in days gone by

1. Resuscitating the drowning victim – c1910

1. Resuscitating the drowning victim – April 2015

Cardiopulmonary resuscitation has come a long way.  Paramedic discussions in the training room these days focus on fine details such as how to reduce hands off compressions times by a few seconds and how to integrate ventilations in without interrupting the rest of the resuscitation.  Defibrillators, once the domain of cardiologists and the chosen intensive care paramedics, hang proudly on the wall in shopping malls now waiting for almost anyone to tear one down for rapid use.  But resuscitation hasn’t always been drawn straight from the ILCOR documents.

One example of yesteryear comes from a somewhat legendary little pocket book known as ‘The Bushman’s Companion’.  This was printed in 1910 by a man to become revered for setting in motion the Royal Flying Doctor’s Service, Reverend Dr John Flynn.  This little pocket book was intended for very rural people to provide them with a blend of scripture and practical first aid advice.  How could you not have something to offer every situation with that combination!  I quote from this book as to how to resuscitate the drowning victim.

There is hope for cases under water for even quarter of an hour.  As to treatment. We cannot do better than quote ‘The Argus’ on the Schafer system as used by the surf bathers at Manly Beach.   A very slight knowledge of physiology shows us that the best way of warming the body is to restore the fleeting breath.  The lungs and heart, in their subtle mechanism, their perfect chemistry, do all the rest – so that to rub the body, to force spirits down the throat (I never cease to be impressed how often forced spirits feature.  How did we let that fall out of favour?) is just a waste of time until breath has been given back.

You just place the patient face downward, his arms extended outward and upward at an angle of 45 deg. from the shoulder and turn the head slightly to one side so that the mouth is open and free to breathe.  In that attitude, don’t trouble about the tongue.  It drops forward into its natural position and does not clog the windpipe (ah there are people now who still don’t get that!!).  Then get behind the patient, place your palms open and widespread over the elastic lower ribs of the body and thumbs a few inches apart and close to the backbone.  Press downward and forward  with the whole weight of your body, gently and firmly, and the elastic ribs are squeezed inward against the lungs.  The first motion frees them of water, because with the body in that position there is natural downward drainage from the lugs to the mouth (again, there is airway one oh one).  When you have pressed the ribs in, release the pressure suddenly so that they spring back to their normal position.  Count up to four quickly and then apply the pressure again.  Keep on this way till you have reached twelve pressures then rest for ten seconds and go on again.  Do not give up for an hour at least (Only now are we starting to revisit that not giving up early might be a better idea).  There may still be a spark of life (he should have copyrighted that) flickering under your hands – a human soul on the edge of eternity.

We would all agree that such wording would greatly improve current texts.  I say this in all seriousness as two things leap out from this.  Firstly a great debt is owed to all the early pioneers including John Flynn.  Secondly a bit of everyday and fun language in learning and texts should be mandatory and not a novelty.  But wait, the good doctor provided a post ROSC postscript as well.

Not till after breathing is restored must circulation be thought of.   Then place patient in dry, warm blankets. Rub limbs well always toward the heart.  Use hot bottles. Give hot coffee. Hot poultices on chest, front and back may assist breathing.  Patient must be watched carefully for some time.  Breathing may fail and call for another course of ‘pumping’.

There isn’t enough spirits and hot coffee in todays clinical practice guidelines. Not for the patient’s anyway.

Jeff Kenneally

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