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Anf
Anf's picture
Cardiac arrest in training

There's an article on the BBC news today that is frankly quite scary.

https://www.bbc.co.uk/news/av/health-50072515/cardiac-arrest-in-fitness-class-caught-on-camera

Someone who looks perfectly fit and healthy, suddenly collapses and goes into cardiac arrest.

I'm sure we all know this can happen but is presumably very rare. Rare enough for many of us to not even give it any thought. But this article makes it all the more real.

This gets me to thinking. Is it a reasonable assumption that someone you train with will know what to do in that event?

It also got me to thinking, when sparring, where some clubs have strict rules meant to protect their members, are the rules based on sound science? For example, at my last club, we weren't allowed to strike the head, or anything below belt height. Ie we could only strike to the torso. In reading up on CPR I came across articles that said a blow to the chest can also shock the heart into abnormal rhythm so CPR is actually dangerous if the recipient doesn't need it. By extension then, a wallop to the chest could cause a cardiac event, which opens up many questions around training practices and rules, and even applications in self defence.

Tau
Tau's picture

If only there were a book available that covered this. Something specialising in martial arts injuries and other emergencies. One that actually discussed a real-life cardiac event in the dojo. One written by a specialist nurse and multi-style martial arts practitioner.

Someone really should write such a book ;-)

Anf
Anf's picture

Tau wrote:
If only there were a book available that covered this. Something specialising in martial arts injuries and other emergencies. One that actually discussed a real-life cardiac event in the dojo. One written by a specialist nurse and multi-style martial arts practitioner.

Someone really should write such a book ;-)

I have a copy of such a book. It's an excellent book too I might add. One that is both very informative yet still easy to follow for ordinary non-medical sorts such as myself.

Les Bubka
Les Bubka's picture

Got that book too, great work by Peter.

Iain Abernethy
Iain Abernethy's picture

Hi Anf,

Anf wrote:
I'm sure we all know this can happen but is presumably very rare. Rare enough for many of us to not even give it any thought. But this article makes it all the more real.

I’ve been at karate events where people have had heart attacks. I know of a few others too. It’s rare, but it’s something we should all give thought to. All instructors should have valid first aid training – renewed every few years – and therefore this should be something they consider and have the training to address.

Anf wrote:
This gets me to thinking. Is it a reasonable assumption that someone you train with will know what to do in that event?

It should be. As I say, all instructors should have recognised first aid training. When we book all the instructors on courses, we also always open up places to other students who want to attend (free of charge; the club pays all costs). This means we have a number of qualified first aiders present at every session. It’s useful to members in their everyday life too.

In my 30 odd years of teaching, I have had to use my first aid training several times. I’ve also had to use it a few times outside of the dojo (most recently with a child who came of their bike at speed and knocked themselves unconscious). I consider first aid training – under a qualified first aid professional to a recognised national standard – to be something all dan grades should do; and it’s vital that instructors in charge of a group have such training.

All the best,

Iain

PASmith
PASmith's picture

I've done first aid training several times now. When younger when being a "senior resident" in Uni halls of residence and more recently as an assistant instructor in martial arts. Never had call to use such a qualification thankfully.

And to be honest I'm not entirely sure how I'd react in such a circumstance. One day of training every couple of years and some practice on a dummy just doesn't seem enough to ingrain the right level of knowledge or experience?

Iain Abernethy
Iain Abernethy's picture

PASmith wrote:
One day of training every couple of years and some practice on a dummy just doesn't seem enough to ingrain the right level of knowledge or experience?

I’d agree it is far from ideal, and it certainly does not make one a expert, but the process of CPR is relatively simple and I believe that most people will be able to deliver it as prescribed following such training … providing the shock of the situation is not overwhelming.

In my case, almost all incidents in the dojo have been relatively minor (bumps and bruises). We’ve had unconsciousness as a result of strangles, but the correct process was followed, and consciousness quickly regained. Many years ago, I was sitting next to a gent that had a heart attack during a break on a karate course we were both on. In that case I alerted everyone, and an off-duty police officer quickly took charge. Ambulance was there quick, and all was well.

The ones that needed me to do something significant have all been outside the dojo i.e. choking on food, child knocked unconscious falling from their bike, significant cuts, etc.

In addition to my martial arts first aid training (done every few years), I used to get a little bit more in my prior profession. As an electrician in chemical plant we had training yearly in order to assist colleagues if needed. I also was a senior shop steward and safety representative, so I got a little more in those roles too. I’ve therefore probably had a little more training than most (I’d guess at 25+ courses). Nevertheless, I would not claim high degrees of confidence or competence … but to date I’ve always manged to do the right thing when required.

Worth remembering our job as first aiders is to summon the experts and stop things getting worse until they arrive. The emergency services often stay on the line and provide guidance too. A charged mobile phone with a signal is arguably more important than our first aid kits.  

On the courses I have done, we were always provided with revision materials to refer too. And there are good resources specifically aimed at martial artists (i.e. Peter’s book). Memory jogging between formal courses is therefore a good idea.

In other threads we have likened self-defence training to first aid training. Both are life skills that cover the functional basics. They both have a specific goal and focus. First aid aims to give us the skills needed to stop things getting worse until the experts can get there. Self-defence covers personal security skills and back up physical actions to help avoid harm from criminal activity. First aid does not make one brain surgeon. Self-defence training does not make one a skilled fighter. However, first aid does not need someone to perform brain surgery (not what the situation requires). Likewise, self-defence does not need advanced fighting skills (not what the situation requires).

