Bystander CPR on the Island Princess

[peety3]

But, I do have some serious safety concerns after an incident on the last day of our cruise.

 

So these are my concerns. Anyone who has taken bystander CPR knows that an AED makes a huge difference in outcomes. This is an automatic diffibrilater devise that is designed so a layman can use it. Almost every restaurant has one, most country club's keep then in the bar and most bartenders are trained in their use. They are all over the airport. I was very disturbed to find out that Princess staff are not trained in CPR and that this devise was not available. What we were told was that the staff is taught not to intervene and wait for "medical" to arrive.

 

We plan to write to Princess with our concerns, but, wanted to share on cruise critic as well.

First, congratulations on a successful CPR event. I do hope you're proud.

 

That said, it's concerning that an AED wasn't available quickly, but at least it wasn't needed in this case. My prior EMT training has led me to conclude that if an AED is needed, the only paths to survival are either an AED or chemical intervention by paramedic or higher.

 

Further, I really wish you'd have addressed this with Princess before posting on CC. There could be more to the story which would really help out your understanding (and hence our understanding) of the story. For example, what if the medical staff was already engaged in another event? There's always going to be a finite limit on how many simultaneous events can be covered. With all due respect, that's not a serious safety concern in my eyes, just a fact of life.

[pablo222]

Given the limited number of available medical responders on board and the fact that they are likely coming from deck 4, it may take the medical team a while to get there.

 

The medical folks have a special card for the elevator

that causes it to drop all calls and go directly to the

floor requested.

 

And, I'm not sure it would be a good idea for some crew member

with no training to try and assist.

[custompcsys]

There's always going to be a finite limit on how many simultaneous events can be covered. With all due respect, that's not a serious safety concern in my eyes, just a fact of life.

 

You're absolutely correct. That's why EMS systems are tiered....first responder, BLS, ALS, and definitive care (hospital). Apparently there is no first responder component aboard ship, and there should be, especially given the limited resources available.

[custompcsys]

And, I'm not sure it would be a good idea for some crew member with no training to try and assist.

 

Also correct...that's why I stated in my post that crew should be trained to the first responder level.

[pcl2001]

This passenger was very lucky indeed that you were there when she arrested. What you likely witnessed was a v-fib seizure, and the fact that you were able to establish unresponsiveness and cardiac/respiratory arrest almost immediately is what enabled you to recover a pulse with CPR only. Great job! That woman is still here because of you.

 

After more than 20 years in EMS and a CPR instructor, its disturbing to me that crewmembers are instructed not to intervene. I realized this is most likely a liability issue, but in cases like this time can make all the difference. Given the limited number of available medical responders on board and the fact that they are likely coming from deck 4, it may take the medical team a while to get there. Crew members trained to the level of first responders could make all the difference. You could have a hundred AEDs spread all over the ship, but they won't do a bit of good if people aren't trained to use them or instructed not to interfere. The American Heart Association CPR program is designed to train the general public and have as many trained responders as possible out walking the streets. There is no reason, in my opinion, that crew can't be trained to at least the bystander level with AED.

 

And what the heck were they going to do with a wheelchair for an arrest???

 

Ideally all the crew would have CPR training, but it would be very expensive and difficult to track. There's not much benefit to Princess for doing this, given the relatively low frequency that cardiac arrest occurs onboard. They already go above and beyond what they're required to do in terms of medical services as it is. You're more likely to survive a cardiac arrest on the ship than in most places on land due to the fast response. There's always a medical responder with an AED on-hand that can be pretty much anywhere on the ship in less than 5 mins. You won't find that in many places on land.

 

Princess was also the first and currently the only cruise line using paramedics as first responders. The other lines use nurses that may or may not have any emergency or first responder experience.

Edited May 3, 2014 by pcl2001
add something

[IECalCruiser]

I can't comment on your specific incident other than to say that it is very fortunate that you as a trained first responder was nearby.

 

I can comment that there were two Code Alpha's in two weeks on the Golden on 2012 and one on an 11 day cruise on the Emerald last year. We happened to be near each of those three incidents (stay away from us on cruise ships :eek:). Within 2-3 minutes after hearing the Code Alpha, the first medical responders arrived running to the site and others followed shortly. I was impressed with the quick response. Included in the response was oxygen, a gurney and medical apparatus in several cases. I didn't go into the next room where the emergency was to actually see what was done. Obviously a phone call needs to be made and the staff near the bar may have mishandled that.

 

Sent from my iPhone using Cruise Critic Forums mobile app

Edited May 3, 2014 by IECalCruiser

[sunshine426]

Cruise Critic has always provided a sounding board...and that is why I used it. I certainly am not bragging about my actions, but, expressing a safety concern.

Frankly as I began CPR my thought was that survival options were not good. Thankfully in her case pulse was established via CPR. I was also concerned that she was transported on a wheelchair. All I could think of was what if she needs CPR during transport. We checked on her later in Medical. And saw an ambulance dockside in FLL so hopefully she is all well.

