actually, it is clear that having an organized cardiopulmonary resuscitation program is part 128 00:11:57.910 --> 00:12:01.250 of any hospital's responsibility to its community. 129 00:12:01.250 --> 00:12:08.650 Published reports of the success of cardiopulmonary resuscitation in hospitals having programs 130 00:12:08.650 --> 00:12:14.670 vary widely, but current estimates would indicate that at least one in four patients can be 131 00:12:14.670 --> 00:12:15.130 saved. 132 00:12:15.750 --> 00:12:21.370 Cold figures mean relatively little, but I'm sure you'll agree that the very first patient 133 00:12:21.370 --> 00:12:28.050 whose useful life is restored to him as a result of coordinated activities of a resuscitation 134 00:12:28.050 --> 00:12:34.170 program more than justifies the time spent making sure that the program exists. 135 00:12:35.730 --> 00:12:39.690 You have seen how the resuscitation program functions at the Hoover Pavilion. 136 00:12:41.330 --> 00:12:45.970 Although your own hospital may differ in many respects, the organizing principles to be 137 00:12:45.970 --> 00:12:47.710 followed are essentially the same. 138 00:12:49.370 --> 00:12:52.490 First, decide on who will coordinate the program. 139 00:12:52.490 --> 00:12:57.530 Second, train as many people as possible in resuscitation techniques. 140 00:12:58.650 --> 00:13:04.210 Third, arrange duty schedules so that a core of trained personnel is always on hand. 141 00:13:04.570 --> 00:13:08.850 Fourth, place drugs and emergency equipment in strategic spots. 142 00:13:09.570 --> 00:13:12.950 Fifth, set up a special arrest notification system. 143 00:13:13.770 --> 00:13:17.690 Sixth, reevaluate your program three or four times a year. 144 00:13:17.690 --> 00:13:24.570 These are the six fundamental principles, and any hospital can base a program on them. 145 00:13:27.930 --> 00:13:30.950 There remains only the question of who will put the program in motion. 146 00:13:31.650 --> 00:13:36.510 Maybe you are the one who can take the first practical step toward making sure that when 147 00:13:36.510 --> 00:13:42.250 cardiopulmonary arrest occurs in your hospital, everyone knows what happens next. 148 00:14:32.570 --> 00:14:35.370 Thank you.