What’s it like to save a life?

An adrenalin-charged rollercoaster ride. Even Royal Life Saving Australia chief executive Justin Scarr,who has taught thousands of people how to do CPR,found doing chest compressions and mouth-to-mouth under pressure was shocking.

Scarr was enjoying his breakfast at a hotel in the Maldives while on a surfing trip when he had to resuscitate a small child. Always watchful of anyone in a pool,Scarr had noticed the boy in the pool earlier. When he spotted an older man looking worried,Scarr discovered that the boy had “slipped off the edge directly into deep water”.

“The boy’s jaw was clenched and it was hard to open his airway.”

Scarr pulled the boy out of the water and started doing mouth-to-mouth. Other holidaymakers tried to stop him,unaware of his background.

“The boy’s jaw was clenched and it was hard to open his airway,” Scarr says. “Judging by his condition and recovery,the boy had been on the bottom for minutes,somewhere between three and seven minutes,maybe. He was unconscious and not breathing. He may have had a pulse still but it was difficult to assess in that condition.”

At that point,time stood still,says Scarr. “It felt like I was surrounded by an amphitheatre of onlookers. I felt incredibly nervous and worried that this tiny boy,blue and limp,would die,and I wouldn’t be able to save him.”

Then the boy started moving.

“It reinforced how acting quickly can make a difference and how the training does come back. CPR really does save lives. Drowning is a breathing emergency – mouth-to-mouth really does matter,” says Scarr.

For the rest of the vacation,the child became known as the “luckiest boy in the world to be saved by the head of Royal Life Saving Society Australia”.

As well as teaching CPR for more than 40 years,Terry McCallum has performed CPR many times in an emergency. “This will sound strange:I have lost count,” he says. Former students will call to tell him they saved a life using CPR. “If you are doing CPR,your adrenalin will go through the stratosphere. And when you come back down,you will be shaky,” says McCallum.

As I finished writing this story,we had a family emergency and I called triple zero after a relative appeared to have stopped breathing.

Very,very shaky,I discovered. As I finished writing this story,we had a family emergency and I called triple zero after a relative appeared to have stopped breathing. My heart started banging. I found it difficult to talk,and to think clearly.

But given I had just done a training course (run by McCallum),I did feel more confident under pressure and could remember to follow many of the steps that I had been taught. With help from NSW Ambulance’s call taker,Jo,who stayed on the line with me for 27 minutes,my relative recovered well. In a coincidence,an ambulance heading to my house was diverted to go to the aid of someone nearby who had arrested.

How common are cardiac arrests (and how often do people do CPR)?

Unlike with a heart attack,a person who has had a cardiac arrest has stopped breathing. The heart has stopped adequately pumping blood,which carries vital oxygen to the brain.

The longer that person goes without oxygen,the more likely they are to have neurological problems if they are resuscitated later (it takes from four to six minutes for brain cells to start dying).

In contrast,a person who had a heart attack will be breathing and complaining of chest pains,says the Australian Heart Foundation. Unless that person suffers a cardiac arrest,too,they won’t need CPR. But they will need an ambulance and should go to a hospital as soon as possible.

Minutes passed. None of the coaches,trainers and others trained in first aid recognised that he had had a cardiac arrest.

A report by NSW Ambulance found most cardiac arrests are caused by heart attack or other heart issues. They are also triggered by respiratory failure,a stroke,blunt trauma,sudden infant death syndrome,a drug overdose,drowning,suicide,or snake and spider bite.

Cardiac arrests account for one in eight deaths in Australia,dwarfing the number of people who die on the roads.

Data from the Australian Resuscitation Outcomes Consortium (Aus-ROC) cardiac arrest registry shows 26,000 people have a cardiac arrest in the community each year in Australia.

Only 1400 survive.

It is a similar story across the world. Very often,onlookers don’t even recognise the signs.

