The Survival Wheel Richard E. Nicholson, M.D.
Dr. Nicholson is Medical Director, Connecticut Mutual Life Insurance Company, Hartford, Connecticut. He currently serves as Chairman of the Emergency Cardiac Care Task Force for the Connecticut Heart Association and the New England Regional Heart Association.
The following is suggested lecture material using the Survival Wheel (Figure 1) as an introduction to a CPR course. A pointer should be used to indicate the various subjects on the Survival Wheel as they are discussed. This material may be expanded for presentation to in-plant groups, community groups, etc.
disease is the leading cause of death in the H eart United States today . Fifty-four percent of all deaths are attributed to disorders of the heart and blood vessels . Fact: Over three million Americans have coronary heart disease. Fact: Over one million Americans have heart attacks each year and almost 700,000 die . Fact: Half of these die before they reach the hospital. Heart attack has reached epidem ic proportions in the United States and, although there has been improvement in heart disease mortality in the past few years , the change has not been dramatic. Card iopulmonary resuscitation is only one spoke of a Wheel of Survival - of a Stratified System of Life Support, scaled for survival in the face of ep idemic odds. When CPR becomes necessary, the damage has been done! When CPR becomes necessary, it may be too late! At that moment you, as a rescuer, are confronted with sudden death . What is needed , then, is a plan of prevention. What is needed is a long-range plan for survival. A plan of survival geared for the actual moment of cr isis. Occupational Health Nursing, September 1977
Prudent Living is essential to survival. Prudent heart living is a life style that minimizes the risk of future heart disease . It includes: weight control, physical fitness, sensible nutrition , avoidance of cigarette smoking, control of high blood pressure, reduction of blood cholesterol and fatty acids by careful selection of foods in the daily diet, reduction of alcohol consumption, and a periodic check-up by your friendly neighborhood physician! Certain High Risk Factors are known to contribute to early heart attack and stroke. Early awareness of these risk factors and doing something about them through a life style that rnlnlrnlzes the risk of future heart disease is, again, essent ial to survival. The risk factors wh ich seem to contribute to early heart attack and stroke are: cigarette smoking, high blood pressure, increased fats in the blood stream (cholesterol and triglyceridesJ, diets high in hard fats and cholesterol, overweight, a sedentary life with lack of exercise, increased tensions and anxiet ies, diabetes mellitus, and family history of early death from heart disease especially heart attacks. For example, a man who smokes more than one pack of cigarettes a day has nearly twice the risk of heart attack and nearly five times the risk of stroke as the non-smoker. A man whose blood pressure is over 150 systolic has more than two times the risk of heart attack and nearly four times the risk of stroke as a man with systolic blood pressure below 120. A man with a blood cholesterol of 250 or above has about three times the risk of heart attack and stroke of a man with cholesterol below 194. But, the greatest single risk factor is SEX! This does not 13
..
ENTER HERE PRUDENT LIVING
CHANGE IN LIFE STYLE
HIGH RISK FACTORS
REHABILITATION
PLANS FOR ENTRY INTO SURVIVAL SYSTEM
CORONARY CARE UNIT (ADVANCED) EMERGENCY ROOM (ADVANCED)
THE SURVIVAL WHEEL
MOBILE LIFE SUPPORT (BASIC AND ADVANCED)
SIGNALS FOR SURVIVAL CRISIS ACTION DON'T DELAY - GET HELP
ADVANCED LIFE SUPPORT (ON-SPOT STABILIZATION)
ENTER SURVIVAL SYSTEM CPR BASIC LIFE SUPPORT
FIGURE 1 THE SURVIVAL WHEEL
mean the horizontal type but rather gender type sex. It's the man who pays with 5 to 20 times more heart attacks than women, and accounts for the fact that there are four widows to everyone widower. So, who says "the weaker sex"! We don't know what protects the female from early atherosclerosis - the blocking of the vital arteries of the heart and brain by greasy rust-colored plaques of fats and cholesterol - but it is probably those "happy hormones" - the female sex hormones. However, in recent years women are beginning to catch up in the heart attack sweepstakes regardless of these circulating hormones and this is thought to be mainly due to the increase in cigarette smoking among young women. Since the female is being liberated on every other front, perhaps she wants to equalize with men in the Heart Attack Follies as well. Every family, every person, especially those living alone should have a well-prepared plan for emergencies - for Entry into a System of Life Survival Units. Precious moments should not be wasted in cardiac or stroke crises when seconds count. Is the telephone number 911 available in the community for handling all emergencies? If not, emergency phone numbers police, fire, ambulance, physician should be in one easily accessible location, usually the front of the telephone directory. Each family, each person should be thoroughly familiar 14
