On an otherwise typical Thursday afternoon in the fall of 2016, Heather Johnson saw a young man collapse on the floor at her London, Ont., gym. Johnson was a 21-year-old university student at the time, and she had previously worked as a lifeguard. She reacted immediately: running to the victim’s side, feeling for a pulse and quickly performing cardiopulmonary resuscitation (CPR). Her training paid off, and the young man had been successfully resuscitated when Emergency Medical Services arrived (another bystander had called 911).
But despite the positive outcome Johnson found her memories of the experience to be unsettling and dark. She developed difficulties sleeping and found it hard to concentrate on school work. “I started having nightmares, just seeing his face,” she says. A few days after the incident, doctors diagnosed her with post-traumatic stress disorder (PTSD). She says at no time during her CPR training was she made aware that saving someone else’s life could carry risks to her own.
Johnson is not alone. Professionals in the resuscitation field say there is a growing need to ensure that people understand the emotional risks of performing CPR, and that they are guided to professional help in case they develop emotional distress. “We need to be more tuned into supporting lay rescuers,” says Katie Dainty, a resuscitation researcher who founded the Bystander Support Network in 2017 to help people struggling with the after-effects of an intervention. “We need to let them know that they’re heroes and that we can get them help if they need it.”
The importance of lay-responders performing CPR
Certainly there is great need for lay-responders to perform CPR. Eight in 10 cardiac arrests occur outside of a hospital in Canada, meaning there are approximately 40,000 cases of potential lay-responder CPR attempts each year. The Heart and Stroke Foundation estimates that as few as five percent of people survive a cardiac arrest occurring outside of a hospital, though that number doubles when CPR is administered immediately.
Contrary to the perception of high survival rates suggested by movie and TV dramas, the vast majority of people who receive CPR still die. But while survival rates among cardiac arrest victims are well-documented, there has been little research on the health effects on the lay-responders who try to save them. Yet the potential for emotional trauma and distress may be significant. One U.S. study in 2015 showed that as many as 28 percent of internal medicine residents involved in performing CPR experienced PTSD symptoms, suggesting even professionals face difficulties coping.
Changing CPR training programs
For the most part, emergency response teams have few or no protocols on how to support lay-responders. Nor do the main CPR curriculums used in Canada, which make no more than a passing reference to the potential for any after-the-act distress. Currently, the Canadian Red Cross, the Heart and Stroke Foundation of Canada and St. John Ambulance develop curriculums for instructors, and each organization certifies more than 500,000 people in CPR each year.
But there are nascent signs of a shift in how CPR is taught. Don Marentette, national manager of first aid programs at the Canadian Red Cross, says his organization is working on adding a section to its CPR curriculum on the risks of developing emotional distress, though he was unable to offer a firm timeline as to when the changes would be implemented. He says that currently instructors can talk about PTSD or emotional distress in their classrooms if they want to, but there has been some resistance to altering the curriculum from instructors who take a “legacy approach” to CPR teaching. “It’s also perhaps due to the fact that many instructors are not prepared to have the conversation about distress and PTSD,” he adds.
The Heart and Stroke Foundation of Canada is also working on changing its CPR curriculum, and plans to incorporate an educational component on emotional trauma following CPR by the fall of 2019. Shelley Parker, senior manager of Resuscitation Services, Design, and Delivery at Heart & Stroke, acknowledges that the emphasis has always been on getting more people engaged with CPR training. “I think [changing the curriculum] was seen somewhat as detrimental to getting the public trained or getting them to step in,” says Parker. “We’ve all worked to get the public more engaged with responding to cardiac arrests, and we focused so much on that aspect of it.”
Despite the “legacy” approach that some take to teaching CPR, changing the curriculum to include a section on PTSD would be well-received by many instructors. “It would be a really great addition,” says Ashkon Pourheidary, director of Coast2Coast First Aid and Aquatics. His organization’s instructors follow the Canadian Red Cross curriculum, and most are hesitant, he says, to steer away from the prescribed course material.