In 2018,a US professional basketballer,26-year-old Zeke Upshaw,collapsed and died in the middle of a game in front of thousands of spectators on the court and watching at home. Minutes passed. None of the coaches,trainers and others trained in first aid recognised that he had had a cardiac arrest or started CPR promptly.

If the survival rate is low,the statistics are encouraging where first-aiders do step in. “We know that people who get bystander CPR have double the chance of survival,” says Janet Bray,an associate professor at Monash University. “People who get an AED[an automated external defibrillator] shock have triple the chance.”

Given that 20,000 of the 26,000 cardiac arrests each year happen in homes,it’s vital that everyone knows how to perform CPR,says Bray,the chair of the Aus-ROC Registry.

Where did CPR come from?

The hope of bringing someone back from death is an old one. The ancient Egyptians attempted to shock people back to life using rectal fumigation and enemas administered byneru phuytor “guardians of the anus”. The Bible includes an account of Elisha reviving a dead boy by applying “mouth-to-mouth,eyes to eyes,hands to hands”. “As he stretched himself out on him,the boy’s body grew warm.”

InPericles,Prince of Tyre,William Shakespeare wrote that “death may usurp on nature many hours. And yet the fire of life kindle again.”

By the 1700s,another procedure involved blowing tobacco smoke into the victim’s rectum;others used fire bellows to reinflate the lungs. Dr John Curry,author ofPopular Observations on Apparent Deaths from Drowning,Suffocation,etc.,of 1792,reported on the differences between apparent death “which only lies dormant” and absolute death,“in which the vital principle is completely extinguished”.

A history of modern CPR in the Journal of the Royal Society of Medicinefinds that chest compressions and mouth-to-mouth have been used intermittently over time,only to be discarded. Dr Raymond Hurt writes that a description of compressions by a Dr John in 1868 could be a present-day description of cardiac massage:“The right hand was now crossed over the left and forcible pressure made;the hands then being suddenly removed,the chest was allowed to expand by its elasticity.”

In Sydney in the 1950s,the Royal Life Saving Society of Australia tested four methods of artificial respiration on 12 volunteers (mostly lifesavers).

“The man will die in three to four minutes if he doesn’t receive oxygen so he must be kept alive by artificial respiration ...”

“This patient is about to be drowned,” warns a black and white film made by ABC Television,of the experiments. To stop the volunteer’s breathing,each was given a lethal dose of poison – a “jungle juice”.

“Physiologically,he will be like a man drowned or asphyxiated,” says the narrator. “The man will die in three to four minutes if he doesn’t receive oxygen,so he must be kept alive by artificial respiration until the effects of the curare[the poison] wear off.”

Experts attempted to resuscitate the male volunteers using four different techniques,including today’s mouth-to-mouth technique.

The less successful methods are shown above:the hip lift;the Silvester (arms pulled back above the head);and the Holger Nielsen (patient face down,bent arms pulled). One of the volunteers was kept alive for an hour using different methods of artificial respiration.

Following these tests,mouth-to-mouth was adopted worldwide. The dozen men survived to receive British Empire Medals for heroism and bravery. As volunteer Allan Simpson recalled in 2009,when he was 70,“I know they had stopped me breathing,and that was a big thing,it was a simulated drowning. I felt someone had to do it,and it was a good thing for medical research.”

McCallum tells us the history of Resusci Annie,the mannequin invented in the 1950s by Norwegian toymaker Asmund Laerdal to help people learn CPR. The face of the mannequin is based on a death mask of a young woman who drowned in the Seine in Paris in the late 1880s. Estimated to be only 16,the woman’s body was put on show for identification.

“She might not have lived to tell the tale,but she has transformed training for medical emergencies.”

“She is the face that we have all kissed during practice for cardiopulmonary resuscitation,but do we ever stop and wonder about the story behind this mesmerising face?” write researchers inTheBritish Medical Journal.

