When CPR Doesn’t Work! Explained by Roy Shaw, Paramedic

Coping with the loss of a loved one or even a stranger can be extremely difficult. But more difficult than grieving, is feeling guilty that the person died because of something that may or may not have been done or done correctly.

In this video, I explain in detail what CPR is, and what it’s not and why a person should not ever feel guilty that they didn’t do enough to keep a victim of cardiac arrest alive. I hope that this video brings peace and understanding to why a rescuer should never feel that they are at fault when a person doesn’t survive cardiac arrest, though the bystander attempted CPR or wanted to give CPR. I hope it helps.

A Response To A Rescuer Who’s Attempts To Revive Her Father Were Unsuccessful

Dear Rescue Fans,

I received yet another loving email from a person who’s father died in the front of their automobile while they were driving them to the hospital. Due to things outside her control, she was unable to move her dad to the ground so she improvised and did CPR while he was reclined in tlost loved onehe car the best she could. She has struggled for some time with this and found some relief from my episode on “Did I Do CPR Wrong?”.
I just replied back to her and I have to believe there may be others who have tried to save a life with CPR and felt it was not successful. So I’m going to include my reply to her in this blog entry and for those of you who are suffering, I hope it helps.

This person said in her last paragraph of her email: “I have struggled with this in so many ways, yet feel comfort in being with him when he left. I have struggled to find any material that related to my experience. I have felt isolated in not being able to share how I lost my dad, This story, the words you have written, have helped me process and understand my own experience. Thank you.”

This was my response:
Dear __________,

I’m so very sorry for the loss of your Father. I’m sure this must have been most traumatic for both you and your mother. I want to re-ensure you that what you did for your dad that day, was the most brave and loving gift you could have given both your dad and your mum. Every thing you did sounds perfect in order to give your dad the best chance of survival possible under the circumstances. The fact that he did not survive the event does not have anything to do with your efforts. Remember, CPR is only a time buyer in case the person is going to respond to medications and advanced medicine. It’s not a guarantee. The fact that you had the courage to try and the compassion to help is amazing. Please let your mother know that her reaction to the situation is also very normal. She lost the love of her life. Her soul mate and her husband. It’s a nightmare that is happening for real, right before her eyes and it’s not wrong for her to be so overwhelmed with grief and fear that she could not help. That’s why paramedics are not called to their own homes for emergencies. It’s too emotional. So please, let your mother know that she is not at fault for her reactions either.

I hope and pray that you will receive peace during this time of healing. But please know that everyone has a day to die and it’s never easy to experience it. CPR just keeps the window of opportunity to survive open a little longer. You gave that to your dad. As a father myself, I can only imagine how I’d feel to know that my daughter loved me so much that she would give me CPR while waiting for the ambulance to arrive. What love.

Be at Peace,

P.S. I’ve included the video that explains this message in detail. I recorded it so long ago, it’s hard to find so I’m going to bring it back to the top. Share it with anyone you may know who may benefit from it.

They’re Choking And I Can’t Get Them Out Of The Wheelchair!

Maybe you work with patients that are wheelchair bound and may, at times, be too large or have disabilities that limit your ability to get them out of the wheelchair in a hurry. Especially when they begin to choke during meal time. I received a phone call message regarding this very situation and though we had a great discussion about what to do for the patient over the phone, the person I was talking with thought it would be a great idea for it to be made into a video training. So, here you go Maria! I hope it helps.

Best Wishes,


Response to Post About ARVD and The Contraindications of CPR?

I received a feedback post that I wanted to respond to by video:

The post read as follows:


My wife has a heart condition called ARVD. This involves the RIGHT VENTRICAL and the things you are asserting(about CPR) will injure or kill the person.  Please see the website at Johns Hopkins on ARVD. This is a congenital heart disease that WILL NOT RESPOND TO STANDARD RESCUE PROTOCOLS. Because it involves the right ventricle the symptoms and treatments are all different. Lynn wears a Medic Alert bracelet and part of the information is to NOT perform standard CPR protocols, but to contact her doctors for information on how to proceed. She has a pacemaker and ICD, and cannot be given lidocaine or any of the standard cardiac resusitation drugs that ACLS requires. We will add that oxygen, lying on the left side and transporting to a facility familiar with heart electrophysiology, and ARVD treatment. This disease is found in athletes (runners, football and basketball players,
tennis and extreme sports) who seem on the outside to be fit, but have a heart that is not functioning as it should. This disease runs in families and it traceable through genetic testing at Johns Hopkins.



It must be difficult having a loved one struggle with a cardiovascular disease as mysterious as arrhythmogenic right ventricular dysplasia(ARVD), but I want to reiterate that CPR performed by bystanders will still give more benefit than doing nothing at all.