Creating more support for bystanders who perform CPR
On the other side of things, there is a need to better help lay people who experience PTSD after performing CPR. To this end, the Peel Region of Ontario is piloting a program—the first of its kind in Canada—to offer standardized follow-up and counselling to all lay-responders who administer CPR in public (due to personnel limitations, lay-responders who perform CPR in private homes are not currently included in this program). Paul Snobelen, specialist of community programs at Peel Region Paramedic Services, runs the program and personally contacts lay-responders after an incident for a debriefing session. He notes that many lay-responders find it comforting to learn about the science behind what they saw—for example, why there was blood in the airway, and why victims soil themselves or vomit. “A lot of these people don’t need cognitive therapy for what happened, they need a technical understanding,” he says. He adds that the Red Cross has contacted him about potentially adapting a similar program in other regions across the country.
Snobelen says lay-responders who have participated in the Peel program cite a common theme: Their actual experience of delivering CPR was markedly different from what they had pictured. The current CPR courses “are not doing a realistic job of showing people what it really looks like,” says Snobelen. He has reached out to over 300 bystanders since the program was launched, and only one individual so far has expressed not wanting to be be involved with any follow-up after the resuscitation event.
As further evidence that lay-responders are seeking support, since the Bystander Support Network was established in 2017, over 100 people have signed up to be members, and approximately 30 people who performed CPR have submitted their personal stories. The network serves as a virtual hub where lay-responders can find resources about CPR and connect with other people’s resuscitation experiences. Although the network itself is unable to provide any direct counselling to lay-responders, it will often redirect them to appropriate help.
Whether it’s altering CPR courses to better prepare people or offering support to lay-responders after the event, change is clearly needed. Heather Johnson was certainly surprised to have developed PTSD, but also feels lucky to have had early access to psychological supports through the encouragement of her peers. “I think I would’ve still been having nightmares for sure,” says Johnson when describing an alternate reality where she hadn’t received any proper help. “I would’ve been scared to ever be in another medical situation again.”
Wilson Kwong recently completed his internal medicine training at the University of Toronto and is currently a palliative care fellow at the University Health Network. He is also a freelance writer and is pursuing a Certificate in Health Impact, offered jointly through the Munk School of Global Affairs and Public Policy and Dalla Lana.
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Wow my son has changed instantly after saving my life I feel so guilty
I’ve never heard of this before and I’ve helped a few people by saving them so reading this I wouldn’t have believed it, my son had to do CPR on me for 7-9 mins and had to watch the paramedics take over and tried to save me they thought I might not even make it to the hospital, my poor son wasn’t allowed to come with me because of covid and with no one contacting him he didn’t know if I was dead or alive and I was alone! He started getting anxiety he couldn’t shut his thinking off or sleep! I feel horrible!!!
I remember almost all the details about the day I performed CPR on my sister. It is more than just remembering though. I’d compare it to a vivid video that replays in my head whenever it crosses my mind or a trigger word is heard. One of my brothers was a passenger in a car accident and ended up completely breaking his brainstem. After a week on life support and a transfer of hospitals, the decision was made to take him off life support. The same type of vivid memories play in my head of being woke up and told I need to get to the hospital because my brother was in a car accident to watching my brother turn blue in the face until dying from lack of oxygen.
The day I performed CPR on my sister, I was woken up by my mom screaming my name and telling me my sister had O.D. My sister has a severe heroine addition and thankfully my mom had checked on her when she went into the bathroom and didn’t come out after several minutes. I ran to the phone and dialed 911. My mom and I were on both sides of her trying to wake her up, but she was unresponsive. My girlfriend, at the time, was standing in the hallway watching when my sister’s 2-year-old son walked out. I can still see her standing there and the look of total disbelief on her face. I told my girlfriend to take my nephew into the bedroom and close the door. At this point my sister started turning blue just like how my brother had. The dispatcher then answered and my mom frantically explained the situation and kept saying, “She’s turning blue! She’s not breathing.” The dispatcher ensured emergency responders were on the way and that she will talk my mom through CPR. When my mom performed the first breathing step of CPR she stopped and said it was not working and couldn’t do it. I instantly held my sister’s nose and took over the breathing. I can still taste a sour vomit like flavor of when I was breathing into her mouth. I then did compressions and alternated between the two as the dispatcher instructed until the EMS arrived and Narcaned her.
