On Memorial Day weekend in 1971, my father passed away suddenly at the age of 42 from a heart attack.
I was reminded of this recently while reading last week’s book recommendation, American Sirens: The Incredible Story of the Black Men Who Became America’s First Paramedics by Kevn Hazzard.
A portion of the book details the role that Dr. Peter Safar played in the development of Cardiopulmonary Resuscitation (CPR). Until I read the story that included considerable information about Safar and his career, I didn’t realize that he resided in the same suburb of Pittsburgh, Mt. Lebanon, where I was raised.
In a particularly sad irony, Safar’s oldest daughter Elizabeth died suddenly from an asthma attack which resulted in a cardiac arrest at the age of 12, five years before my father’s passing.
Reading about Safar and the role he played in the development of CPR and the field of emergency medicine (the roots of which are in Pittsburgh’s Hill District through an organization known as Freedom House) reminded me of how much I take for granted today.
CPR, which today is considered an afterthought (of course everyone knows what it is and could probably figure out how to perform it even if they’ve never been trained) was not well known in 1971. Furthermore, the concept of an EMS ambulance, which today is akin to a rolling ICU, was also unheard of in the 1970s.
In the 70s if a call was made for an ambulance to treat someone in distress, the first responder would usually be a police officer driving a paddy or station wagon that contained a stretcher. The only “first aid” equipment in the vehicle to help the person breathe would have been an oxygen cannister.
Safar envisioned the concept of CPR and began to work on it while serving at Baltimore City Hospital in 1956. Due to the skepticism of the medical community, it would take another 17 years before the American Heart Association would adopt standards for CPR in 1973.
To prove that CPR was effective, he arranged for several experiments in which volunteers (who received $150 each) would permit Safar to first sedate them and then administer a concoction that would in fact paralyze them so that they were unable to breathe on their own at which point CPR would be performed on them with the results documented for medical purposes. To validate that CPR could be performed by anyone, a large group of volunteers to include, housewives, janitors and Boy Scouts were enlisted to administer CPR on the willing subjects. Amazingly, not one patient was “lost” during the experiment.
Here are a couple of excerpts from the book that detail the experiments that led ultimately to the adoption of CPR as the gold standard for dealing with a cardiac event in the field.
Safar had never conducted a study of his own…to prove mouth-to-mouth worked, he’d have to keep the sedated volunteers alive while also recording the physiological response to the ways he was keeping them alive. It was all about data. Empirical and undeniable evidence.
To capture it, each test subject would be attached to a series of monitors tracking—before, during, and after the tests—their heart rate, blood pressure, and oxygen levels, as well as how much or little the various methods of resuscitation inflated their lungs. All this was either explained to, or already understood by, the test subjects. So too did they have a working knowledge of Safar’s cocktail of IV sedatives and paralytics, which included curare, the compound once used in the Amazon to make poison arrows.
The sedatives, given first, rendered them unconscious. Once out, the victim would then be paralyzed, head to toe, unable to draw even the slightest breath. At this point they would be perilously (but safely) close to “clinical death” and entirely vulnerable, living proof of Safar’s theory.
Whatever the risks, however unappealing it sounded to play a completely helpless human guinea pig, Safar had no trouble recruiting volunteers. Offered only $150 and a chance to make medical history, thirty-two doctors, nurses, and med students agreed to be rendered unconscious and unable to breathe for hours at a time. And they agreed to do this not once but repeatedly, over the course of forty-nine separate experiments.
It signaled their dedication to medical advancement but also a tremendous amount of trust in a doctor who’d never done anything like this before. And because the goal of his study was twofold—to prove one life-saving technique worked and also demonstrate that another didn’t—he would have to subject his victims to a combination of both.
First, they would be treated by medical professionals performing the backpressure, arm-lift method. Next, they would receive the new mouth-to-mouth method that Safar had convinced them was superior.
The second part wouldn’t be performed by professionals, though. Instead, the one method that could, possibly, keep them alive would be administered by people who were untrained. Very untrained. To show just how easy to learn and effective mouth-to-mouth was, Safar recruited, among other laypeople, Boy Scouts as young as ten to keep his victims alive.
The first test was held on Saturday, December 8. For the location Safar chose one of the operating rooms at Baltimore City Hospital because they were closed on the weekend, so he and his odd assortment of volunteers would be left undisturbed. The OR was large and gleaming white, scrubbed sterile, and crammed with equipment and people. The victims were laid out on the floor, awaiting their fate.
Standing around them, watching in an anxious semicircle, were the rescuers. Men in ties, women in dresses, all with hands clasped or arms folded, their faces full of grave concentration. Sprinkled throughout were the Boy Scouts. Buzz cuts and those perfectly folded scarves, uniform shirts bristling with the patches of past achievement. These children stood, hips cocked, as if they were ready, as if they’d always been ready.
Dressed in white scrubs, Safar began by sticking an IV needle into the arm of each of his victims. Once the line was running, he slowly pushed the sedatives. This took multiple doses and several minutes, but little by little, one heavy eyelid at a time, they all slipped into unconsciousness. Next came the paralytics, this stage going faster than the first, the deadly serious undertaking gathering a momentum of its own until the victims were fully paralyzed. They were now unconscious and not breathing, reliant solely on their rescuers, and would remain this way for three hours.
He started with the old method—back-pressure, arm-lift—which meant that his professional, Chief Martin McMahon from the Baltimore Fire Department, was up first. The simulated victims were now as close to actual victims as the healthy and willing can get. They weren’t breathing and, if something wasn’t done quickly, could go into cardiac arrest in only a few minutes. It would be impossible to overstate just how close to the edge Safar was pushing it at this point.
Forget for a moment that they weren’t breathing. Because the victims were unresponsive and their airways unprotected, if during the demonstration one of them vomited, they’d be unable to stop themselves from choking on it. Gone unnoticed or left uncorrected, it could kill them. And if it were to happen now and someone died, it wouldn’t just be the end of the study but possibly the end of Safar’s career.