Black and white cookies? Crescent rolls? Blue Moon beers? As millions of Americans in a narrow band across the country stock up on eclipse related party commodities for the first transcontinental total solar eclipse since 19181, first responders and hospitals are actively preparing for an influx of visitors to their towns and cities. Beyond the usual summer buzz in tourism capitol, Charleston, South Carolina – a city in the direct path of eclipse totality – Emergency Management and hospital officials have been meeting for months discussing how to handle the flood of over one million visitors expected to visit the state. 2
“We are preparing for a significant influx of visitors to Charleston. We plan to add four additional ambulances, two motorcycles, two marine-based paramedics, and eight additional quick response vehicles,” reports Deputy Chief Todd McGeorge of Charleston County Emergency Medical Services (EMS). McGeorge is a member of the massive team of local, state, and federal public safety agencies planning for this event.
This increase in visitors during Charleston’s already busy tourism season is expected to stress the infrastructure with gridlock traffic, internet outages, and delays for emergency responders. 3 Ambulances responding to and transporting critical patients to area hospital emergency departments may have extended transport times due to higher traffic volumes on the road. Crews also face potentially longer turnaround times in busier Emergency Departments before going back in service. These increases in overall service times result in less ambulances available to transport patients and can potentially create a backlog of emergency calls if there are not enough available units.
Patient outcomes from serious medical emergencies, including cardiac arrest, are greatly influenced on the actions of trained bystanders even when EMS is not delayed. Delays due to events such as eclipses, hurricanes, and violence make bystander intervention even more vital for victim survival.
The American Heart Association defines cardiac arrest as “the abrupt loss of heart function in a person.”4. Cardiac arrest occurs in people with or without a history of heart disease or warning signs such as chest pain. It occurs in over 350,000 people each year in the United States. The victim of cardiac arrest will die without immediate treatment but there are simple steps bystanders can take to increase the chance of survival. Bystander cardiopulmonary resuscitation (CPR) more than doubles the chance of surviving an out‐of‐hospital cardiac arrest. 5
The Cardiac Arrest Chain of Survival provides a simple way to remember the important factors that contribute to victim recovery. The links are Early Recognition and Activation of the Emergency Response System (911), Immediate high-quality Cardiopulmonary Resuscitation (CPR), Rapid Defibrillation, Basic and Advanced Emergency Medical Services, and Advanced Life Support and Postarrest Care.6
Bystander intervention encompasses Recognition through Rapid Defibrillation. These are vital functions that family, friends, and complete strangers can perform to help the victim of cardiac arrest in the first minutes before EMS arrives. Recognition is detecting if cardiac arrest may be present – when someone is not responding and not breathing normally – and reporting the emergency to 911. Many other medical emergencies such as seizures, syncopal episodes (passing out), and overdoses may present themselves similarly to cardiac arrest. These ailments also require intervention from EMS personnel – so if in doubt, 911 should be called.
If the person is not responding and is not breathing normally, CPR is the next important step that should be performed. With Hands Only CPR, rescuers push down hard and fast on the lower half of the breast bone to the beat of “Staying Alive” (at 100 times per minute). No mouth-to-mouth or rescue breathing needs to be performed with Hands Only CPR, however, if the rescuer has training in performing this step and a breathing barrier is present, two rescue breaths can be included after every set of 30 compressions. Rescue breaths must not take longer than 10 seconds so that chest compressions can be resumed with minimal hands-off time. High-quality, uninterrupted CPR delivers oxygen and blood to the brain and vital organs while the heart is unable to do so.
The next Chain of Survival link is Rapid Defibrillation which is performed with an easy-to-use Automatic External Defibrillator (AED). These devices are located in many publicly accessible areas such as workplaces, shopping malls, grocery stores, and airports. Once 911 has been called and CPR initiated, another rescuer should obtain the AED if one is nearby. While CPR continues, rescuers should turn on the AED and follow the voice prompts to apply the pads to the patient’s bare chest. The AED will provide commands to stop CPR (this is a perfect opportunity to switch who is performing compressions) and to push the shock button if indicated. Prior to pushing the shock button, rescuers should ensure everyone is standing clear of the patient. After the shock has been delivered, CPR should be resumed immediately leaving the AED on and the pads in place.
The AED will regularly prompt when it is ready to check the victim’s heart rhythm again and will advise whether or not additional shocks should be delivered. CPR and defibrillation should continue until responders arrive on scene and take over or until the victim displays an obvious sign of life.
A recent nationally representative survey conducted by researchers from the Journal of the American Heart Association reported that only 18% of adults (n=9022) are currently trained in CPR. Study segments of older adults and lower socioeconomic status were less likely to have had CPR training.7 These statistics are concerning due to the importance of knowing how to perform CPR and to use a defibrillator. This also means that if there are 17 people attending your eclipse party, statistically only 3 of them (or less if they are stuck in traffic) are prepared to respond to a cardiac arrest.
CPR quality directly correlates to cardiac arrest survival and is dependent on routine practice and familiarity. Many trained adults only practice CPR once every two years when they are in the classroom for their certification renewal, some wait longer than this to update their skills, and a portion may never attend another CPR training. Skills degradation is the reduction of CPR quality that begins after the rescuer completes their CPR training and continually grows until they practice CPR skills again.8 While CPR training has been simplified over the years to make it easier to recall in emergencies, routine practice and familiarization are the best ways to ensure rescuers are confident and comfortable in recognizing when CPR is needed and knowing how to perform these lifesaving skills.
By the time the United States mainland sees its next eclipse in 2024 approximately 2.5 million people will suffer from cardiac arrest. Their survival is dependent on actions from bystanders like you. Don’t leave them in the dark when they need you the most. The American Heart Association has a national listing of approved courses where rescuers can learn CPR and how to use an AED. Please visit www.heart.org/cpr to sign up for a course near you.