My parents ended up getting custody of my nephew. However, for several months after my nephew would say, “Mama fell.” I remember thinking how much of this will he be able to remember and how this would affect him. I never once thought of how it would affect me. Over the course of the following year my grades began to slip in college and I developed severe anxiety and panic attacks. I constantly worry about her. Wondering if today is the day I am going to get the call that she is died. I went from getting A’s to F’s. It is difficult for me to concentrate on my school work, which only adds to my anxiety. My nephew’s father also suffers from the disease of addiction and is rarely in his life. I grew super close with my nephew and took on the roll as his big brother/father figure. I recently moved to continue my education, but being away from my family makes me feel like I am unable to help if something goes wrong. When my anxiety started becoming worse and grades started slipping again, I wrote down all the things that cause a strong negative emotion. I have come to accept the death of my brother and I must live my life to the fullest because there is no sense in two lives being wasted. However, when I got to giving my sister CPR I realized it caused me physical pain and flashbacks. I suppose I bottled up this memory and never fully dealt with it or told my sister how it has affected me. Resulting in the manifestation of anxiety. There are only a few things that seem to be beneficial to reduce my anxiety, such as exercising and helping others. However, when I exercise I become “hyperfocused” and lose track of time. Then before I know it 3 hours have passed and my school work still isn’t done. Or I help my friends with projects and lose track of time. I’m not sure if I will ever be able to fully return to who I was before this, but I believe acknowledging that this is possibly the cause my anxiety is the first step.
I didn’t do cpr on anyone but i did do the heimlich maneuver on my mom not just once but twice the first time i was you younger i kinda had just turned 14 we where at a party and i saw her going out the front door and she was making a wierd sound so i followed her she pointed out she couldn’t breathe so i did the heimlich maneuver on her but i didn’t even know if i was doing it right so i stopped and went inside to tell someone to help me and no one was listening to me so i ran back to my mom who still couldn’t breath and did it again she finally started to breathe with what i was doing and when she did she said she wasn’t chocking on anything she just couldn’t breath at that point a few people where outside id never fealt any adrenaline like that as i had that day after i fealt proud of myself of what i had just done though since i had always wanted to be in the medical field i was glad i saved my moms life that incident i thought about it for about 3 weeks and it slowly started to fade from my everyday thoughts but the second time(i 16) we had just wrapped are christmas time event i think i knew my mom was on the phone because he was talking i was comfortably on the couch with my little sister when i hear my mom coughing and getting water then she comes kinda towards the living room(she was patting her chest)and that’s when i notice she couldn’t breath and when my fight or flight instincts kicked in i jumped out of the couch and got to my mom faster than my sister could even get up from the couch and i started doing the heimlich maneuver on her and i started screaming for my dad and so was my sister who was next to me just watching me try to help our mom but even tho i was doing it i never trust myself enough to know if it’s going to work so that’s why i screamed for my dad but kinda by the time he gets to us she started to breath again and she was chocking on a the peanut skin she had said but like after that incident i was never the same because i never thought in my life i was going to be doing that again to my mom or to anyone it’s something you see being done but never think your going to have to and i thought i was going to forget about it and be the same just as i had the first time ,,well after that day every time i hear some cough i look at them and don’t look away till i know they are breathing and every time i do hear someone cought i just feel this adrenaline shoot inside of me and every time i hear my mom alone in the kitchen getting water or coughing i feel like i have to check up on her constantly to reassure myself that she’s okay i get anxiety and start to over think if i don’t hear her moving or talking while she’s in the kitchen i don’t go to sleep till i know she’s not going to eat anymore or when she’s home alone i think of her constantly but to me she doesn’t look traumatic from what she went through like she even kept eating the peanuts after she was chocking which kinda shocks me because every time i think of peanuts i think of what if i shoke,,,ever since the 2nd time happened i constantly think about it i may have reacted fast but inside i always wonder the what if it wouldn’t have worked.i personally don’t know if i actually do or don’t have ptsd since what i went through doesnt compare or even come close to what others have gone through.hope the best for anyone reading this and may god bless you<3
First of all you are a hero!! And I think that the response you are having is normal to trauma. I’m not a doctor but you should reach out too Nami it’s a Nation wide Service that can direct anyone who is in need of some Therapy to put this in perspective and wrap your head around why your body is responding to the trauma this way. PTSD as I understand is just your fight or flight hormone rising and falling and it can get off track like a train jumping track everybodys body response differently.