The fact that the right ventrical is dysplastic should not have anything to do with CPR performed as an emergency intervention in order to try and circulate any increased amount of oxygenated blood to the brain and vital organs.   As with everyone who goes into sudden cardiac arrest, there is no study showing that any amount of CPR would make a cardiac arrest victims biological condition worse.  If left alone, and no automatic circulation and oxygenation is present,  the body would continue to go without gas exchange circulation.  This is why most emergency protocols, and 911 systems will encourage CPR regardless of the underlying pathology related to the cause of death.  Out in the field, the goal is to keep the victim biologically alive enough to make it to the hospital or advanced care where when applicable, reversible conditions can be made right.  I did contact John Hopkins and after a short discussion with an ER nurse, it was confirmed that ARVD has different protocols for cardiac arrest.  Most victims of ARVD do not know they have it and therefore would present as a spontaneous sudden cardiac arrest event.  If this occurs, most EMS 911 dispatch systems are going to encourage CPR. I hope this helps and I’ll let you know what I find out from the American Heart Association when they respond to my question for clarity regarding this special case. I hope this helps.

Best Wishes,

Roy, RoyOnRescue.com

Life and Death With Dignity…and Privacy

just received a question from a student who asked:

Dear RoyOnRescue,

“In thinking about the use of an AED, what if the person is a woman and we have to “bare the chest”.   Should we place the AED pads under the shirt, or do we have to actually bare the chest for proper use of an AED?”


This is a good question and one that is uncomfortable for some to think about.  Whenever a rescuer is working on a patient, male or female,  a rule of ethics applies.  We as rescuers should be thinking about the dignity and respect of the patients privacy and confidentiality at all times.  This includes times where we may have to “Bare” the chest of the victim in order for us to defibrillate or treat them.  We should seek to be discrete as long as we are able to get the job of rescue accomplished without delay.   If the person is able to be defibrillated without full removal of the clothing that’s great.  If the person needs to have shirt or underclothing cut or removed in order to defibrillate properly than that will need to be done.  If there are bystanders, those bystanders could turn their backs to the patient and try to make a human curtain around the patient in order to protect the patients privacy and dignity.  Think about if this is in a public workplace or location where the person is known.  They may survive if everything goes the way it should and if they do, they will probably return to this workplace.  We must make sure that as far as we can control, we protected their dignity and helped them as much as possible without complicating or slowing down the rescue process.

I hope this helps.

Best Wishes,



Person Falls Face Down, Unresponsive!

On this episode of RoyOnRescue we take a closer look at a questions a person had about what to do if a person falls, has a potential neck injury, is face down and is unresponsive.  This can be a complicated scenario when it comes to assessing the person for airway,  breathing and circulation. Watch this episode to hear one way to respond to a person in this situation, treat them without causing further harm and maybe save a life.


A student emailed in a great question and one in which can be a very tough one to answer!      It’s challenging enough to get bystanders to begin CPR.  But when we complicate the scenario with a person yelling; “They have a DNR, don’t do CPR or you’ll get sued!”   This can really complicate matters.  What do you do?   Stop CPR and hope that the withholding of potentially life saving CPR is legitimate?  Don’t stop CPR and continue to upset the people that are yelling stop in the first place?   Whoa! Tough spot to be in.

In this episode I’m going to do my best to explain the very complicated issue surrounding Do Not Resuscitate orders(DNR) when CPR is already in progress or about to begin.

Sample of Proposed DNR Guidelines From BENO-Ethics

How to Give CPR to A Ventilator Patient

This week a student asked:

“I take care of a child who has a trach and is on a ventilator when he sleeps.  Do you have a course for cpr involving a patient with a trach if we were out and did not have access to a vent?”

Though we don’t offer any specific ventilator training, I thought this would be a good time to do a royonrescue episode covering this topic.

I didn’t want to delay this reply any longer than necessary so as Jody Marvin and I were on the road discussing training issues for ProCPR.org, I thought we would take advantage of the drive time and answer this very good question.

It’s hard enough initiating CPR or rescue breathing for a person who doesn’t have any special needs, but then when it’s complicated with something like a tracheostomy, it can really become confusing.  I hope this video blog helps clear things up.  Keep the training questions coming I think it really helps everyone who’s concerned about rescue and saving lives.

Best Wishes,


Giving CPR to People With Bleeding Chest Injuries

I received an email that I think we can all benefit from.

It read…

“Since most of the first aid measures for a no pulse, no breathing situation is immediate CPR, is it alright to do CPR if the victim has a wound on the chest that is bleeding profusely? This is not that I have seen this situation, but I like to think that if it happens I would know what to do!”
C. H.

That’s a great question C.   Sometimes it’s easy to get distracted by a serious traumatic injury and forget the basics and what needs to be done first in order to try and save the person’s life.  Or, we can look at a complicating injury such as a chest wound and think,  How am I going to do CPR on this person, there chest has a serious bleeding wound right where I’m going to give my compressions?

In this episode of RoyOnRescue we are going to look a proper treatment plan if we ever came across a person who had a serious chest injury and needed CPR.