with the type emergency facilities offered in the community. Are advanced Mobile LifeSupport Units available? Is the emergency service by commercial, municipal or volunteer units available? What emergency medical services are offered by the police? By the fire department? Where are the hospitals in the community? And especially where are the emergency rooms located within these hospitals? What are the capabilities of these hospitals in handling cardiac emergencies? In the emergency room? In the Cardiac Care Unit? Enroute to the Cardiac Care Unit? Thus a few moments of meaningful thought advanced plans for Entry into a System of Life Survival may make that difference between life and death when seconds count. Signals for Survival are those early warning signs of impending heart crisis: An uncomfortable pressure, squeezing, fullness or pain in the center of the chest, behind the breast bone which may spread to the shoulder, neck or arms (the pain may not be severe). Other signals may include nausea, vomiting, profuse sweating, shortness of breath and a feeling of weakness. With such symptoms act at once! There should be no delay! The patient, family, friend or stranger should put into operation at once the prepared plan for entry into a life survival system. Denial of these Signals for Survival as being due to a heart attack is very commonplace. This is in itself an inherent technique for Survival since to admit those fatal
NICHOLSON
words "heart attack" is to imply for many certain and inevitable doom. Such denial leads to an average delay of three to five hours from onset of symptoms to a call for medical help. But there is a greater chance of Survival if correct action is taken within two minutes of these heart signals. When the CRISIS of sudden death does occur then action must begin at once. Do not delay! Get help for the victim! Enter into the Survival System operative in your community: Begin one-man CPR for witnessed or unwitnessed cardiac arrest. Call for help. When another rescuer arrives, begin two-man CPR. One of the longrange goals of the American Heart Association is to have a trained CPR rescuer at the side of the victim, and in survival action within one minute of sudden cardiac arrest. Rescue teams should be summoned by the telephone number 911, if available. Such teams must be trained in basic life support CPR. They should be trained in Advanced Life Support, skilled in definitive treatment and use of adjunctive survival equipment. They should be in voice contact with a hospital-based physician. The victim should be stabilized on the spot prior to transportation to the hospital. Such stabilization should be maintained by Mobile Life Support to the hospital through both basic and advanced survival methods as standardized by the American Heart Association. An estimated 100,000 lives each year can be salvaged by such Basic CPR and Advanced Life Support techniques. The hospital emergency room should be alerted and should be prepared to take over when the rescue vehicle
arrives, applying again tnose Standards advocated by the American Heart Association for Advanced Life Support. Certain hospitals in a community should be designated by the American Heart Association as meeting high Standards for cardiac care: in the Emergency Room, enroute to the Coronary Care Unit and in the Coronary Care Unit itself. Once the crisis has passed and the cardiac patient is recovering, the next phase of Survival begins: planned and progressive Rehabilitation of not just the damaged heart alone but the person as a whole. A Change in Life Style is invariably necessary in order to attain and maintain good cardiac status as well as a healthy physical and mental well-being. This life style change may not be easy but it is necessary in Survival. Each and everyone of us must realize that once there has been an attack on your heart by you - as indeed a heart attack is - there is a high risk of another attack occurring within five years. Thus, attention to each one of the steps of Survival becomes more critical the second time around the Cardiac Survival Wheel: A more prudent form of heart living - increased awareness of those risk factors which contribute to heart attack - advanced plans for action in case of crisis - no delay - alert to the Signals for Survival - getting help fast - family members learning CPR - support of better community cardiac care through education of the general public in Basic Life Support CPR - through Advanced and Mobile Life Support Units - and through improved hospital emergency facilities and procedures. For it is only through application of these elements of Survival that we in America can hope to save those hearts too good to die.
