Please adjust your sound to the level of this voice, which will be the same as that of the narrator.
This patient's heart has stopped.
Unless the proper measures are taken within the next four minutes, he will be beyond hope of resuscitation.
In your hospital, what happens next? Once cardiopulmonary arrest has taken place, what should happen next? Someone trained in resuscitation procedures should arrive almost immediately and start to revive the patient.
The recently developed technique of external or closed -chest cardiac compression, used in conjunction with mouth -to -mouth breathing, has proved to be a simple and effective way of keeping the patient alive until more elaborate measures can be taken if necessary.
In a small number of hospitals, training in these emergency techniques has been underway for some time.
Yet, it is in the hospital that cardiopulmonary arrest still claims many of its victims.
One reason for this is that the need for resuscitative measures may not be recognized soon enough.
A second is the lack of hospital -wide training in these emergency and definitive measures.
Still another may be that trained people and equipment are not able to reach the patient in time.
When arrest occurs, is your hospital ready? Since the basic resuscitation procedures, external cardiac compression and mouth -to -mouth breathing, are relatively simple, most hospitals are already adequately staffed and equipped to cope with cardiopulmonary arrest.
Therefore, the central problem in designing a hospital -wide program is to bring trained people to the patient quickly, wherever he may be.
Obviously, hospitals differ greatly in size and physical setup.
In a large hospital, one of the difficulties in providing emergency aid to the cardiopulmonary arrest victim may simply be a matter of geography.
The distance between wards can sometimes seem like miles.
An overtaxed elevator system can also seriously limit the speed with which help can arrive.
In a small hospital, the availability of staff members may be the major consideration.
Experience in hospitals which have set up emergency cardiopulmonary resuscitation programs has clarified the main steps that must be taken.
By following these, your hospital, regardless of its size, can initiate an effective life -saving program.
First, of course, someone must take an active interest in setting up the program.
Maybe you can be the one to start things moving at your hospital.
To begin with, a committee should probably be named to coordinate and direct the program.
One of its first jobs will be to evaluate the effectiveness of current procedures, their strengths and possible weaknesses.
The committee's next task would be to study hospital procedures and layout, to judge the of trained personnel and equipment at any time.
This will, in most cases, mean taking a hard look at the resuscitation training now underway.
Are enough people being trained? Are their responsibilities clearly defined? What are the chances that the nurse who finds a victim of cardiopulmonary arrest will recognize it and be able to start resuscitation? Second, a continuing training program in the techniques of external cardiac compression and mouth -to -mouth breathing should be organized.
This training should eventually be given to all staff positions, residents, interns, nurses, and paramedical personnel.
In the community at large, these techniques are now recognized as emergency life -saving procedures to be followed by any trained person when cardiopulmonary arrest is discovered.
Third, an emergency program should be in effect at all times, day or night.
Since a team to initiate resuscitation must be drawn from on -duty staff, detailed scheduling will be required to ensure that trained personnel are always available when a cardiopulmonary emergency arises.
This includes not only trained nurses and paramedical people, but physicians who must carry out the definitive steps in resuscitation.
Fourth, supportive drugs and equipment, such as a squeeze bag and mask.
A cardioscope and a defibrillator should be made readily available to the resuscitation team.
These supplies should be placed at strategic locations where they can be obtained immediately.
Some hospitals may find it practical to have special carts for cardiopulmonary emergencies.
Others may rely on a resuscitation kit at each nursing station.
Whether the equipment provided is simple or elaborate simply depends on your hospital's resources.
Fifth, an emergency notification system should be adopted so that the nurse does not have to leave the patient in order to find trained help.
Code 4, room 341.
Code 4, room 341.
The alarm can be given in a coded announcement over the public address system by a signal to a receiver carried by selected on -duty staff members.
Code 4, room 341.
Or, as shown here, by a more traditional method.
Help, somebody, 334.
Sixth, and very important, these emergency procedures should be rehearsed and reviewed three or four times a year to make sure that changes in personnel and hospital layout haven't lessened the efficiency of the system.
