Doctors, firefighters, paramedics and many others gathered Monday morning at UC San Diego School of Medicine to insist that this region can do better, much better, if more regular people are ready to act when they see someone collapse.
"If you get bystander CPR, your chance of survival doubles," said Dr. Zack Shinar, chair of emergency medicine at Sharp Memorial Hospital, noting that few medical procedures can similarly improve the odds so significantly. "Every minute that we wait, that we're waiting for the medics to arrive, we decrease that (chance of) survival by 10 percent."
And yet, comparatively few are ready to meet that moment.
Research has shown that less than half of those who need to be resuscitated get immediate help from a bystander, burning many of the six minutes they have until permanent cognitive damage occurs.
Enter Revive & Survive, a new joint initiative from the San Diego County public health department and the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego. The collaborative effort aims to train 1 million residents in hands-only cardiopulmonary resuscitation.
That's a big goal — about one-third of the region's total population — but it is what's needed, experts said, to move the needle on heart attack survival.
"We want everybody, no matter where they live in the whole county, to know how to do this very simple intervention that can really improve outcomes and save lives," said Dr. Cheryl Anderson, Wertheim's dean.
Leaders gathered on campus Monday to launch the endeavor, making sure to get a little CPR practice in after speeches and a flash mob that had everyone dancing to Stayin' Alive, the 1970s Bee Gees hit that just so happens to have a beat that lands right in the 100- to 120-beat-per-minute range recommended for chest compressions.
Bystander training is only part of what's needed to increase cardiac arrest survival rates.
Most call 911 when a heart attack occurs, and emergency dispatchers frequently find themselves coaching distraught loved ones in chest compressions, often put on speaker phone to listen in and coach as best they can.
Here, the county has been working for years to improve things. Dr. Kristi Koenig, medical director of the county emergency medical system, said her office began training dispatchers about six years ago in the new hands-only CPR technique.
Building a more complete training process for dispatchers uncovered an obstacle. Often, in the first minutes of cardiac arrest, it can appear as if they are still able to breathe. They gasp for breath, but the effort is futile. It's a natural reflex called "agonal breathing," and it can delay the start of CPR because the person ready to start chest compressions is deceived into thinking action may not yet be necessary.
In this moment, emergency dispatchers need a mountain of confidence to urge action when agonal breathing happens. Koenig said her office helps them know what to listen for.
"During training, we've played various actual recordings of people with agonal breathing so they could hear the differences, because it's not always going to sound the same," Koenig said.
There is no time, she said, to play those recordings to the person who will perform CPR, but dispatchers can give them the courage to start pushing during those final gasps.
Maureen O'Connor, program manager of San Diego Project Heart Beat, said that many are worried in the moment that CPR might actually be unnecessary and hold back out of uncertainty.
"If you think somebody might be in cardiac arrest, bare their chest," O'Connor said. "If they let you, that's a good sign.
"I always say, if they allow you to do CPR, then they need CPR."
Many emphasize that CPR is less complicated than it used to be.
In 2008, the American Heart Association changed its cardiopulmonary resuscitation recommendation, removing rescue breathing — the part where a person was advised to pinch the nose and breathe into the mouth — after research found that it really was far less essential than properly-spaced chest compressions in terms of keeping blood flowing during the critical minutes before a patient's heartbeat is restored, often with a shock from an automatic defibrillator.
How long will it take for Revive & Survive to train 1 million people in bystander CPR ? Koenig said she'd love to see the goal reached by the end of the year.
Is that a little over ambitious? O'Connor, the San Diego Project Heart Beat manager, said she doesn't think so. Her organization already does thousands of 10-minute trainings per year and many local organizations, especially the local chapters of the American Heart Association and the American Red Cross, also operate similar programs.
"Easy, all we need is for lots of people to come out and do it," O'Connor said.
The new program has a list of available training partners and sessions on its website, revivesurvive.ucsd.edu.
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