By Art Hsieh, EMS1 Editorial Advisor
Several organizations joined forces Tuesday and held a media event in front of San Francisco City Hall to promote National CPR & AED Week. Along with spokespersons from the American Heart Association, the City and County of San Francisco, and cardiac arrest survivors and saviors, we spoke to the urgency of training the public in bystander CPR. Our message was clear: CPR is easy to learn, cheap to acquire, and may truly save a life.
As the emcee for the event, I had the honor of introducing the guest speakers. Several thoughts crossed my mind as the event proceeded:
- In many parts of the country, the professional rescuer side of the system is in place. From prehospital care providers, to emergency department staff, to intensive care personnel, once in the system you’ll be likely to receive professional care. Certainly there is room for improvement, and optimizing response and care will be a never-ending process. But as a society, we have built our modern emergency care system around the tenet of reducing death by sudden cardiac arrest.
- Nationwide, that survival rate continues to be dismal despite the untold millions or even billions of dollars that we have invested in the system since the 1970s. Nine percent is the current estimate. It essentially hasn’t changed in several decades.
If you take these points, you might conclude that we’re throwing good money after bad; perhaps the logistics of reversing sudden cardiac arrest is just too great to overcome. To me, it’s the opposite — we’re not spending enough, in the right places and at the right times.
Clearly there are systems in this country that have demonstrated survival rates to near 50 percent. Estimates are that closer to 70 percent of SCA victims can return to a productive life. We have seen advances in our understanding of bodily functions during low- and no-flow states, and have developed effective approaches to supporting life when death is at its doorstep.
Folks, we haven’t figured out how to distort the time-space continuum. Best as I can tell, we haven’t been able to slow or stop the clock of anoxia and tissue death at the moment of collapse.
Science fiction transporter technology is still a ways off. Result: except for the very rare occurrence of witnessing the SCA event, the response system must depend upon the kindness of strangers for their assistance in preserving the potential for life prior to the arrival of professional responders.
This is our charge. If we are to expect any change in the current state of cardiac arrest survival, we must be the agents of that change. Not just to provide the access to training, although that can be a very effective first step.
In systems where resuscitation rates are high, EMS systems have encouraged their communities to participate in the response by providing high quality training prior to arrival of the rescue unit. Rather, it’s about changing mindsets. This must occur at several levels.
First, our mindset must change. In SCA we are not the key to survival. The public is. The sooner chest compressions begin, then higher the likelihood of resuscitation. It’s that simple. We must drive this change.
Second, the community mindset must change. For SCA outcomes to improve, bystanders must be willing and prepared to assist when called upon. Pre-arrival instructions have been useful in getting people to perform effective CPR. If we could encourage our friends and neighbors that CPR is simply a life skill that can be learned in middle school, we could see a dramatic change in save rates.
Third, our society mindset must change. To me, this means enabling laws that require citizens to learn CPR. We’ve done this with seat belts, helmets, fire alarms, sprinklers...each has been demonstrated to reduce death and disability. Immediate CPR has the same effect. The training can be delivered very easily in a middle or high school health curriculum. No hoopla, no fuss, just the simple explanation of how and when to perform.
Having been a student of resuscitation care for nearly 30 years, the time to make these changes is now. Our understanding of SCA has never been so complete. Response systems have matured and are not likely to increase in size and scope any time soon. Let’s make the effort to reduce the number one cause of death in the United States, once and for all.
Art Hsieh, MA, NREMT-P, is Chief Executive Officer & Education Director of the San Francisco Paramedic Association, a published author of EMS textbooks and a national presenter on clinical and education subjects.