There’s a really neat ebook on your Google play that helps me get grounded and back on track . It’s call Letting Go the daily meditations for codependency. By Melody Beattie. It just a tool for helping anyone struggling with any thing that is potentially holding you emotionally hostage to move on from the trauma, you are reliving the trauma like a memory loop and when this happens you are desperate for reprieve. Scientificly your Cortisol hormones that control your fight or flight response are stuck. No one can stand this for long periods because we start too feel like we are losing our minds because you are probably not reaching rem sleep, which we need to maintain healthy though functioning. What happens when someone is sleep deprived well we can’t make rational decisions and then be start trying to make sense out of things when our brain your computer has been hijacked by malicious malware. The operating systems won’t work until you fix it by installing a program that removes it. I absolutely believe beyond a shadow of a doubt you will get through this with the correct tools. Look on YouTube for video for Breathing techniques, Tapping tools that work on pressure points, I know it sounds silly but these methods are tried an proven solution.
I have never experienced PTSD until recently after my daughter dropped dead 5 days ago. It was the most horrifying moment of my life that I could remember at that moment. I never panic, but I did. She has seizures and Chronic Heart disease, but nothing could have prepared me for this. Her eyes didn’t roll back in her head like a regular seizure, no they looked like they melted off towards opposite sides, as she was saying mom something is wrong, mom i can’t see. Of course her eyes disappear in a way that terrified me. Then she crumble like a piece of paper but backwards. All I could do was start CPR protocol. Problem is I hadn’t taken a CPR class in 20 years because of my health. She had no breath, no heart beat, no expression, no response. I started doing the 2 clear breath and compression, I had forgotten about so much. I couldn’t find my phone. I ran too my neighbor said call 911 my daughter isn’t Breathing. I returned to do whatever I could. Because she has had a history of drug use, I assume it could be that even though she was in a program. So I grabbed the narcan and did two sprays in ear nose. No response, back too CPR. By this time I’m going into full panic mode but I knew if I panic she would die. One neighbor came and helped take over he got exhausted so I took over, no response still. I’m screaming why don’t I hear sirens from Medics? Another neighbor came and started compression. Still no response. I’m screaming at her fight God dam it, you have never back down from a fight now fight. I Narcan her again, nothing still doing compression. I’m doing the breath but at this point I’m having a full blown asthma attack and seeing stars but still conscious. He starts to get tired. I start telling him you can’t give up she will die. Finally another neighbor comes in with 911 on a speaker phone. She starts telling us what to do again clear breath. Rhythm to the compression, someone poured ice on her and us. It was Chaos. I opened the last nacan and sprayed it. One big breath and I hit her heart and yelled breath!! I could hear the siren finally. The last thing I had done made her heart start beating. Thank God. They hit her with adrenaline, narcan and something else because of her vital signs. I am going into shock I’m shaking uncontrollably by this point.
Since this happened I keep reliving it. I see her face and it feels like a huge ocean wave is knocking me down, my ears start too ring, I start shaking, vomiting and hyperventilating. Food tastes like card board. I never know when it’s gonna hit me, new symptoms some worse than the last, I feel paralyzed and feels like my feet are in concrete. WTH is happening the crisis is over. Why is my body insisted on reliving it. I realize it’s only been a few days, but my daughter was rushed back to the hospital for a collapsed lung. And of course I blame myself because I lost my shift for the first time in my life during a crisis period when I was needed. But since when are we expected to be perfect?? I realize what was happening I’m having PTSD reaction. So every time it starts I try to remember deep breath.
Stop ✋ beating yourself up. You are probably punishing yourself and you owe it to yourself to find out why. Plus ➕ we are living in unsettling times with little security. A corrupt deep state government. Try not to focus on outside influence. It self care you need to pay most attention to. Hot Epsom salt bath with your favorite essential oil like chamomile helps for nerves. Keep doing this self care because when your cortisol stay high you need too focus on relaxing breathing techniques. Take up Yoga ♀️ most of all go too Facebook and look for groups where they’re private and focus on PTSD and talk with people who are going through the same experience and keep checking with Nami for a good therapist who can help that isn’t gonna push Parmacutical drugs for only Last option. See if Canabinoids are safer because they’re non addicting. My daughter has seizure from a feel good doctor who took her 2X over the legal limit on Xanax so find one who uses other options first. Sometimes after running out of resources you are left with the only choice for reprieve. There’s natural Valium in essential oil you could rub accross your heart too calm the hypotension symptoms. But only you can decide what is best for you and what works for you. Besides no one knows exactly what you are experiencing except for you. May you find your answers and have some light at the end of the tunnel. You are enough. And it will get better
My partner overdosed due to her antidepressant medication changing to a generic brand and had a very serious adverse affect on her. I was there and she turned blue and was not breathing and I had to give her CPR until the paramedics arrived, thankfully she survived, but I have suffered an enormous amount of PTSD and all I can see is her face when she was dying. I don’t know how to move on with the relationship now and it feels as if I can not be with her anymore. How can I get help? I feel so guilty I can’t bare it, as I should be grateful she is still with us. I can’t sleep, I have nightmares and I can’t eat. Can someone please suggest something or somewhere I can got to get help to overcome this as I love my girl very much but I can not see the relationship continuing if this does not go away. Please help.
