Resuscitation 92 (2015) e15
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Overestimated electrical exposure risk associated with hands-on defibrillation? Sir, We congratulate Lemkin et al. on their recent well-done study measuring a plausible worst-case energy-transfer scenario that rescuers might encounter while performing routine resuscitative measures.1 However, we are concerned that the conclusions may overstate the risks, and potentially cause rescuers even greater fear of inadvertent shock, resulting in yet longer pauses in CPR. The authors’ estimation of electrical hazard for contact used the assumption that contact would be between two anatomic sites with some finite distance between them, and mention that a shock hazard exists even if the only points of contact are both hands on top of the chest; however, in standard CPR, the hands are placed at the same location on the chest.2,3 Consequently, the value of the variable Vrescuer in most, if not all, scenarios, is likely to be 0, and the derived rescuer-received dose (RRD) would likewise be 0 in the vast majority of cases. The alternative case of contact by additional other body parts may offer a mechanism for greater RRD, but given the fact that little evidence exists that any rescuer or bystander has ever been seriously harmed by receiving an inadvertent shock,4 it appears that this is an unlikely (multi-fault mechanism) scenario. We therefore advise caution before generating unnecessary fear or hesitancy in rescuers attempting to provide optimal care for their patients. Conflict of interest statement No authors have any conflicts of interest relevant to this work.
http://dx.doi.org/10.1016/j.resuscitation.2015.01.037 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.
References 1. Lemkin DL, Witting MD, Allison MG, Farzad A, Bond MC, Lemkin MA. Electrical exposure risk associated with hands-on defibrillation. Resuscitation 2014;85:1330–6. 2. Owen A, Harvey P, Kocierz L, Lewis A, Walters J, Hulme J. A randomised control trial comparing two techniques for locating chest compression hand position in adult basic life support. Resuscitation 2011;82:944–6. 3. You JS, Chung SP, Park JY, et al. The utility of the HeartSaver Sticker for maintaining correct hand position during chest compressions. J Emerg Med 2012;43:184–9. 4. Kurz MC, Sawyer KN. Reply to letter: risk of injury to rescuers who use hands-on defibrillation. Resuscitation 2013;84:e133.
Erik Kulstad ∗ Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL 60453, United States Michael Garrett Garrett Technologies, 1955 Techny Rd., Suite #1, Northbrook, IL 60062, United States Melissa Naiman Center for Advanced Design, Research, and Exploration (CADRE), University of Illinois at Chicago, 1737W. Polk St., Suite B14, Chicago, IL 60612, United States Frank Garrett Garrett Technologies, 1955 Techny Rd., Suite #1, Northbrook, IL 60062, United States ∗ Corresponding
author at: Advocate Christ Medical Center, Department of Emergency Medicine, Oak Lawn, IL, United States. E-mail address: [email protected] (E. Kulstad) 23 January 2015
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Overestimated electrical exposure risk associated with hands-on defibrillation? Sir, We congratulate Lemkin et al. on their recent well-done study measuring a plausible worst-case energy-transfer scenario that rescuers might encounter while performing routine resuscitative measures.1 However, we are concerned that the conclusions may overstate the risks, and potentially cause rescuers even greater fear of inadvertent shock, resulting in yet longer pauses in CPR. The authors’ estimation of electrical hazard for contact used the assumption that contact would be between two anatomic sites with some finite distance between them, and mention that a shock hazard exists even if the only points of contact are both hands on top of the chest; however, in standard CPR, the hands are placed at the same location on the chest.2,3 Consequently, the value of the variable Vrescuer in most, if not all, scenarios, is likely to be 0, and the derived rescuer-received dose (RRD) would likewise be 0 in the vast majority of cases. The alternative case of contact by additional other body parts may offer a mechanism for greater RRD, but given the fact that little evidence exists that any rescuer or bystander has ever been seriously harmed by receiving an inadvertent shock,4 it appears that this is an unlikely (multi-fault mechanism) scenario. We therefore advise caution before generating unnecessary fear or hesitancy in rescuers attempting to provide optimal care for their patients. Conflict of interest statement No authors have any conflicts of interest relevant to this work.
http://dx.doi.org/10.1016/j.resuscitation.2015.01.037 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.
References 1. Lemkin DL, Witting MD, Allison MG, Farzad A, Bond MC, Lemkin MA. Electrical exposure risk associated with hands-on defibrillation. Resuscitation 2014;85:1330–6. 2. Owen A, Harvey P, Kocierz L, Lewis A, Walters J, Hulme J. A randomised control trial comparing two techniques for locating chest compression hand position in adult basic life support. Resuscitation 2011;82:944–6. 3. You JS, Chung SP, Park JY, et al. The utility of the HeartSaver Sticker for maintaining correct hand position during chest compressions. J Emerg Med 2012;43:184–9. 4. Kurz MC, Sawyer KN. Reply to letter: risk of injury to rescuers who use hands-on defibrillation. Resuscitation 2013;84:e133.
Erik Kulstad ∗ Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL 60453, United States Michael Garrett Garrett Technologies, 1955 Techny Rd., Suite #1, Northbrook, IL 60062, United States Melissa Naiman Center for Advanced Design, Research, and Exploration (CADRE), University of Illinois at Chicago, 1737W. Polk St., Suite B14, Chicago, IL 60612, United States Frank Garrett Garrett Technologies, 1955 Techny Rd., Suite #1, Northbrook, IL 60062, United States ∗ Corresponding
author at: Advocate Christ Medical Center, Department of Emergency Medicine, Oak Lawn, IL, United States. E-mail address: [email protected] (E. Kulstad) 23 January 2015
