Sidewalk CPR Is Spreading

The practice of hands-only CPR emphasizes compression over compression and breathing, so more people may be willing to do it.


Jamie Yee Hintzke, program manager for Alameda County Emergency Medical Services, helps train kids to use sidewalk or hands-free CPR.

Photo by Lance Yamamoto

If you’re like many people, you’re more than willing to jump in to save a life. Maybe you’re trained in CPR. But maybe you’re also a bit grossed out by the thought of doing mouth-to-mouth resuscitation on a stranger. Would this stop you from acting in an emergency?

The world of CPR, or cardiopulmonary resuscitation, has changed. Today’s CPR standard for bystanders is hands-only. Hold the breathing. Hold the mouth. Hold any exchange of bodily fluid.

“There are still people out there who view CPR as hands-mouth and wonder if they’d ever be able to put their mouth on someone in an emergency, worried about the gross factor,” said Lynn White, national director of clinical practice for American Medical Response, an ambulance company serving some Bay Area communities. “You don’t really have to provide breaths initially to be of a benefit to somebody. They finally realized it was a lot easier just to ask bystanders to do compressions and not mess around with breaths.”

Hands-only CPR has many names: sidewalk CPR, compression-only CPR, bystander CPR. All refer to cardiopulmonary resuscitation that involves only chest compressions and calling 911.

If someone has collapsed, stopped breathing, and is unresponsive, the most helpful thing you can do is call 911 and immediately start pushing on the chest to keep the blood moving.

“Blood flow overshadows breathing,” said Mike Jacobs, cardiovascular care manager for Alameda County’s Emergency Medical Services. “I don’t need breath; I need flow. I need you to move that oxygen around.”

“It’s not just the yuck factor,” Jacobs said of mouth-to-mouth. “Even if someone is willing to do this with the best intention, it’s a very, very difficult skill.”

Cardiac arrest occurs when the heart suddenly stops pumping blood. Heart attack occurs when an artery to the heart is blocked and can occur suddenly or over time with symptoms. Both require emergency treatment, but CPR doesn’t help with a heart attack, unless it has led to cardiac arrest. Cardiac arrest is a clinical death. CPR can keep the blood flowing, extending life and preventing brain damage. The goal is to keep the blood flowing until paramedics or trained help arrives. Experts advise pumping on the center of the chest as soon as one can, without worrying about technique or hurting the person.

“As sudden cardiac arrest occurs, the clock starts ticking. In five minutes, brain injury starts occurring, and in 10 minutes, it’s permanent, and usually people don’t survive,” said Mary Nopachai, an obstetrician at Kaiser Santa Clara who became a CPR advocate after using the procedure to save her 4-year-old son’s life on a playground slide.

There are exceptions to hands-only versus compression and mouth-to-mouth. With respiratory failure, people need air through the mouth. Hand-breath CPR is also recommended for babies and young children.

But don’t guess at CPR. Get trained. There’s a major push underway to train as many people as possible in hands-only CPR, led by the American Heart Association. An estimated 30 to 40 percent of the national population knows hands-only CPR. The goal is to increase it by 20 percent by 2020.

Alameda County is a leader in hands-only CPR training, especially for students. About eight years ago, the county launched a program to train seventh-graders in hands-only CPR using portable mannequins they could take home and use to train friends and family. An estimated 150,000 people have been trained, including those trained by the students, said Jacobs, who designed the program. On average, each student trains four others.

“It’s the world’s largest CPR program,” said Jamie Yee Hintzke, a program manager for Alameda County Emergency Medical Services, who runs the program with Jacobs. “It’s very empowering for a lot of kids.”

Now the rest of the state is poised to catch up with Alameda County: A new state law requires all ninth-graders in school districts with mandatory health classes to take hands-only CPR and becomes effective in the 2018-19 school year. Some districts already train students voluntarily. The mandate doesn’t come with any funding, however

“We’ve very excited. We’re doing the best we can to send the message to school districts, superintendents, and school principals, making them aware of the law,” said Mike Deitch, Bay Area community CPR manager for the American Heart Association, who worries about word getting out.

For folks in Alameda County, the new law is great news — with a tinge of disappointment. The county lobbied hard for the requirement to apply to seventh-graders, not ninth-graders, based on data showing middle-schoolers are more likely to embrace CPR and teach it to others.

But the bottom line is getting people trained, Jacobs said, and his department will do all it can to support the law. “I can’t have a paramedic on every street corner and every shopping center. We the people have to take care of we the people.”