First aid training is designed to give us the skills to stop things getting worse while the exerts are on their way … and in the modern age it is very likely you will have another expert on the phone (in contact with those on route) who will be able to advise and guide. Whilst more training is always better, I can see how training every few years minimum would be enough to ensure competence in this scenario for the majority. I also think it’s a good idea for any given club to have multiple trained first aiders. That too will help ensure there are always people on hand who can help.

All the best,

Iain

Neil Babbage
Neil Babbage's picture

One thing that has changed significantly in recent years is the wide availability of AEDs. Many / most sports halls, gyms and leisure centres will have an AED and someone who knows how to use it. They are cheap enough that large clubs might consider investing in their own. While not a panacea they have improved the immediate treatment of heart attacks and survivability.  For statistics see https://www.sciencedaily.com/releases/2018/02/180226085812.htm  

Among the study's results [a study of 49,555 out-of-hospital cardiac arrests in the US and Canada]:

• Cardiac arrest victims who received a shock from a publicly-available AED had far greater chances of survival and being discharged from the hospital than those who did not; 66.5 percent versus 43 percent.

• Cardiac arrest victims who received a shock from a publicly-available AED that was administered by a bystander had 2.62 times higher odds of survival to hospital discharge and 2.73 times more favorable outcomes for functioning compared to victims who first received an AED shock after emergency responders arrived.

• Victims who received an AED shock from a bystander (57.1 percent) using a publicly-available device instead of having to wait for emergency responders (32.7 percent) had near normal function and better outcomes.

• Without a bystander using AED shock therapy, 70 percent of cardiac arrest patients either died or survived with impaired brain function.

Iain Abernethy
Iain Abernethy's picture

Neil Babbage wrote:
One thing that has changed significantly in recent years is the wide availability of AEDs. Many / most sports halls, gyms and leisure centres will have an AED and someone who knows how to use it.

The last First Aid course our club did covered the use of AEDs (Automated External Defibrillator) and it’s my understanding their use is now a mandatory unit on all recognised first aid courses. They are very simple to use (another example of where movies and TV have lied to us). They are also in many public places now due to a long-standing government initiative.  One of the old phone boxes on the street adjacent to my home as one in that can be released for public use by calling the emergency services. As Neil as pointed out, the use of AEDs significantly improves the chances of a positive outcome; which would account for their widespread distribution in public places (at least in the UK) and First Aid training ensuring lots of people know how to use them.

All the best,

Iain  

PASmith
PASmith's picture

The last First Aid course our club did covered the use of AEDs (Automated External Defibrillator) and it’s my understanding their use is now a mandatory unit on all recognised first aid courses.

Yep. The last first aid course I did organised by the TAGB (couple of years ago now) had that component. Really worth doing as it explains that actually they almost work by themselves once placed correctly and that helps remove the worry about trying to use one.

Iain Abernethy
Iain Abernethy's picture

PASmith wrote:
Really worth doing as it explains that actually they almost work by themselves once placed correctly and that helps remove the worry about trying to use one.

Totally agree. Not recommending skipping the training, but I’m pretty sure that even someone with no training at all would be able to follow the images on the pads and the audio instructions and hence use them successfully.

All the best,

Iain

Tau
Tau's picture

I've been reading this thread with interest. There is some great information on here. It is funny how defibrillation was not so long ago something you only ever saw on television being performed by consultant A&E doctors in hospital and now anyone can be trained to do it and the equipment is often close by. I have performed defibrillation and it is indeed relatively easy. The public devices make it almost foolproof.

I've long since maintained that learning and teaching martial arts and first aid have a lot of commonalities. One that I am keen to assert is that simplicity is key. Typically the most effective pragmatic self protection skills are gross motor skills with clear priorities. It is the same for first aid. Trust me when I say the ABC system works.

However there is something not covered here that I think is poorly taught yet is important. And indeed there is commonality between first aid and self protection scenarios. That is, the aftermath. In martial arts we may talk of the black dog. CPR is horrible and I wish instructors would express this so as to ensure students understood this. 

I joked earlier in this thread but I would like to quote from my book here because I stand by my words and there's no point re-typing them:

I need to conclude this section with honesty. CPR is horrible. It’s traumatic for everyone involved, it’s undignified. And it usually doesn’t work. For someone to have a cardiac arrest there must be something seriously medically wrong with them and it’s highly unlikely that we’ll be able to fix that in the dojo. The victim’s eyes are usually open, staring at you. There may be vomit. You will usually fracture their ribs or sternum in the course of performing CPR.

The objective of CPR is to keep them in such a condition as expert health care professionals will have a chance to do something. If you’ve done a first aid course then you should have been told of the poor chances of actually succeeding. But it’s important to try. And as a martial artist, try your damn hardest, even in the face of probable failure. Don’t give in unless you have to. Why? Because you might succeed. You might save that life. You might keep them in a state such that health care professionals can give the drugs or stick in a needle to relieve pressure on a lung. And because you’ll probably see the person’s family in the future and you need to be able to look them in the eye and be able to tell them with honesty that you did your best. You also need to be sure that you did your best and you need to not beat yourself up if you didn’t succeed. All health professionals who have done CPR will tell you that they’ve failed more than they’re succeeded. Yes, that includes me.

I said at the start of this chapter that CPR is a lot like self protection skills. I hope you never need to attempt CPR. But I also hope you get and keep the skills for the day that you may need to!