Today’s mannequins are also called L’Inconnue de la Seine (Unknown Woman of Seine),the Mona Lisa of the Seine and The Most Kissed Girl in the World. “She might not have lived to tell the tale,but she has transformed training for medical emergencies and saved many lives,” they write.

Can anyone learn how to do CPR?

If I can,you can.

At a course run by McCallum and attended by a mix of swimming teachers,lifeguards,administrators and others from Carlile Swimming Lane Cove West,it took just two hours to learn how to do chest compressions,mouth-to-mouth and to use a defibrillator. Some courses teach it in 20 minutes.

Because teaching CPR should be something that people should remember,McCallum’s course is infotainment at its best – some black humour,compelling details and practical advice that makes his messages stick.

First,he explains the terms involved. Cardio (meaning heart) and pulmonary (lungs) resuscitation add up to CPR,a combination of chest compressions and rescue breathing (commonly called mouth-to-mouth or the kiss of life).

Then he begins with the question,“What am I trying to achieve?”

“Preserving life,” he tells the class. “The chances of someone sitting up and saying hello before the ambulance arrives is only about 7 per cent. They’re usually down there,” he says pointing to the ground where a mannequin lies,“because of some medical condition.”

“The aim of CPR is keeping the cells of the brain alive until the paramedics get there.”

“You doing CPR is not going to fix that,” he says. “The aim of CPR is keeping the cells of the brain alive until the paramedics get there. ”

McCallum is also blunt about the stamina required to do CPR,which he says is not conveyed in online videos. “[CPR] is brutally physical,” he says. “I don’t care how often you go to the gym. You’re going to wear out after three minutes,which will seem like 20.”

I wore out in much less time,and pressing to a third of the depth of the chest was difficult to do.

Because it is hard to do it for a long time,McCallum coaches the class in how to ask someone else to take over doing CPR,before their hands leave the casualty’s body:“You are going to take over in a minute. Watch what I do,I am going to do 100 compressions at about two a second,and I am pressing here.”

The pace required for compressions is daunting,so experts recommend you practise ahead of time to music. New York-Presbyterian Hospital experts put together a list of catchy songs onSpotify that have the right beat to achieve the most effective rate of 100 to 120 beats per minute. Ironically,Queen’sAnother One Bites the Dust also has the optimal beat.

So,howdo you do CPR?

After checking that there is no danger to you or the casualty,McCallum says the first step is to check for a response. He recommends squeezing the person’s shoulders briskly,and calling loudly,“What’s your name? Can you hear me?” He doesn’t leave anything to chance. He is very loud.

Call for help as soon as you can by calling triple zero (000). If you are with someone else,ask them to locate an AED.

Next,check that the person’s airway (throat) is unobstructed. You may need to roll the patient on their side to remove any obstruction using your fingers (or theirs) to remove food or debris. Once it is clear,check for breathing.

If they are not breathing,roll them on their back and start CPR immediately. That means chest compressions at a rate of 100 to 120 a minute. If you are also doing mouth-to-mouth,do 30 chest compressions then two breaths,and then start the process again.

McCallum tells the class some rescuers might fear breaking a patient’s ribs. In truth,ribs may break or make an ugly sound,but it is better for your patient to be alive with a broken rib than the alternative.

Some people are afraid of using a defibrillator. McCallum attributes this to television medical shows. “They have seen people jump violently,” he says. The defibrillators outside of hospitals do enough to do the job,and are not as complex or powerful as those in emergency departments. “The AED will stop the heart,allowing it to restart itself. It’s like the old tradition of whacking the top of the tele when it plays up.”

Do you have to do mouth-to-mouth?

No. If you are squeamish about doing mouth-to-mouth on a stranger,or don’t feel confident,experts recommend doing chest compressions alone. That means instead of doing 30 compressions followed by two breaths,you continue pumping the heart at 100 to 120 beats a minute for as long as you can,or until help arrives.

