Cardiopulmonary resuscitation (CPR) is one of the most studied and developed medical interventions in the emergency medical service (EMS) field. As first responders we must be trained properly within the current standards of CPR. CPR has a long history of development, and still continues to be evaluated and changed to reflect the best evidence based practices. The goal of CPR education is to have those who witness a cardiac arrest, or those who respond to a cardiac arrest, be able to act appropriately to increase the chance of survival for the victim.
The start of CPR was in 1740 when The Paris Academy of Science studied and officially recommended mouth-to-mouth rescue breathing for victims of drowning. They found introducing expelled air from the rescuers lungs to the victim’s lungs would help them survive longer. Rescue breathing was the only form of CPR until 1891 when DR. James Friedrich Maass documented the first closed chest compressions on a human. Friedrich’s peers were skeptical to believe that his chest compressions would be so successful because of the significant damage they had on the body. When chest compressions are done effectively sometimes the victim’s ribs and sternum are cracked or even broken. Medical scientist found that sometimes during CPR compressions and rescue breathing was not always effective as the heart would sometimes stop beating or pumping. In 1947 Claude Beck, who was a cardiovascular surgeon, successfully used an automated external defibrillator (AED) on a 14 year old boy when his heart when into fibrillation (ineffective beating) during surgery. This AED allowed Beck to deliver a shock to this boy’s heart and restart the correct beating rhythm. This AED was developed by James Rand, and was used in open-chest situations only like during opened- heart surgery. After nine years of development, Paul Zoll used a more updated AED in the first closed-chest defibrillation during CPR. Then in 1954 James Elam proved that expelled air (from the rescue breather’s lungs) was sufficient to maintain ample amounts of oxygen in the victim’s blood. In 1960 CPR was fully developed with chest compressions and rescue breathing put together in a sequence. Start the compressions first and then add in the rescue breathing in between compression segments. The American Heart Association (AHA) started a program to formularize doctors with closed-chest-compressions and started to educate them all over the country. CPR was then studied and recorded, and once it was deemed useful and successful, training programs became available for the general public. All the while these medical professionals using CPR and AED’s were doctors. It was not until 1969 in the state of Oregon, when the first EMT successfully defibrillated a patient during the CPR sequence. The correct sequence is compressions, rescue breathing, and then shock with the AED.
As CPR continued to be studied and critiqued for the next twenty years, doctors and medical professionals discussed a program called Advanced Cardiovascular Life Support (ACLS). This program went in more advanced airway management, pharmacology and early recognition of respiratory and cardiac arrest. After The Third National Conference on CPR, in 1979, the ACLS program was developed and released. During this same time period the American Academy of Pediatrics (AAP) worked with the AHA to develop the first specialized courses for pediatrics (Children) in 1988. There were three courses developed, Pediatric Basic Life Support (PBLS), Pediatric Advanced Life Support (PALS) and Neonatal (children ages 0-4weeks) Resuscitation. The three programs for pediatrics are still used and being taught all over the country to EMS, nurses, and doctors. In 2004 the AHA and International Liaison Committee on Resuscitation (ILCOR) released a statement and research stating that an AED may be used on pediatrics from ages 1-8 years of aged, only if they
