Timely act Can Save a Life
Sudden cardiac arrest(SCA) can happen to people of all ages and kills more than 6 lakh in India every year as per official statistics. It can occur anywhere, in the hospital or outside the hospital. Death occurs within 10 minutes. For every minute that defibrillation is delayed, the chances of survival decreases by 10%. The present survival rate in SCA is only 1 %, as there exists considerable delay in receiving emergency medical care. Immediate defibrillation with AED can improve the chances of survival upto 75%. Sudden cardiac arrest is not the same as heart attack, instead, it occurs as a result of a variety of reasons, including heart attack, drowning, electric shock, burns, road traffic accidents, variation in blood potassium levels, poisoning etc, and is commonly identified by sudden collapse and cessation of carotid pulse(neck pulse). Breathing may be absent, abnormal or the patient may be just gasping. Unless on the spot basic life support is provided, the chances of saving the victim’s life is almost nil.
When the heart stops functioning all of a sudden, the pumping of the blood to the brain and various organs suddenly ceases, and the patient faints. The oxygen supply to the organs and cells get impaired. Even a patient without a beating heart, can be brought back to life through timely Cardio Pulmonary Resuscitation(CPR) and with the aid of machines like Automated External Defibrillator(AED). With no exception, everybody, literate or illiterate, can do this, and hence precious lives can be saved. The only precondition is that, they have to be trained at the grass root level on basic CPR and AED.
What is CPR?
CPR involves two steps, and can be done by a single person, or simultaneously by two people, depending upon the situation. The first step is chest compression and the second one is rescue breath. 30 good quality compressions on the lower half of the mid chest using the palms placed one above the other with the fingers entwined, at a speed of 100 to 120 per minute, reaching a depth of 5 to 6 cm, is recommended as per guidelines. This should be followed by 2 rescue breaths, given using a pocket mask or mouth to mouth. Make sure that each rescue breath is sufficient enough to produce a chest rise in the patient. Intervals between compressions should be reduced to the bare minimum. Chest compressions should be continued until pulsations are felt in the neck, checked once in every 2 minutes. This resuscitation technique stimulates the ceased heart and it gets restarted, thereby restoring the blood flow to the brain and the vital organs. The rescue breaths will provide the necessary oxygen supply to the lungs. AED machine, if available in the vicinity, should be connected to the patient as recommended.
AED machines are installed at all main railway stations, airport, and major bus stands, but it is sad to note that no one is aware of its existence, use or importance. It is a simple, small, handy portable electrical device, capable of delivering an electric shock to stimulate the heart at such critical situations. It is safe to both the patient as well as the operator and has got two terminals, each provided with a pad.
As per the illustrated instructions on the pads, one pad has to be attached to the right upper chest of the patient, and the other one below his left lower chest.
Switch on the machine and then onwards, the voice instructions from the machine have to be followed. Once the neck pulse is restored, patient has to be kept in ‘recovery position’ or even given rescue breaths only at the rate of one breath every 6 seconds. Resuscitation attempts have to be continued until the emergency rescue team arrives at the scene, or until the patient is shifted to the Emergency Medicine department of the nearest hospital.
Grass root level training in basic first aid like CPR, AED and even trauma management have to be imparted to the first responders (i.e. police, fire force, railway, KSRTC and private bus or taxi or auto workers, military, paramilitary, forest , excise, politicians, social workers, trade unionists, NCC, NSS, scouts, home guards .etc). Posters illustrating steps of CPR and AED have to be exhibited at all public places. AED machines have to be installed in sufficient quantity at all public places. The 24 hour telephone numbers of all the nearby hospitals have to be displayed.
In order to improve pre hospital management of sudden cardiac arrest, a two tier strategy is required. At the first level, BLS(basic life support) trained public will serve the purpose. Ambulance services, with trained emergency medical technicians can form the second tier.
–– Dr Naveen Mohan,MBBS,MD Assistant Professor & Consultant Emergency Physician, Department of Emergency Medicine & Critical Care, Amrita Institute of Medical Sciences(Kochi)