Here it must be kept in mind that because of the high rate of personnel turnover prevalent today, new employees and staff members should be trained as soon as possible after joining the hospital.
One illustration of how a resuscitation program functions can be found at the Hoover Pavilion, a 160 -bed hospital in Palo Alto, California, which serves a community of some 60 ,000 people.
To give us a clear idea of the results of their program, the staff agreed to let us film a dramatized incident of cardiopulmonary arrest.
If a nurse at the Hoover Pavilion discovers that a patient has gone into cardiopulmonary arrest, she immediately turns on an emergency light and buzzer.
Next, she flattens the bed and starts mouth -to -mouth breathing.
Meanwhile, the nurse at the desk notifies the switchboard operator to page the resuscitation team by announcing code 66, followed by the location of the arrest.
Code 66, room 214, Dr.
Smith.
The page is repeated three times every 20 seconds until a physician acknowledges.
Code 66, room 214, Dr.
Smith.
The operator will also telephone the patient's personal physician if he is not in the hospital.
When help arrives at the arrest scene, a bedboard or a meal tray is inserted to support the patient, and external cardiac compression is continued.
Naturally, until help came, the first person there would have performed both ventilation and compression alternately.
When the warning light goes on and the emergency page begins, one of the senior registered nurses sends for a resuscitation cart to be brought to the patient's room.
One of these inexpensive handyman's carts, stocked with drugs and instruments, is kept near each nursing station.
In addition, a cart with cardioscope and defibrillator is located on every floor.
The first physician to arrive at the patient's bedside automatically takes charge until the personal physician can get there.
Otherwise, he will continue to supervise resuscitation activities until the patient is revived or is pronounced dead.
If resuscitation efforts are successful, the physician in charge determines whether the patient should be transferred to the intensive care unit.
Of course, he will stay with the patient until present danger is thought to be over, whether or not the patient is to be moved.
As soon as the emergency has been dealt with, the nursing supervisor sees to it that all equipment is cleaned, that drugs and other disposable supplies are replaced, and that the resuscitation cart is returned to its station.
She then starts to fill out a special form which describes in detail the course of the arrest from the time of discovery until the final outcome.
The physician in charge completes the form and adds his comments regarding the case.
These forms are essential to a continuous review of the resuscitation program.
As you can see, the resuscitation team at the Hoover Pavilion is actually formed on the spot from personnel on duty when cardiopulmonary arrest occurs.
The physician in charge of the resuscitation program at the Hoover Pavilion is Dr.
Grant Fletcher, an anesthesiologist who is also director of the respiratory unit at the Palo Alto Stanford Hospital Center.
What you've just seen is our hospital's resuscitation program in action.
We feel strongly that having such a program gives any patient who suffers a cardiopulmonary arrest in the hospital a better chance of survival.
We also feel that with the knowledge of resuscitation techniques becoming more widespread, hospitals not having organized programs may be losing patients who might otherwise survive.
Actually, it is clear that having an organized cardiopulmonary resuscitation program is part of any hospital's responsibility to its community.
Published reports of the success of cardiopulmonary resuscitation in hospitals having programs vary widely, but current estimates would indicate that at least one in four patients can be saved.
Cold figures mean relatively little, but I'm sure you'll agree that the very first patient whose useful life is restored to him as a result of coordinated activities of a resuscitation program more than justifies the time spent making sure that the program exists.
You have seen how the resuscitation program functions at the Hoover Pavilion.
Although your own hospital may differ in many respects, the organizing principles to be followed are essentially the same.
First, decide on who will coordinate the program.
Second, train as many people as possible in resuscitation techniques.
Third, arrange duty schedules so that a core of trained personnel is always on hand.
Fourth, place drugs and emergency equipment in strategic spots.
Fifth, set up a special arrest notification system.
Sixth, reevaluate your program three or four times a year.
These are the six fundamental principles, and any hospital can base a program on them.
There remains only the question of who will put the program in motion.
Maybe you are the one who can take the first practical step toward making sure that when cardiopulmonary arrest occurs in your hospital, everyone knows what happens next.
Thank you.
