I binge-watched Netflix’s Jessica Jones series last night, and there was one scene that really bugged me. It was in the back of an ambulance, and Jessica’s friend Trish went from a normal (if rapid) heart rate straight into a flat line. There was no transition. You don’t have to understand this reference to know one thing. That is not how “flatlining” works.
I say this because I’m a certified EMT…something I don’t mention much, because it sounds like bragging. However, none of you know who I am anyway, so let’s ignore my hubris for now. I’m bringing this up because this is such a commonly used gimmick in both film and television: this flat line on the cardiac monitor. It seems to symbolize an immediate death, indicating that CPR is needed and needed now.
In reality, when there’s a flat line on the screen, the patient is actually in a state called asystole. This is the last stage of cardiac arrest. Meaning: kiss your ass goodbye. This is what occurs when there’s no longer any electronic or mechanical activity taking place in the heart anymore. You can’t shock or compress the chest of a person with asystole and expect anything other than death to result. They’re gone.
When a patient has a heart attack and their heart is actually failing, you would start compressions during a state called ventricular fibrillation (V-fib). On a cardiac monitor, this is not a flat line. It’s actually a series of squiggly lines, like so:
The heart is a powerful muscle that is designed to last a lifetime. It doesn’t generally go from working straight into no electrical activity whatsoever. There are steps it has to go through first. With V-fib, the heart isn’t beating (which is why the patient has no pulse), but it is still jerking and sparking. There’s still some life to it. With asystole, there’s no coming back.
Also, in the show, it really bugged me that the ambulance kept moving when Trish went into cardiac arrest. They didn’t even bother starting CPR. This would never happen in real life. On an ambulance, when someone’s heart stops, the paramedics and EMTs alike pull over, call for backup, and start compressions. All the studies show that this is the only way to possibly bring back a patient like that. The patient has to be on a hard, still surface. It might not seem as dramatic as a quick transfer to the hospital via ambulance, but it’s their only chance.
So, seriously, Hollywood. When you decide to throw in all these high-drama scenes involving medicine, would you consult someone who actually knows what the hell they’re doing for once?
Flatlining picture from Niccolls and Dimes
V-fib picture from LITFL