The Richard Dawkins Foundation for Reason and Science is reporting, via Facebook. a study that shows ‘CPR is depicted on television medical dramas as significantly more successful than it is in reality…’ (see https://www.facebook.com/RichardDawkinsFoundation?fref=nf). There are many comments to this research including
- That it is not ‘new’ because it has been well know for a long time that success rates from CPR are low; and
- That they should not publish the data as it may discourage people from attempting CPR and even if success rates are low, they’re better than nothing.
The report actually relates to a study by the University of California reported in Science Daily which reports that the survival rate for people who receive CPR is about 37% with only a 13% long term survival rate. The research was not, however, about survival rates from CPR, but survival rates as depicted on TV. The researchers watched episodes of medical dramas from 2010 and 2011 and found that on TV, 70 of patients who received CPR survived. The research was not reporting on survival rates of CPR but how CPR is depicted on TV.
There can be no argument that data on the survival rate of CPR or other treatment should not be published for fear of discouraging people. Whatever the survival rates are, they should be identified. The issue for the researchers was that they fear that people who have no exposure to CPR other than via TV will have artificial expectations of what to expect if they are ever called upon to perform it. This may lead to people stopping CPR too early as the patient hasn’t coughed and recovered as they do on TV, or they may feel they have done something wrong if the patient doesn’t recover.
That brings me to my point and why this post is on an law blog. I speak to first aiders, fire fighters and paramedics and the question often arises ‘can I be liable if I attempt CPR but there’s a poor outcome?’ The answer is ‘no’. As explained often enough, an action in negligence requires:
- A duty to act
- Failure to act as a ‘reasonable person’ and
- The failure causes the damage.
Putting aside the question of whether or not there is a duty to act, let’s assume a person with a first aid certificate attempts CPR perhaps with some poor consequences, fractured ribs and the patient dies. Even if the family could show that the responder’s technique was less than text book perfect, so what?
They would also have to prove, on the balance of probabilities or, to put that another way, that it is more likely than not, that had the CPR been performed in a text book manner, the outcome would have been different. If the survival rate is 37% then it is more likely than not that even with text book perfect CPR, the patient would not have survived. Any failing in technique did not cause the person to die, it was whatever that caused their heart to stop.
One Facebook commentator said:
As a beach Lifeguard we are told they are dead if you have to do CPR so don’t get your hopes up. I have revived many and not revived 1. It is all about team work and doing your best. What could the do sue you? OH WAIT!
The implication of ‘OH WAIT!” is that they could sue you. Speaking from Australia I remind my readers no-one has been sued for doing CPR and if anyone tries to sue in those circumstances, they’re not going to win.
People being trained in CPR should be given information on success rates so :
- They actually feel confident to have a go, knowing that doing CPR is better than doing nothing; but
- They should not have false expectations that CPR will save their patient’s life.
First aiders and others should be reassured that if the patient dies it is not their fault:
- Less than ideal technique will not be the cause of the person’s death; and
- The fact that the person died is not evidence that the first aider did not perform CPR appropriately.
The importance of this study is not to do with CPR or survival rates, but the artificial expectations that TV may create. First aid instructors, paramedics and nurses need to keep in mind that people may have unrealistic expectations and that could lead to feelings of guilt in the first aider and, for the surviving relatives, feelings that their loved one has been poorly cared for.
As the study authors conclude:
“The findings from this study emphasize the need for improved physician-patient communication and discussions around advance care planning decisions, such as CPR,” said Jaclyn Portanova, Davis School Ph.D. in Gerontology student and first author of the study. “Without these discussions, patients may rely on misinformation from TV in their decision-making.”
The same is true for first aid instructors who should communicate the reality to their students so they, to, don’t ‘rely on misinformation from TV in their decision-making’ and in their emotional response to the outcome.