I’m reading this article right now because I have ptsd from coming home from work to my girlfriend’s suicide. I performed CPR on her until the paramedics and police got there. CPR courses don’t teach you how it really is. And the self blame when it doesn’t work. I’m a medical assistant and my CPR recert is coming up. I struggle with PTSD to this day and it’s been a year since my loss and it’s forever stuck in my head. I am not looking forward to CPR class at all.
Thanks for sharing, Nice blog.
In 2014 I was on a holyday with my family, my father (68) became difficalties with breathing and collapsed, I did cpr like a maschine, no emotions…nothing, 10 minutes later he was taken to the hospital but because of the fluid in his longs he suffered brain damage and was in a coma and layed on the maschines for a week till we got the call he passed away, that was all in holiday. Returing home was bad but the backflash came after the burial, and till this day I feel over emotional, guilt and worthless….although I know I couldn’t helped him to survive, I still feel like this and it won’t go away.
I would like to recertify but it is expired The cost is 100.00 which is too costly.
I have been an Registered nurse for just 2 years and I am currently working on a medical and oncology ward. Two nights ago on night duty I went into a patients room at 0530am to follow up on his low blood sugar of 3.9mmol that I had given glycogell and juice for half HR prior. The pt was only 61yo and was facing multiple tests for ? New lymphoma. When I entered the room his head and shoulders were hanging off the bed, he was a large man of 105kgs, I rolled him back on to the bed, he was blue, unresponsive and not breathing. I pressed the code button, checked airway and started CPR whilst waiting for the ICU team. The pt ended up being revived intubated and went to ICU. I was extremely shaky and had to make the difficult phone call to the family. Prior to this I had hurt a muscle in my back exercising the day before and after the adrenaline wore off my back was in spasm. When the morning staff came on I was trying to hold myself together, I was worried about all the tasks that I didn’t get completed and kept wondering if I could have prevented this by checking on him sooner. The pt ended up passing away 26 hrs later when his life support was turned off with his family by his side. He had suffered a cardiac arrest and then a stroke in ICU. As soon as the first morning staff arrived I felt like I was going to vomit, then I was holding back the tears. When I made it too my car with my crook back I burst into tears, although all the team was very supportive and telling me what a great job I had done and that I should be proud I felt I’ll, I felt I failed my pt and I kept seeing the look on his face when I rolled him over. He was dead! I remember every compression and felt every rib I broke with the compressions. It’s been a rough 48hrs with back pain and emotional turmoil, however I am finally feeling a little bit proud that I fought hard for my pt and gave his family a chance to have a proper goodbye. I still keep seeing his face. Hopefully it will ease over the coming days. One good thing was that all that CPR training just fell into place when I need it.
I believe that there should be more serpport for servilions such as myself after the traumatic event of performing CPR in my case on my father. Wich thankfully had a happy ending. But even so this did not tack away the trauma that I was subjected to that day.I felt totally overlooked and as a 19 year old was experiencing symptoms of PTSD. but in sumerie I’m not tacking anything away from the emergency services they altimatly saved my dad’s life. Wich I don’t tack for granted. I just felt the opertunity to express my opinion on the aftercare of the people how have had to experience this first hand because it is traumatic.
I remember including my experiences of the realities of when you actually do cpr for the first when I taught the course.
It was well received from the candidates.
It would be nice to see heart and stroke beef up what is taught in their programs so people are aware and can take care of themselves after such a life altering experience such as performing CPR.
This is one of the reasons why I have enjoyed my work with and encouraged my instructor to get involved with Odyssey medical. As it not only gives them hands on experiences, it also opens up a whole new world of opportunities to learn, cross train and share their expertise.