High-Profile CPR

Embrace the superiority of mechanical resuscitation


 
 

A.J. Heightman, MPA, EMT-P | From the November 2011 Issue | Tuesday, November 1, 2011


Richard Senneff, a 29-year veteran firefighter/paramedic with the Los Angeles Fire Department (LAFD), the first paramedic to enter Michael Jackson’s bedroom, was called  to the stand in the trial of Conrad Murray, MD. I was confident that he’d be a good witness because of his nearly 30 years of street experience.

He did our profession proud with his calm, confident demeanor and to-the-point answers to every question. The attorneys quizzed Senneff about the care the LAFD crew rendered, but they were most interested in what he observed and documented in Jackson’s bedroom. From his tenure in EMS, he was credible when he reported that the doctor’s actions seemed “frantic” and several things “did not add up” to him.1

Senneff testified that Murray was not performing CPR adequately and “was leaned over the patient and holding the patient’s torso. He was moving the patient from the bed to the floor.” That bit of information clearly established that, if Murray was performing CPR before EMS arrived as he claimed, he was doing it in an inappropriate manner.

Senneff also said that his past experience led him to believe that Jackson had an underlying health condition. He said, “Doctor’s in the house. IV pole, IV hooked up to the patient—it didn’t seem normal.”1

But Murray initially denied Jackson had any medical conditions and never reported administering the propofol to him. “That did not add up to me,” Senneff said.2

The prosecution asked Senneff to describe the actions of the drugs he administered to Jackson, including sodium bicarbonate, which was given to try to counter acidosis.

He was also asked to explain a confusing time jotted on a response printout and to describe bag-valve-mask operations. Senneff had quick, accurate answers to each question, including how the time setting on his cardiac monitor was off by an hour.

His professional performance prompted me to wonder how much-less-experienced paramedics would have done if they treated Michael Jackson and were put on the witness stand. I also thought about an area I think EMS providers will be asked about during future court cases: why they performed manual vs. mechanical CPR on their patient.

The LAFD crew escaped scrutiny for their CPR practices, particularly the manner in which it was performed while they left the bedroom, walked down a stairway and out to the ambulance, and loaded and transferred Jackson to the hospital and into the hospital emergency department (ED). This process is often referred to as mobile CPR.

This wasn’t an issue because they performed what would be called the standard of care in mobile CPR four years ago. But if you read this month’s “Case of the Month,” on p. 20, which highlights the success (and perhaps the critical necessity) of using mechanical CPR, you’ll understand why I believe it’s an area of prehospital (and hospital) care that will be recommended in future AHA Guidelines for CPR & ECC.

Although there’s not a lot of research that has proven the superiority of mechanical vs. manual CPR, it’s an area that’s made sense to me since I first read an article in JEMS 20 years ago about research by noted CPR educator Ed Stapleton that showed the inadequacy of non-mechanical CPR while moving a patient to, and in,  an ambulance.3

Most EMS providers don’t want to admit that the traditional method of mobile CPR is woefully inadequate, inconsistent and probably deleterious to their patients.

The CPR traditionalists who debate me over mechanical CPR are driving cars and emergency vehicles that were painted by computerized, mechanical devices. They fight fires with apparatus equipped with computerized pumps that electronically monitor and adjust the pressure to make sure firefighters get a consistent flow of vitally needed fluid at the nozzle end.

So why is the heart any different? They wouldn’t let me paint their vehicles by hand or trust me to hand pump water to them like Ben Franklin and his fellow firefighters did in 1736. But they continue to do manual CPR on their patients for 30–45 minutes in unusual locations and positions, and mobile environments—even though they know it will be interrupted frequently and performed inconsistently.

They also hand over their patients to EDs that allow petite nurses to do manual CPR on a 250-lb. patient’s chest on a flexing bed mattress until those famous words, “call the code” are uttered.

I believe crews called to testify after their involvement in future resuscitation attempts for rock stars and other high-profile patients will be closely scrutinized. They will be asked to justify why they allowed the patient’s circulatory pump to lose prime frequently throughout their resuscitation attempts.

Sorry Dr. Murray, Ben Franklin, hand- pump operators and CPR traditionalists, your methods, although appreciated, are outdated, inconsistent and unreliable. It’s time to accept the arrival of the industrial revolution. JEMS

References
1. Lloyd J. (Oct. 1, 2011). Michael Jackson’s Doctor Never Mentioned Key Drug: Paramedic. In NBC Miami. Retrieved Oct. 16, 2011, from www.nbcmiami.com/entertainment/celebrity/Michael-Jackson-Conrad-Murray-T....
2. Hernandez M, Gregory J. (Sept. 30, 2011). Conrad Murray Trial: Paramedic says Murray Never Mentioned Propofol. In ABCLoc21. Retrieved Oct. 16, 2011, from http://abclocal.go.com/kabc/story?section=news/entertainment&id=8373978.
3. Stapleton E. Comparing CPR during ambulance Transport: Manual vs. mechanical methods. JEMS. 1991;16(9):63–72.




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Related Topics: Patient Care, Cardiac and Circulation, mechanical CPR, cpr, A.J. Heightman, Jems From the Editor

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A.J. Heightman, MPA, EMT-P

JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, has a background as an EMS director and EMS operations director. He specializes in MCI management.

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