I feel terrible and lost. 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, the patient 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, etc. 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 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 nothing at all. Many first responders describe tunnel vision when faced with new situations throughout their entire 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 to provide CPR or call 911. Many people describe this as “acting on instinct.” However, there is also another common response to these critical situations. A person may freeze and not immediately intervene 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 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 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 a patient’s 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 the problem. As hard as it may be to accept, sometimes everything can be done right, and the person will not 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.

Why did I second guess myself or my actions?

During an emergency, the suddenness and gravity of the situation causes the body to release 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 bystanders watch? Why did they take videos?

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

Why did 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 memory 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 the hormone Epinephrine, which redirects blood flow to your muscles to enhance strength and endurance. Moving someone and/or giving chest compressions are not easy. Epinephrine 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 pain, 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 felt pain in the hours and days following.

What were the paramedics doing, and why?

When paramedics attend to a cardiac arrest they have a sequence of actions that they perform to ensure that the person they are assisting has the best possible chance of survival. The specific procedures performed may vary depending on local protocols, resources, and the patient’s condition. You may see both firefighters and paramedics assisting in emergency care. The crew on scene works as a team, collaborating with each other and additional healthcare professionals to provide comprehensive care. Here is a list of first responder actions that you may have observed:

    • Paramedics quickly assess the situation to determine if a cardiac arrest has occurred. They evaluate the patient’s responsiveness, breathing, and pulse. If cardiac arrest is suspected, they initiate emergency procedures immediately. They may ask bystanders about past medical history, allergies, medications, when they last consumed food, and if someone witnessed the collapse.
    • Cardiopulmonary resuscitation (CPR) is a fundamental step in the management of cardiac arrest. Paramedics perform high-quality chest compressions to maintain blood circulation and oxygenation. They also provide rescue breaths using a breathing device known as a bag-valve mask to deliver oxygen to the patient’s lungs. To assist in the delivery of oxygen they may insert a device into the patient’s mouth to protect the airway from the tongue and assist in adequate ventilation.
    • Suction may be used if there is excessive fluids, vomit, froth, or blood in the mouth. They will use either a manual or electronic suction device to clear the mouth of any substances.The device is similar to what you may have experienced at the dentist. They may need to repeat this process several times based on how much fluid is being produced by the patient.
    • Paramedics have devices that are often referred to as a “Cardiac Monitor” which has an automated external defibrillator (AED) setting to deliver electrical shocks to the heart in a controlled manner. This aims to restore a normal heart rhythm, particularly in cases of ventricular fibrillation or ventricular tachycardia. The machines analyze the patient’s heart rhythm and administer shocks if appropriate. The cardiac monitor often has additional cables and accessories that can be connected to a patient. This allows responders to see the different rhythms produced by the heart, indicating where the issue may be located. It will also provide CPR feedback and monitoring of the vital signs.
    • Automated CPR devices like LUCAS or Auto-Pulse may be applied to the patient’s torso. These devices will provide automatic delivery of CPR chest compressions, allowing paramedics to focus on other tasks outlined in this section. These devices are especially valuable when staffing resources are limited.
    • Paramedics may administer certain medications during cardiac arrest. These medications, such as epinephrine help support the heart’s function and restore a regular rhythm. Paramedics establish IV access to deliver medications and fluids. In some cases, they may use another method called Intraosseous (IO) access. This looks like a small drill that allows them to insert a needle into the bone instead of using a vein.
    • In some cases, paramedics may need to secure the patient’s airway with advanced techniques. This can involve intubation, which involves inserting a breathing tube into the patient’s trachea or using supraglottic airway devices to maintain a clear airway and assist with ventilation. The device used to insert this tube looks like a hook with a handle and a light, or screen allowing the paramedic to see inside the patient’s airway.
    • Paramedics continuously monitor the patient’s vital signs, including heart rhythm, blood pressure, oxygen levels, and carbon dioxide levels. They interpret changes in the patient’s cardiac rhythm and adjust interventions accordingly.
    • Transport to the hospital occurs after initial resuscitation efforts. Typically this may include several rounds of CPR and defibrillation as required. During transport to the hospital for advanced post-cardiac arrest care, paramedics provide ongoing monitoring and continue interventions as needed. Depending on local protocols, paramedics will consult with their designated medical director or base hospital to discuss the treatment options. In some circumstances resuscitation may be terminated by the paramedics in the field, when it is determined that advanced interventions will not change the outcome.
Thank you to our contributors

Paul Snobelen & Sachin Agarwal

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