Thursday, November 12, 2009

Responding To Cardiac Arrest - Every Minute Counts!

A Singapore medical team is endeavoring on an ambitious target of emergency response time of 2 minutes (see the news from Channel News Asia below)

This would be especially important in setting of responding to a sudden cardiac arrest case where every minute counts! The reasons being:

  • Resuscitation is most successful if defibrillation is performed in about 5 minutes after collapse
  • Effective bystander CPR, provided immediately after cardiac arrest, can double a victim’s chance of survival (Click here to download the entire AHA Guidelines 2005 in pdf free)
  • Even with the latest development of various gadgets and medications, the interventions that unquestionably contribute to improved survival after cardiac arrest are early defibrillation for VF/pulseless VT and prompt effective bystander BLS
Unfortunately, one of the shortcomings of responding to cardiac arrest in Malaysia is the ambulance response time which may take between 15 to 20 minutes or longer (click here to read my article on Shortcomings of Cardiopulmonary Resuscitation in Malaysia or download the article in pdf). Furthermore, our public may be reluctant to perform mouth-to-mouth breathing on a total stranger that we do not know, especially when responding to a victim of a different gender. This could probably be due to the socio-cultural barrier in our community (click here to read or here to download in pdf the article on the survey that I have done with my colleague, Dr. Yazid on the attitudes of our own students in responding to cardiac arrest).

Fortunately, in responding to non-traumatic sudden cardiac arrest in an adult (which most commonly due to a coronary event), it has been found that cardiac compression is more important than mouth-to-mouth breathing. In fact, the American Heart Association (AHA) is advocating performing Hands Only CPR or compression-only CPR in cases when the potential rescuer is not familiar with the steps of CPR or unwilling to perform to mouth-to-mouth breathing.

Hands Only CPR is simplified to 2-step only:
1. Call for emergency medical response (in Malaysia, it is 999)
2. Put your hands in the center of the victim's chest and start pushing fast and hard

Click here to read more on Hands Only CPR or download an article in pdf.
(*Of course, in cases where the primary insult is asphyxia or respiratory etiology, for example, drowning in children, respiratory failure in children, toxicology cases, oxygenation is still very important and in such cases, rescue breathing is important).

Watch the video on Hands Only CPR below:

SINGAPORE: A medical centre and two medical posts have been set up within Suntec Singapore to take care of APEC delegates. And if needed, a team on standby can render help within two minutes.

So far, there have been no emergency cases.

Three doctors and six nurses are on duty everyday.

And since the start of the summit last Saturday, the medical team has been seeing an average of 10 patients daily, mostly for minor illnesses such as flu, headaches and abdominal pains.

The team is also equipped to respond to major cases like heart attacks and any incident which may involve many casualties.

Suresh Pillai, head, APEC Medical Sub-Committee, said: "There will be an extra medical team that will be activated from all the hospitals. All hospitals will have a field medical team on standby to move in the event of a mass casualty incident.

“So they have been prepped to be on standby and move out within five minutes in a mass casualty incident and they will response to whichever site the incident may be in."

On the potential threat of Influenza A H1N1, the team's response will be similar to any flu-like illness, but precautions are in place.

Mr Suresh added: "We have to make sure that we have the anti-viral drugs available and we also needed to ensure that we could do H1N1 testing at the medical centre itself. At this point of time, there is probably no need to do any of these things, since the situation is well controlled and stabilised."

Those who require follow up treatment in hospital, will be sent to the Singapore General Hospital or National University Hospital.

VVIPs who need to be sent to the hospital will be escorted by police.

Media personnel too are well-taken of with a 24-hour medical centre within the media area.

The media centre is also opened round the clock, housing some 30 broadcast booths and 300 work stations. - CNA

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