25th Annual AAOHN Presidents' Meeting New York, New York
Biltmore Hotel
October 1 & 2, 1977 Occupational Health Nursing. September 1977
15
Dr. Nicholson is Medical Director, Connecticut Mutual Life Insurance Company, Hartford, Connecticut. He currently serves as Chairman of the Emergency Cardiac Care Task Force for the Connecticut Heart Association and the New England Regional Heart Association.
The following is suggested lecture material using the Survival Wheel (Figure 1) as an introduction to a CPR course. A pointer should be used to indicate the various subjects on the Survival Wheel as they are discussed. This material may be expanded for presentation to in-plant groups, community groups, etc.
disease is the leading cause of death in the H eart United States today . Fifty-four percent of all deaths are attributed to disorders of the heart and blood vessels . Fact: Over three million Americans have coronary heart disease. Fact: Over one million Americans have heart attacks each year and almost 700,000 die . Fact: Half of these die before they reach the hospital. Heart attack has reached epidem ic proportions in the United States and, although there has been improvement in heart disease mortality in the past few years , the change has not been dramatic. Card iopulmonary resuscitation is only one spoke of a Wheel of Survival - of a Stratified System of Life Support, scaled for survival in the face of ep idemic odds. When CPR becomes necessary, the damage has been done! When CPR becomes necessary, it may be too late! At that moment you, as a rescuer, are confronted with sudden death . What is needed , then, is a plan of prevention. What is needed is a long-range plan for survival. A plan of survival geared for the actual moment of cr isis. Occupational Health Nursing, September 1977
Prudent Living is essential to survival. Prudent heart living is a life style that minimizes the risk of future heart disease . It includes: weight control, physical fitness, sensible nutrition , avoidance of cigarette smoking, control of high blood pressure, reduction of blood cholesterol and fatty acids by careful selection of foods in the daily diet, reduction of alcohol consumption, and a periodic check-up by your friendly neighborhood physician! Certain High Risk Factors are known to contribute to early heart attack and stroke. Early awareness of these risk factors and doing something about them through a life style that rnlnlrnlzes the risk of future heart disease is, again, essent ial to survival. The risk factors wh ich seem to contribute to early heart attack and stroke are: cigarette smoking, high blood pressure, increased fats in the blood stream (cholesterol and triglyceridesJ, diets high in hard fats and cholesterol, overweight, a sedentary life with lack of exercise, increased tensions and anxiet ies, diabetes mellitus, and family history of early death from heart disease especially heart attacks. For example, a man who smokes more than one pack of cigarettes a day has nearly twice the risk of heart attack and nearly five times the risk of stroke as the non-smoker. A man whose blood pressure is over 150 systolic has more than two times the risk of heart attack and nearly four times the risk of stroke as a man with systolic blood pressure below 120. A man with a blood cholesterol of 250 or above has about three times the risk of heart attack and stroke of a man with cholesterol below 194. But, the greatest single risk factor is SEX! This does not 13
..
ENTER HERE PRUDENT LIVING
CHANGE IN LIFE STYLE
HIGH RISK FACTORS
REHABILITATION
PLANS FOR ENTRY INTO SURVIVAL SYSTEM
CORONARY CARE UNIT (ADVANCED) EMERGENCY ROOM (ADVANCED)
THE SURVIVAL WHEEL
MOBILE LIFE SUPPORT (BASIC AND ADVANCED)
SIGNALS FOR SURVIVAL CRISIS ACTION DON'T DELAY - GET HELP
ADVANCED LIFE SUPPORT (ON-SPOT STABILIZATION)
ENTER SURVIVAL SYSTEM CPR BASIC LIFE SUPPORT
FIGURE 1 THE SURVIVAL WHEEL
mean the horizontal type but rather gender type sex. It's the man who pays with 5 to 20 times more heart attacks than women, and accounts for the fact that there are four widows to everyone widower. So, who says "the weaker sex"! We don't know what protects the female from early atherosclerosis - the blocking of the vital arteries of the heart and brain by greasy rust-colored plaques of fats and cholesterol - but it is probably those "happy hormones" - the female sex hormones. However, in recent years women are beginning to catch up in the heart attack sweepstakes regardless of these circulating hormones and this is thought to be mainly due to the increase in cigarette smoking among young women. Since the female is being liberated on every other front, perhaps she wants to equalize with men in the Heart Attack Follies as well. Every family, every person, especially those living alone should have a well-prepared plan for emergencies - for Entry into a System of Life Survival Units. Precious moments should not be wasted in cardiac or stroke crises when seconds count. Is the telephone number 911 available in the community for handling all emergencies? If not, emergency phone numbers police, fire, ambulance, physician should be in one easily accessible location, usually the front of the telephone directory. Each family, each person should be thoroughly familiar 14
