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By now the waiting room was filled with troopers and policeun to arrive Hospital personnel who had not been informed of the accident but had noticed the cluster of police At this time, no one really knew the nature of the accident and there idespread confusion about it; an An inquisitive crowd began to gather in the lobby The EW ad inforeways fro," one of them said over and over

A few minutes later, another ambulance pulled up and Ralph Orlando, a fifty-five-year-old father of four, was taken off He had suffered a cardiac arrest on the way to the hospital and closed cardiac iven by a nurse, the first person who happened to reach him as he was taken from the ae was taken over by a resident The patient was taken to OR 1, where full re-suscitative procedures were begun

The routine of cardiac resuscitation is now so standard that few people realize how recent it is The basic principle of closed cardiac e was first properly described in modern times in 1960 (It had been described in the nineteenth century but was not commonly practiced) Prior to that time, a cardiac arrest was alht to be open eon incised the chest and squeezed the heart directly with his fingers Although frequently successful, open -term benefit; one study in 1951 indicated that of patients who underwent open ed froe is now a last-ditch effort only

Closed cardiac htly packed in the chest between breastbone and backbone Rhythh to produce a pulse Direct open e is therefore not necessary, and the hazards of this surgery are avoided

The purpose of cardiac e is to maintain blood circulation which, in conjunction with artificial respiration, provides blood oxygenation for the brain The brain is the organ en; under in after three minutes of circulatory arrest In contrast, the heart itself isafter ten or more minutes But by this tiun, the brain will be irreversibly daed

In soh to start it beating again, but the enerally accompanied by a variety of other es from the arrest This includes the injection of Adrenalin, calcium, and sodiu these techniques, has de extent

The procedure for Ralph Orlando was the standard one: closed e and artificial ventilation, with simultaneous injection of substances to correct metabolic imbalance This procedure failed to induce spontaneous contractions of the heart un

No one had any idea how long it had been since Orlando had suffered his arrest; presumably whoever had ridden with him in the ambulance knew, but that person could not be found

Initial electroshock therapy failed Using a long needle, Adrenalin and calciuht heart ventricle, and further shocks were administered It was noelve minutes since his arrival

While this was going on, the rest of the EW staff was organizing itself around the other patients One resident was assigned to oversee the care of each injuredroom across from Orlando, John Conamente was also surrounded by people He was si intravenous lines inserted in both ar questioned by the resident, who stood at his head and shouted in order to be heard over the noise of the people working around him The resident conducted a typically stripped-down history and systeht take ten or twenty minutes

The resident asked, "What happened? Did it fall on you?" (At this time, most people still did not know the nature of the accident, except that soroup of construction workers)

"Yeah," John Cona"

"Where else? Did it hit your shoulders?"

"Yeah"

"Did it hit your head?"

"No"

"Were you unconscious?"

"No"

"Does your left arht leg hurt?"

"Yes"

"You have pain anywhere else?"

"No"

"Your chest hurt?"

"No"

"Breathe okay?"

"Yes"

"Pain in your belly?"

"No"

"Pain in your back?"

"No"

"You ever been in the hospital before?"

"No"

"You ever had an operation before?"