Much criticism has been leveled by Dina, and her strident supporters, against Rebecca in the area of CPR performed on Max at the scene of the accident in the Spreckles mansion. The criticism implies Max would have been “salvageable” if only Rebecca had done CPR “better” or “sooner”, and that she had not only a duty, but as mandate to do so as a health care professional.
Just for reference, here is some information about California’s Good Samaratin Law:
http://knowledgebase.findlaw.com/kb/2009/Oct/32614.html
http://firstaid.about.com/od/medicallegal/a/07_no_good_sam.htm
Rebecca was a Lasik technician, probably a certified ophthalmic assistant, and possibly a certified ophthalmic technician. This is not a position such as an EMT, or ER nurse. It is highly likely that Rebecca NEVER had performed CPR on any actual person, but only on CPR mannequins for periodic renewal. From this perspective, I would classify RZ’s skill level as essentially a layperson in the area of knowledge and experience performing CPR, not as an experienced health professional. She worked in an outpatient setting in a Lasik clinic—and I’m not exaggerating when I say that if a Lasik clinic is having a lot of experience performing CPR, something is terribly, terribly wrong.
So, if we consider that RZ had potentially little to no experience performing CPR, let alone CPR on a child trauma victim, that puts her actions into perspective at the time of Max’s injury. Docs and nurses and other health professionals are thrilled when out of hospital CPR is performed at a high level, and the patient has an underlying condition that is salvageable. We continuously strive to increase the level of CPR skills and motivation in the general public with education and refresher training. But this is not the case most of the time. Laypeople become nervous, some panic, but most try their very best. The overwhelming majority still may not be able to deliver CPR continuously, with sufficient skill, to deliver a mean arterial pressure greater than 50 continuously. That is what is required according to a number of studies for the patient to have even the 11% chance of leaving the hospital alive. Only about 23% make it to the hospital ER with any amount of BP at all. That’s a pretty tall set of expectations for a layperson, who may have braindumped their entire CPR skills refresher from a few years back.
The overwhelming majority of patients who ARE saved with out of hospital CPR have experienced sudden cardiac arrest from an electrical disruptive physiological cause—NOT trauma. Think the high school athlete who collapses from something like undetected Wolf Parkinson White syndrome. Or middle aged and elderly people who collapse in v-fib or v-tach. These situations are not at all the same as massive head trauma, and spinal cord trauma. That’s why AED’s have proliferated—because for a tiny proportion of out- of- hospital cardiac arrests, the definitive treatment to save their lives is prompt electricity—defibrillation. Even then, statistics indicate barely 11% will survive to hospital discharge. This was NOT Max’s situation. Not by a long shot.
So I think it is supremely unfair to state or insinuate that Max would be alive today “IF ONLY” Rebecca had somehow done CPR as well, or better than the best ER nurse or Paramedic. She was in shock—she called 911 promptly—the situation had her FULL attention, and she was trying. Yes, she appears to have been pretty hysterical when paramedics arrived—and why shouldn’t she be? This beautiful child she loved was terribly injured, and in cardiac arrest. Who WOULDN’T be hysterical?? I have done CPR probably hundreds of times, but if it were a loved one of mine, I'm sure I'd be less collected or more nervous than usual.
There is simply nothing I can see that would justify any allegation of “negligence” in the area of CPR by a bystander like Rebecca. It is further character assassination of a woman who died an absolutely horrific death, with no justification of this criticism based in scientific fact. Max sustained a very serious spinal cord injury at the level of about C-1, 2. That is not compatible with life for nearly all patients. Statistics about SCI (spinal cord injury) don’t lie. The global hypoxia he experienced as a result of his prolonged arrest hastened his demise, but it’s highly unlikely he would have survived, even with “expert” CPR at the moment of his cardiac arrest. The ¾ inch of necrotic spinal cord described at autopsy explains the prognosis.
I won’t bore anyone at this point with a lengthy explanation of primary and secondary injury patterns in spinal cord injury (that's for another post), and the consequences of stretch/ distraction cord injuries, but this is easily googled for any who are interested. He didn't just have a "little bitty" contusion that would have resolved with some steroids and time.
Rebecca could not have saved Max with "better quality" bystander CPR. The fatal damage was done when he impacted the floor—whatever the pattern of that fall was. That’s my opinion, based on the medical science, the autopsy report, and all I’ve read about this case.