If you are on the phone with an ambulance dispatcher after having called triple zero,you will usually just be asked to do chest compressions only. This continues until help arrives,or you have access to an AED that allows the heart to restart.

In some cases,mouth-to-mouth is vital. Says Scarr:“Mouth-to-mouth is important for children and drowning.

“Drowning is a breathing emergency,so air/oxygen matters. With drowning,like choking,air intake into lungs is restricted,meaning the lungs receive less oxygen,impacting the ability of heart to circulate blood through the body.”

Where do you find a defibrillator?

As well as your local hospital,you will have the best chances of finding a defibrillator in community or aged care centres,local schools,shopping centres,gyms,public libraries,sporting clubs and zoos.

The US city of Seattle has one of the highest survival rates for cardiac arrest,about 62 per cent. That’s because children there learn CPR at school,and there are defibrillators on many street corners. The city has also launched anapp and a website to make it easy for the public to locate an AED in an emergency.

In Australia,only 2 per cent of people in cardiac arrest outside hospital receive an AED shock.

“Most people are highly unlikely to ever need to do CPR but if you do,it is likely to be someone close to you,your child,your family member,or your father.”

Scarr has made a mental note of the location of publicly available AEDs within 400 metres of his home in Curl Curl on Sydney’s northern beaches. “Most people are highly unlikely to ever need to do CPR but if you do,it is likely to be someone close to you,your child,your family member,or your father,” says Scarr.

If someone does go into arrest,you can perform CPR while sending someone else off to grab an AED. Some councils and ambulance services provide a list of AED locations. Many apps provide the location of AEDs,but most are patchy. Using a combination of apps,including the Heart of the Nation,St John Ambulance’s Resuscitate and Pulse Point,I located several AEDs near me,including at a local school,a Bunnings store and a Coles supermarket.

If you do have an arrest,the chances of survival may be better at a casino than the odds of winning at the pokies.

Experts writing in the journalCirculationsay stories of survival almost always include elements of immediate bystander recognition and CPR,early activation of emergency medical systems,use of an AED,and high-quality CPR by emergency services. The experts,Paul Dorian and Steve Lin,say people who had a cardiac arrest at casinos were shocked with an AED within three minutes and had a survival rate of more than 60 per cent because staff monitoring security video saw the arrests happen.

“The time intervals from collapse to bystander recognition and starting some course of action can be extremely variable. In cardiac arrest,seconds and minutes count,” write Dorian and Lin.

Unlike the tragic case of the basketballer Upshaw,most cardiac arrests inside a sporting arena or stadium have a much higher survival rate because of the presence of AEDs.An Italian study found it was near 90 per cent in some cases.

Watch a Royal Life Saving video on CPR:

Do you need to worry about being sued?

No. Most states and territories protect Good Samaritans,including volunteers and bystanders and those people who go to the rescue of another without expectation of payment or reward. “Rescuers need not fear litigation if they come to the aid of a fellow human in need,” advises the country’s top experts in the Australian Resuscitation Council.

There are no cases where a Good Samaritan has been successfully sued for rendering assistance to someone in need.

There may be moral pressure to help,but other than in the Northern Territory,Good Samaritans are under no legal obligation.

In the NT,a person who fails to come to the aid of another can potentially be jailed for up to seven years.

Once someone decides to assist,McCallum,a member of the council,says they are expected to display a standard of care appropriate to their training (or lack of training) and act at least with “good faith” and “without recklessness”.

Once you start giving assistance,McCallum taught our class that the duty of care continues until:

• The paramedics arrive and tell you they’ll take over
• It is too dangerous to continue;imagine a burning building or rising floodwaters
• The patient recovers
• The patient is declared “deceased” by a qualified professional,or
• You become physically incapable of continuing. In this case,McCallum encourages the responder to ask someone else to take over.

If a conscious person needs help,you should always ask for their consent. If the person is unconscious,consent is assumed. If a parent or caregiver is nearby,McCallum says it is always best to simply ask,“May I help?”