Sunday, November 25, 2007

Pre-Hospital Resuscitation

Here are my slides for the "Pre-Hospital Resuscitation" Talk during the 3rd National Congress On Emergency Medicine.

Update 23 April 2008:
I received the following comment from a reader in

Big note: While most US cities have a ROSC rate of 1-5 % , a few cities ROSC approach 20-40%, namely Seattle/King County Medic One, Boston EMS, Austn Travis County EMS, and Ada County Paramedics. Thier approach is to limit the number of paramedics, but only send them on lifethreatening calls ( a different approach than most US cities) and really push rapid BLS over rapid ALS.

I suggest you read the USA today series "6 minutes to live or die".

Thanks for updating me on the current situation.
My apologies for not knowing the real figures.
I have visited USA Today (the article can be viewed here: Six Minutes To Live or Die) and really amazed on what have been happening in places like Seattle. For example, I quote from USA Today (italic mine):

"Over time, Seattle has learned that more victims of cardiac arrest survive if a bystander intervenes and performs CPR, buying the person time until a defibrillator can be applied. So Seattle's emergency medical system, called Medic One, pushes CPR training and makes citizens partners.

The city has trained ordinary citizens — from taxi drivers to restaurant employees — in CPR, making them members of what is known as Medic Two. Seattle firefighters work as instructors for the program and teach about 18,000 people a year. Since 1971, the city has trained 650,000 people. As a result, Seattle now has one of the highest "bystander CPR" rates in the nation — 44%. That means that nearly half of all cardiac arrest victims get CPR from a co-worker, a loved one or a stranger in the minutes between collapse and when emergency medical crews arrive.

"Seattle showed us it could be done," says Rich Serino, Boston's emergency medical services chief. So Boston launched its own effort to involve citizens in saving lives, offering CPR training to individuals, churches, clubs and anyone who requested it. Menino used his clout as mayor to help EMS forge a partnership with local businesses. The city asked businesses to prepare to react to a cardiac arrest on their premises by having a defibrillator on hand and by having people trained to use it and to perform CPR.

As a result, Boston's bystander CPR rate is 30%; that is, bystanders are already performing CPR when rescue crews arrive 30% of the time. The city has saved an additional 200 lives over the past 10 years with a public training program conducted by the fire department that cost $65,000 last year and is expected to cost nothing next year..."

For us in Malaysia, I think, we need to have a coordinating body - a resuscitation council, etc - consisting on emergency physicians, cardiologist, public health educators, etc... up until someone up there (a policy maker, somebody powerful enough) is sensitive and passionate enough to mobilize such a nationwide scale of campaign, I am not sure how much we can increase the awareness, the knowledge as well as the skills of bystander CPR among the public; that's why I see the effort by IJN [click here for the article] as a positive move to be lauded; yet we need to get the latest message across especially in instilling chest compression alone CPR.


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