[S.S. Cruisers]

Thank you Sunshine for your actions. Obviously you made the difference for this woman and her family. It is always easy to Monday morning Quarterback someone else's decisions. No matter how you look at it, who was or wasn't at fault or whether the first responder had to finish whatever they were doing, 18 minutes is too long of a period of time to get there "first" period.

As far as CPR being included with First Aid Training, not so in California. They are independent classes that may or may not be taken together. The individual has to sign up for one or both of them.

[obnurse]

I'm still astounded they took her away in a wheelchair after having a cardiac arrest! Kudos to Sunshine for stepping in and helping this woman. I hope Princess evaluated the outcome of this emergency and makes changes as needed.

[DrivesLikeMario]

Ditto what obnurse said. Couldn't they have brought a gurney? They have them. I've seen them. Hearing about their slow response time worries me when I have elderly parents that want to cruise with Princess!

 

Sunshine426 - A huge amount of gratitude for your actions! Princess may not have thanked you, but I'm sure there are many who appreciate what you did. Your caring made a real difference in someone's life!

Edited May 4, 2014 by DrivesLikeMario

[IECalCruiser]

Ditto what obnurse said. Couldn't they have brought a gurney? They have them. I've seen them. Hearing about their slow response time worries me when I have elderly parents that want to cruise with Princess!

 

Sunshine426 - A huge amount of gratitude for your actions! Princess may not have thanked you, but I'm sure there are many who appreciate what you did. Your caring made a real difference in someone's life!

As I stated in my prior post, from the time I have heard the Code Alpha over the PA until I have seen emergency staff respond has been a matter of a few minutes on at least three occasions including once on the Emerald last year. I believe the issue with the response might be who made the call for medical assistance, when it was made and how they described the situation. That is probably where the training needs improvement. What the OP experienced was unacceptable.

 

 

Sent from my iPad using Forums mobile app

[jrzebird]

A few thoughts went through my old brain while reading this post. First, to the OP, thank heaven you were there. A woman is alive because of you.

 

I wasn't there, but my thoughts are running to why the crew didn't intervene and why the long response time and wheelchair.

 

I wonder if the lack of intervention was because someone who obviously knew what they were doing (you) had taken over. I can't imagine they would ignore her if no one else was there. Also they may not have understood the severity of the situation.

 

Bringing me to my thoughts on the response .. if the bartender didn't understand what was wrong, perhaps he just reported a woman had fallen and needed medical attention. Hence, slow response and a wheelchair. Or things got lost in translation.

 

I have no idea what really happened, but these were some random impressions I had.

 

Maureen

[Lanwood]

I can't believe the whole situation ended with the bartender requiring your signature for drinks.

 

That's pretty low for Princess, or any cruise line for that matter in my books. I do hope they're reading these threads and paying some attention....

[Pia1913]

Sunshine, I heard all about this when I picked up our friends who were there with you. The arrival of a wheelchair instead of a gurney, tells me the information relayed must have been something like "a passenger fell." A higher power was working for this lady in that you were there.

 

You were wonderful, I was told. :)

[gingera]

I am an ortho-trauma nurse and I gave CPR to my neighbor years ago, and it did take about 15 minutes for the EMT's to get to his home to take over. I was exhausted and my hands were bruised for a few days. It is really hard work to do CPR properly, especially by yourself.

 

Kudos to the OP...!!!

 

BTW, my last CPR update called for chest compressions first, at a 30 to 2 breaths ratio, or at least, that is what I was trained for in my community. Things change every few years..so this may not be accurate at present.

[sunshine426]

Thank you to all who have posted their feedback on this situation. It has actually helped me decompress from the incident and have some clarity on the event. I am actually a pediatric nurse and have taken numerous classes in cpr and other life saving responses. Still, my actions were as a bystander and first responder.

 

To the last post...even knowing the new ratios I found myself falling back on 15:2 ration and confess to opening the airway first and giving breaths. I was focused on giving deep compressions and attempting 100 compressions per minute.

 

Prior to posting this my husband and I did speak to a Princess representative on the ship and plan to address Princess Corporate about it this weekend. You can't fix a problem unless you know you have one.

 

I agree that the person who called 911 probably told them that a passenger fell as that is what I saw initially. Still, wish that the arrival time had been quicker and that based on my report of interventions that a quick call wasn't made to medical to send up a gurney, a second responder and connecting her to a monitoring devise. prior to transfer. ( Kind of like calling for an ambulance instead of driving your loved one to the hospital in the event of a heart attack.)

 

Thanks again for the feedback. And I strongly encourage cpr classes for my fellow passengers.

[gingera]

Thank you to all who have posted their feedback on this situation. It has actually helped me decompress from the incident and have some clarity on the event. I am actually a pediatric nurse and have taken numerous classes in cpr and other life saving responses. Still, my actions were as a bystander and first responder.

 

To the last post...even knowing the new ratios I found myself falling back on 15:2 ration and confess to opening the airway first and giving breaths. I was focused on giving deep compressions and attempting 100 compressions per minute.

 

Sunshine...Yup! I reverted back to the same 15/2 ratio as well at my work...it has worked for many for years.

You are a hero in my eyes and I know

others feel the same way, especially the woman's family!

