Administration and Leadership, Columns

CPR’s Unrealistic Portrayal on the Small Screen

Issue 6 and Volume 40.

“Ah, c’mon! There’s no way in hell they would ever do that!”

A resounding Shhhhhhhhhhh! from the multitude cuts me off. “Seriously?” I continue, undaunted. “That patient doesn’t even have an …”

A now capitalized SHHHHHHHH! reverberates off the living room wall, accentuated with a hail of Orville Redenbacher popcorn leveled toward my person–missing my mouth completely.

This is just a small playback of what it was like back in the day when I was a fiery fresh medic watching a medical-themed TV show with my family. After all, I wanted to impress my kinfolks with my vast knowledge of newly acquired emergency medical protocols and medical terminology that had more than two syllables. It was my civic duty to point out the medical inaccuracies I bore witness to in the scripts and actions of the TV characters while at the same time ruining the entertainment factor.

Medical shows during that time were just turning the corner from portraying doctors like Ben Casey, Dr. Kildare, and Marcus Welby–the purely altruistic, modest, always accessible, flawless heroes (without personal problems) to a cast of newly defined medical sorts who had their own issues of bad health, bad rivalries, bad relationships and bad breath while working in a chaotic environment of saving lives. Though refreshing, revealing doctors as being only human with vulnerable souls can be a little disconcerting if one is a patient about to get a vasectomy from a physician who just found out her boyfriend cheated on her.

An added benefit to these new medical TV series such as St. Elsewhere, ER, Chicago Hope and House was the inclusion of using medical consultants to actually make an attempt at following medical guidelines in treating medically ill or traumatized scripted patients. (Grey’s Anatomy excluded secondary to so much sex going on that nobody had time to actually treat anyone unless an STD was involved.)

Regardless of this somewhat decent attempt to entertain yet educate the audience to the detailed innards of emergency medicine, there are still a few scripted practices that get on my nerves–regardless of my ability to appreciate the fact that maximum drama impact will always supersede medical facts, reality, physiology and co-pays.

A few notable inaccuracies include: a patient diagnosis made within minutes of arrival to the ER and without a team consult, doctors actually performing procedures themselves, doctors ever yelling “stat,” stethoscopes not angled forward in the ears, coma patients only wearing a cannula, patients in flatline being defibrillated, a patient’s survival dependent on a bullet being eradicated immediately, gunshot wounds to the shoulder or leg considered as only minor inconveniences and, finally, EMS providers portrayed as mindless stretcher-bearers having performed no prehospital care whatsoever prior to their destination.

As television screenplay writers continue to strive to make their story lines more clinically precise (thank you, WebMD), there’s still one cinematic medical procedure no one seems willing to amend despite its blatant inaccuracy from both a physiological and psychological level.

You know the scene I’m talking about: The patient is pulseless and apneic and yet within a few minutes of bystander CPR and occasional words of encouragement (slapping optional), the patient, with beautiful skin color by the way, elicits a few coughs (sans emesis), blinks their eyelids as if waking from a nap and then says in a neurologically intact kinda way, “What happened?,” all the while never grabbing their now freshly fragmented and misaligned thorax. Such successful resuscitations transpire 75% of the time, assuming you’re fortunate enough to code on TV as a nonexpendable character. Clinically dead patients brought back to life is a central component to medical shows, but when it comes to CPR, fact and fiction often become blurred.

This kind of CPR (clean, pretty and reliable) differs so much from my usual CPR (can’t possibly recover) that despite the ongoing changes I’ve been trying to keep up with in regard to evidence-based CPR protocols, I’m beginning to think maybe EMS needs to take a page from Hollywood to enhance patient survivability from a cardiac arrest. This might include a new verbal algorithm when all other scientific-based efforts of resuscitation have failed. Hey, what can it hurt after your fourth round of epi and 10,000th chest compression?

Medic: Patient is still pulseless and apneic.

Team Leader: Raises shaking fist to the sky, yelling. Not today! Not on my watch!

M: Still asystolic.

TL: Grabs patient’s collar with both hands. Don’t quit on me (patient name)! Fight, damn you! Fight!

M: Still negative on the pulses.

TL: Looks toward the heavens, howling. Why him/her?! Why? Why? Why?!

M: Still got nada.

TL: Don’t take him/her! Take me instead! … No. Wait! Points to partner. Take him instead!

M: Gasp! Cough! Gurgle!

Seriously though, I believe the falsehoods of CPR (cinematic pulseless recovery) has created a community disservice for the sake of highly impressionable entertainment. The film industry should take on the civic responsibility to enhance the perception of CPR factually–especially when dealing with scripts of surviving family members struggling in their effort to seek realistic expectations of full code resuscitation for a dying loved one. Even if the patient survives a cardiac arrest following CPR, full neurological recovery is not as cut and dry as portrayed on the screen. Now that the viewing audience has openly embraced the explicitness and particulars of medicine being put out by the film industry, let’s not skirt the complicated medical and ethical issues of CPR the medical community, patients and family members need to consider … at least not on my watch.