Key Takeaways

    • With extreme panic and stress associated with witnessing a cardiac arrest, the brain struggles to process all the information coming in and may only be able to see the task in front of them. This is what is referred to as “tunnel vision.”
    • A person may freeze and not jump in during an unexpected incident. They often gasp in preparation for what they will do next. It is not a conscious decision to freeze. 
    • During high levels of stress or adrenaline, the memories of the events might be fragmented, as well as a distorted perception of time.
    • People who act to save a life should remember that they are not responsible for the outcome, only their actions at that moment.
    • The success of the actions of a lay rescuer should be measured by whether an attempt was made at a second chance.
I feel terrible, lost, and have several questions. Is that expected?

Humans are not like power switches that can turn “on” one moment and “off” the next. As the body begins to shut down, many things happen. The human body is made up of millions of cells, and not all cells and organs stop immediately when the heart stops beating normally. In fact, when the heart stops, the brain can survive another 4–6 minutes before permanent brain damage begins to occur. This phase is called clinical death, where much of the body is still alive (though not functioning) but paused as it waits for oxygen. When a person is in clinical death, it doesn’t necessarily represent what we see on TV or in movies.

Movies normally show what someone would look like after biological death which is no movement whatsoever with their eyes closed. This is why people question if someone is really dead when they see them collapse.

Most people do not anticipate going about their daily lives and coming across someone collapsing at home or outside. When it does happen, our minds look for clues to prove why they don’t need compressions. This is where people interpret agonal breathing as normal breathing, twitching as a seizure, or unresponsiveness for fainting. The mind does not assume a person is in cardiac arrest at first. It sometimes takes a minute or two before a layperson (who could also be a family member) accepts that their loved one is in cardiac arrest and needs help.

Why didn’t I notice or hear anything around me?

When the body produces high levels of adrenaline (a stress hormone) due to extreme panic and stress, the brain struggles to process all the information coming in. Someone may only be able to see the task in front of them. This is what is referred to as “tunnel vision.” Studies have shown that tunnel vision also involves selective hearing, or hearing everything but also nothing at all. Many first responders describe this feeling when faced with new situations throughout their careers. The release of adrenaline and other hormones can also sometimes cause blurry vision, sensitivity to light, and even temporary color blindness. This is normal.

Why did I freeze while others acted? Or, why did others freeze while I acted?

When someone witnesses a cardiac arrest, adrenaline starts to flow, the heart rate increases, we get a sugar rush, and our attention moves toward a direct response: calling 911, immediately starting CPR, or calling for others to come and assist. Many people describe this as acting on instinct.” However, there is another common response to these critical situations. That is, a person may freeze and not jump in during an unexpected incident. When a person freezes in the moment, their eyes widen, their mouth opens, and they often gasp in preparation for what they will do next. It is not a conscious decision to freeze

An individual’s window of tolerance and personality can also influence how they respond. Those who initially freeze, once they are instructed or directed to help, typically do. Their brain becomes “unfrozen” when another person is involved, as it creates a sense of safety in numbers.

Why did I second-guess myself or my actions?

During an emergency, the suddenness and gravity of the situation cause the body to release certain hormones that can impair decision-making abilities and cause bystanders to doubt their actions. Even those who have been trained in first aid and CPR may not fully understand the scope of the problem or the best course of action. It is important to recognize that second-guessing yourself in an emergency is a common reaction and doesn’t necessarily indicate incompetence or weakness. It’s a natural response to the stress and uncertainty inherent in emergency situations. This questioning occurs even in professional responders. Acknowledge that reflecting on your actions is normal and that we cannot control outcomes, even in the best circumstances.

Why did they take videos?

When cardiac arrests occur in public areas, you may notice people watching or taking videos with their cell phones. Traumatic events can be shocking and unexpected, leading to a state of disbelief. In these situations, people may feel compelled to observe, process, and make sense of what is happening. Taking videos is common in public spaces and, for the most part, not done with malicious intent. Using a cell phone to watch the emergency unfold can create a sense of physical and psychological distance from reality and is more of a defense mechanism.

Why did the time go so fast, yet not fast enough?

The perception of time is highly influenced by the body’s stress response. Time may seem to slow down due to the increased attention and heightened sensory perception associated with the stress response, or a narrowed focus of attention on the immediate situation or actions. This intense concentration can create a sense of time distortion. When individuals experience high levels of stress or adrenaline, their memories of the events might be fragmented or distorted, causing their perception of time to not align with the actual duration of the emergency or the response times of first responders.

Why was I sore and tired the next day?

Much like a good workout, your body will release specific hormones which redirect blood flow to your muscles to enhance strength and endurance. Moving someone and/or giving chest compressions is not easy. It can also suppress pain signals in the body, allowing individuals to temporarily withstand or ignore pain. However, if you injure yourself during the rescue or have a pre-existing injury, you may not notice any pain until later. Many people say that they have lower back, shoulder, and wrist pain after acting to save a life. We have also observed individuals with chronic issues with their knees and backs who perform CPR without pain during the event but feel pain in the hours and days following. It tends to go back to normal in time.

Why didn’t they survive? Was it my fault?

People who act to save a life often take ownership of the outcome—whether someone lives or dies. But they should remember that they are not responsible for this outcome, only their actions in the moment. In almost all cases of cardiac arrest or other critical incidents, the issue started before a layperson started their actions. An undiagnosed heart problem, unhealthy diet, lifestyle, or family history of heart conditions may have contributed to this occurrence. As hard as it may be to accept, sometimes everything is done right, and the person still doesn’t survive. We act to save a life because we believe that an underlying cause can be fixed or treated and that the person could have a second chance at life. Instead of someone asking themselves “Was it my fault?” the question should be “Did they get a second chance because I called 911 or did CPR?”

When someone responds to a critical situation, they aren’t expected to be flawless. Every situation is different, everyone’s window of tolerance is different, and everyone involved has different life experiences. Forgetting to do things or check things or how to execute steps in the right order is more common than people realize, even for professional responders. Success should be measured by whether an attempt was made at a second chance. So regardless of what actions someone takes — calling 911, starting CPR, administering an AED — they should ask themselves whether the person needing care got care. If the answer is yes, then everything that needed to be done was done.

Thank you to our contributors

Paul Snobelen & Sachin Agarwal

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