What about the bystanders?
“Open your eyes, please open your eyes.” It was late morning last November, when she stepped outside a coffee shop and saw the man collapsed on the ground.
The Toronto woman is trained in CPR; it’s part of her job to promote it. But in that moment she froze.
He was in his 50s, dressed in a light grey jacket and suit pants, and the sounds coming out of his mouth were shallow and agonal, sounds the body makes when it struggles to breathe after the heart has stopped. “Tell them he’s gasping,” the woman, who asked not to be named, yelled to another bystander who was calling 911. She dropped to her knees, put her hands one on top of the other and began pushing on the middle of the man’s chest, hard, deep and fast. She could feel bones crushing beneath her hands.
For a second, she stopped, even though she knew she shouldn’t. “Open your eyes,’ ” she silently willed him. She could see the shoes and pant legs of the people standing around her. Someone had placed a pair of gloves under the man’s head. Another gave her a napkin, because his dentures were coming out.
The ambulance arrived and slowly transitioned her out. She left before the advanced paramedics arrived. She touched the man’s forehead, and quietly said a prayer for him. She doesn’t know whether he survived “but I hope he did and, if he didn’t, I hope his family knew he wasn’t alone, that he wasn’t not touched, and left on the street until the ambulance came.”
Afterwards, “I didn’t want to talk to anybody about it,” she said. “I worried about his family. I was upset with myself and disappointed that I really didn’t want to do it at first, because I was afraid. But I’m so glad I did, I’m so glad I did.”
“I still cry (thinking about it), and I shouldn’t, right? I think we have to find new ways of talking about this.”’
About 40,000 out-of-hospital cardiac arrests occur every year in Canada. Early bystander CPR can increase the chance of survival threefold. But despite an abundance of studies proving its indisputable worth, few have investigated what it’s actually like for “lay rescuers” to try to resuscitate someone who has essentially died in front of them.
What research exists suggests the experience can provoke strong emotional reactions, including nightmares, flashbacks and vivid, uncontrollable thoughts. According to one small study published last year in BMJ Open, “the main concern was whether their actions had led to severe injury, a vegetative state, or death.”
Now, in an attempt to gain a deeper understanding of the phenomenon and adapt CPR training to better prepare people, Canadian researchers have launched a virtual support network (www.bystandernetwork.org) to allow members of the public to share first-hand experiences after responding to or witnessing a cardiac arrest.
The psychological side of CPR is rarely, if ever, discussed, said Katie Dainty, a scientist at Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto. Bystanders are essentially the forgotten people, she said. “We ask a lot of them to respond, and then we just say, ‘thanks.’ The ambulance comes and takes the patient way and they’re sort of left standing there, like, ‘what just happened?’ ”
When the public sees images of desperate rescue efforts, like the strangers who rushed to the aid of Cpl. Nathan Cirillo, risking their own lives after the soldier was mortally gunned down as he stood guard at the National War Memorial on Parliament Hill in 2014, people want to believe they, too, would react.
Yet bystander CPR rates remain astonishingly low, Dainty said. Many cardiac arrests are witnessed, yet only a third of them receive bystander CPR.
Part of the reluctance to act comes from sheer fear and panic. CPR training on mannequins or “Annie,” the CPR doll in a boardroom or classroom “is nothing, nothing like it is in real life,” Dainty said “It can be just a completely chaotic and unpredictable environment.”
Most arrests happen in the home, which adds a whole other layer of trauma and distress, Dainty said. “It’s your husband, your wife, a loved one, it’s happening in your home — maybe you’re doing CPR on your bed. That scene may play in your mind for the rest of your life.” Some people become so paralyzed, they can’t react. “And if you don’t react, then there’s the trauma of not reacting.”
New guidelines published in 2010 recommend untrained bystanders who witness an adult collapse skip mouth-to-mouth breaths and focus on deep and rapid chest compressions instead. But even then, some people worry about doing more harm than good.
Dainty stressed it’s better to do something than nothing, otherwise the victim will most certainly die. Chest compressions double or triple the chance of survival by circulating oxygenated blood through the body to keep the brain and other organs alive, added Dr. Farhan Bhanji, a professor of paediatrics at McGill University and a Heart and Stroke Foundation delegate to the International Liaison Committee on Resuscitation.