Edited May 4, 2014 by gingera

[greenie082756]

This is a great topic to discuss on CC. It makes me realize that I should sign up to do a CPR class real soon. We are so fixed (at least I am) on the adventure of going away on a cruise and "come back new" that we forget about the reality of an emergency.

OP what you did was enormous and you are bringing up a great topic. I have not seen an emergency at sea yet and I don't really want to.

From what I've read, my guess is the communication broke down and perhaps training is needed there as well.

OP,I hope that if ever I need assistance like that, a person such as yourself is there to help.:D

[caribill]

I agree that the person who called 911 probably told them that a passenger fell as that is what I saw initially.

 

Without more detail than that, the response from Princess should be to be prepared for anything ASAP.

 

Better to have too many resources sent than not to send enough. And to send them fast.

[elliair]

Thankfully you were attentive to this lady and you did the right thing. I wonder what happened to her in the first place and what was the outcome for her? I can't judge Princess on this but I would imagine they are prepared for most anything. Regardless, you did the right thing.

[PescadoAmarillo]

The ships do have first responders; there were two paramedics on the Emerald Princess. The doctor is not the one who would normally respond. And I saw them bring a wheelchair on the Emerald Princess for a lady who I was certain was dead, and only found out later that she had survived. But she certainly wasn't able to be taken away in a wheelchair. A gurney should be brought even for a fall. DH is the first responder in our family, but shouldn't one err on the side of caution and be prepared with a backboard?

 

The emergency I reported appeared to be a fall, too. The lady went down right behind me. But I had no way of knowing why she fell, and so reported that she collapsed. They brought a wheelchair then, too.

 

OP- we are all proud of you. DH has been thrust into situations like this before, and I know how much stress there is afterwards, even when the outcome is as good as in this situation.

[IECalCruiser]

Interesting article about an Ultimate Ship's Tour in 2010. CC is blocking the website because it is from a TA who took the UST so I can't post a link. Don't know if that info is still accurate but it stated that AEDs had been eliminated recently because of misuse in untrained hands. The article also claimed that medical staff can respond to anywhere on the ship within two minutes.

 

BTW, glad that the discussion has helped the OP to decompress, at least a bit.

 

Sent from my iPad using Forums mobile app

Edited May 4, 2014 by IECalCruiser

[Loonbeam]

First of all, as a fellow trained First Responder (tho not active) - great work!

 

A couple of thoughts.

 

As I understand it, the crew is trained in first aid, but much more of the cut and scrape variety, not how to handle a significant adverse event. Given in some cases their limited linguistic skills in English, I can see where they might not take a role in treatment if someone obviously better trained is responding. It's similar to flight attendants asking for a Doctor on board.

 

With that in mind, there certainly is room for improvement here. While crew may not be capable of direct intervention, they certainly can assist with crowd management, clearing a path for medical assistance, and someone should have gone to get an AED even if not needed. No one should have 'walked past' for any reason without at least inquiring how to help.

 

The 18 min response time, while long, I am not going to criticize as there are so many factors that can influence it. When I ran with a volunteer fire department, we once got sued for failing to respond timely to a fairly minor call. The suit was dropped after we pointed out we were transporting a cardiac victim to the hospital at the time, so it took a few extra minutes to get the backup unit there from the next town over. It could have been something as simple as an incident in the med bay, or other side of the ship in the same time frame. Room for improvement again, but without knowing all the details, hard to say how much.

 

The issue with the gurney versus a wheelchair is simple - wheelchairs fit in passenger elevators a lot easier, giving them more routes of travel. A gurney can be called for if needed and brought up via other means. Without actually being there, I can't say if a wheelchair was contra-indicated versus a gurney.

 

And personally, I would have comped the drinks, but the bartenders don't really have that kind of flexibility. They can be fired for failing to get a signature.

 

As regards 911 going to the PSD, I am pretty sure it goes to the bridge, not PSD. The bridge is the only point on the ship guaranteed to have a security or similar officer always manned and with no other customer responsibilities. I know one time my wife accidentally pulled the panic cord in the shower and the bridge called immediately to check. While there is an on-call medical team at all times, they are NOT necessarily in the medical office (unless a patient is in there or it's open hours, there may only be a single nurse on duty in the med facility itself.) The bridge is kept advised of where the on call responders are and how to reach them. This is why in a medical emergency you may see responders coming from different directions, one may be coming with the staged gear from the med bay, while another may be coming from lunch or their cabin.

[cdnphotogirl]

An 18 minute response time is completely unacceptable! :confused::eek:

Edited May 4, 2014 by cdnphotogirl

[Darcy15]

As a fellow nurse - well done indeed for saving a life :)

 

Out of genuine interest, what was the Princess response to your intervention? Did they complete an incident report with you, thank you in some way?

 

......I would certainly hope so!

 

After many years of travelling, I have only ever been involved in one 'situation'

 

....and that was at 30,000 feet above Greenland in a United Airlines plane, and I don't want to do that again :eek:

 

I know how frightening all that must have been for you, and hope that you feel more settled after talking about it

 

Very best wishes to you :)