with the type emergency facilities offered in the community. Are advanced Mobile LifeSupport Units available? Is the emergency service by commercial, municipal or volunteer units available? What emergency medical services are offered by the police? By the fire department? Where are the hospitals in the community? And especially where are the emergency rooms located within these hospitals? What are the capabilities of these hospitals in handling cardiac emergencies? In the emergency room? In the Cardiac Care Unit? Enroute to the Cardiac Care Unit? Thus a few moments of meaningful thought advanced plans for Entry into a System of Life Survival may make that difference between life and death when seconds count. Signals for Survival are those early warning signs of impending heart crisis: An uncomfortable pressure, squeezing, fullness or pain in the center of the chest, behind the breast bone which may spread to the shoulder, neck or arms (the pain may not be severe). Other signals may include nausea, vomiting, profuse sweating, shortness of breath and a feeling of weakness. With such symptoms act at once! There should be no delay! The patient, family, friend or stranger should put into operation at once the prepared plan for entry into a life survival system. Denial of these Signals for Survival as being due to a heart attack is very commonplace. This is in itself an inherent technique for Survival since to admit those fatal
NICHOLSON
words "heart attack" is to imply for many certain and inevitable doom. Such denial leads to an average delay of three to five hours from onset of symptoms to a call for medical help. But there is a greater chance of Survival if correct action is taken within two minutes of these heart signals. When the CRISIS of sudden death does occur then action must begin at once. Do not delay! Get help for the victim! Enter into the Survival System operative in your community: Begin one-man CPR for witnessed or unwitnessed cardiac arrest. Call for help. When another rescuer arrives, begin two-man CPR. One of the longrange goals of the American Heart Association is to have a trained CPR rescuer at the side of the victim, and in survival action within one minute of sudden cardiac arrest. Rescue teams should be summoned by the telephone number 911, if available. Such teams must be trained in basic life support CPR. They should be trained in Advanced Life Support, skilled in definitive treatment and use of adjunctive survival equipment. They should be in voice contact with a hospital-based physician. The victim should be stabilized on the spot prior to transportation to the hospital. Such stabilization should be maintained by Mobile Life Support to the hospital through both basic and advanced survival methods as standardized by the American Heart Association. An estimated 100,000 lives each year can be salvaged by such Basic CPR and Advanced Life Support techniques. The hospital emergency room should be alerted and should be prepared to take over when the rescue vehicle
arrives, applying again tnose Standards advocated by the American Heart Association for Advanced Life Support. Certain hospitals in a community should be designated by the American Heart Association as meeting high Standards for cardiac care: in the Emergency Room, enroute to the Coronary Care Unit and in the Coronary Care Unit itself. Once the crisis has passed and the cardiac patient is recovering, the next phase of Survival begins: planned and progressive Rehabilitation of not just the damaged heart alone but the person as a whole. A Change in Life Style is invariably necessary in order to attain and maintain good cardiac status as well as a healthy physical and mental well-being. This life style change may not be easy but it is necessary in Survival. Each and everyone of us must realize that once there has been an attack on your heart by you - as indeed a heart attack is - there is a high risk of another attack occurring within five years. Thus, attention to each one of the steps of Survival becomes more critical the second time around the Cardiac Survival Wheel: A more prudent form of heart living - increased awareness of those risk factors which contribute to heart attack - advanced plans for action in case of crisis - no delay - alert to the Signals for Survival - getting help fast - family members learning CPR - support of better community cardiac care through education of the general public in Basic Life Support CPR - through Advanced and Mobile Life Support Units - and through improved hospital emergency facilities and procedures. For it is only through application of these elements of Survival that we in America can hope to save those hearts too good to die.
25th Annual AAOHN Presidents' Meeting New York, New York
Biltmore Hotel
October 1 & 2, 1977 Occupational Health Nursing. September 1977
15
