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Practice comment

“How news stories encourage people to learn resuscitation”

The collapse and successful resuscitation of footballer Fabrice Muamba thrust out-of-hospital cardiac arrest and cardiopulmonary resuscitation (CPR) into the media spotlight.

The story is inspiring, given that Mr Muamba appears to be making a full recovery with no neurological deficit. In contrast is the tragic story of Piermario Morosini, another professional footballer, who died following a cardiac arrest during a match in the same month.

Despite the similarities between these cases, direct comparisons should not be drawn because circumstances will differ. What is known, though, is that survival to discharge from out-of-hospital cardiac arrest is poor at approximately 5%.

The Resuscitation Council (UK) describes four linked interventions that contribute to a successful outcome following a cardiac arrest. These are early recognition of deterioration and a call for help; early CPR; early defibrillation; then high-quality post-resuscitation care.

Undoubtedly, the last could have played a significant role in Mr Muamba’s survival. However, high-quality early CPR and early defibrillation must not be underestimated. It is more than likely these parts of the chain ensured the return of spontaneous circulation after prolonged resuscitation.

Healthcare professionals delivered this CPR and defibrillation, but not everyone who has an out-of-hospital cardiac arrest will have a clinician on the scene. None the less, the outcome could be just as inspiring.

Bystander CPR - that performed by lay people - has been shown to extend the period for successful resuscitation and at least doubles the chance of survival following a shockable cardiac arrest, where a defibrillator is employed. Despite this, in most European countries, bystander CPR is carried out in only approximately 30% of cases. Is there a need to provide training in CPR to all and improve the provision of automatic external defibrillators?

The recent high-profile cases are likely to make the public realise that simple skills can have a big impact. This, hopefully, will encourage people to “have a go”. In the days after the Fabrice Muamba incident, the CPR instruction page on the British Heart Foundation’s website received many hits. This is an ideal opportunity to promote the need for training.

CPR training for the public is usually accessed through first aid courses or the ambulance services. The potential for a favourable outcome begs the question: should a more formal strategy be adopted?

There have been recent moves to incorporate emergency life support skills into the national curriculum for schools. Despite the clear advantages offered by such an approach, the vast majority of schools do not include it. A petition to include the emergency life support skills in the national curriculum can be found at tinyurl.com/schools-CPR. Perhaps it is time to raise this issue to encourage national debate? There has probably never been a better time to do so. NT

Dan Higgins is senior charge nurse critical care, University Hospitals Birmingham Foundation Trust and freelance clinical educator

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Readers' comments (10)

  • Including emergency life support skills in the national curriculum is an excellent concept and one that I fully support.Increasing the knowledge of the general public in relation to how to administer CPR,can only increase the potential for saving lives in the future.Commencing this learning process in school-aged children(adapting the education to their age group) could prove to be essential,as they would take the knowledge and skills learned into adulthood.The majority of children would thoroughly enjoy learning CPR as an interactive teaching session.

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  • Gail Melling I support your comment more than 100% and just wish it would happen. not only would children carry their skills into adulthood and make them more responsible and aware of the health and safety of others it would make them competent at dealing with accidents in school, in their playtime and during sporting events, in the home and in any public place.

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    General comment

    Incidentally I live in Europe and as a retired nurse am unable to afford the costly refreshers and to learn how to use a defibrillator intended to be very simple, foolproof and for the use of laymen. I nevertheless do not wish to come across one of these for the first time when I actually need to use it and think prior familiarity would be useful. I feel as one does not charge for one's services in an emergency where one could recoup some of the costs for the course they should be offered at a special price or even free. if first aiders can offer their services why can't the trainers also offer theirs for free, I most certainly would not dream of accepting payment for offering such a course.

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  • Anonymous | 6-Aug-2012 9:03 pm

    Sorry ! The old saying "there is no such thing as a free lunch" is true!

    Training involves cost to someone !

    Provision of a venue
    Electricity / Heating
    Advertising
    Paper/Photocopying ( Handouts)

    I could make the list longer but I guess yo u have got the point !

    If you really want "free" training for all the cost would have to be born by the tax payer and I for one don't wish to pay any more tax!



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  • 5.54 am

    what a caddish comment you make.

    you would probably prefer you or your family or any fellow human to be delivered first aid or resuscitation by somebody who has good and up to date skills. a retired nurse willing to update her skills is in a good position to do this if the cost of the course was within her means and a reduction for those in the caring professions would be an advantage as they do not need a full course.

    On your premise, there is no such thing as a free lunch, first aiders should charge for delivering their services as they have to recoup the cost of the course which includes paying for all the items in your list above !!!!!!!!!!!


    If british taxpayers put even very slightly more of the GDP to the health services they would greatly improve and by the way I live in Europe outside the EU so our first aid courses are privately funded and not by your taxes!

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  • Anonymous | 7-Aug-2012 7:50 am

    "I live in Europe outside the EU so our first aid courses are privately funded and not by your taxes!"

    No free lunch then ?

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  • anon 7 7.50

    i don't find your sarcasm very appropriate or helpful and is not a good reflection on professional or even adult reasoning, or respectful for another commentator!

    I was raising a valid point that I am a pensioner who wishes to be ready to offer my services which I regard as my duty but would like to update my skills so that they are more effective and I have the confidence to carry out resuscitation to the very best of my ability as there has been considerable changes since I last undertook a course or was called on to perform cardiac massage in the course of my work which in a hospital environment is rather different. However the cost of course for is prohibitive.

    Furthermore, where I live non-assistance to an individual whose life is in danger is against the law.

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  • Sorry I had no wish to offend

    You can get information from the British Heart Association via the web.


    If you want to attend a course however, I am not aware of any organisation that provides one free. Your local SJAB or Red Cross may be of more assistance.

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  • I missed the bit about you living outside the UK. Information is still available on the Web but I am unable to make any other suggestions.

    Your countries "Good Samaritan" law is unlikely to require a person to to deliver care other than to the level of their knowledge and experience. (Many lay peoples knowledge of First Aid is VERY limited)

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  • Anon 1.40, 10.50

    Thanks. comments aren't always interpreted the way they are intended, I appreciate that and should perhaps be more patient.

    i was really only trying to make the point that where I live the only available courses, run by the Samaritans, local hospitals, schools of nursing and the Red Cross, are too costly and I have no professional contact with them and I no longer live anywhere near where I worked. I guess I was spoilt working in a uni hospital as these updates were always free as was the last one I did whilst working in my local hospital in the UK.

    I could have a look next time I am in the UK and see if they are any cheaper. I will look on the BNF and Red Cross (or St. John's) sites for starters.

    Here all car drivers have to undertake a first aid course with the Samaritans and pass a test in it to get their driving licence and by law carry a kit in their car (as well as a spare of glasses for spectacle wearers incidentally!) and fines are imposed for any infractions as these may be checked if a driver is stopped for any reason (practices I would endorse in the UK or any other country).

    I think as a qualified nurse, whether retired or still on the NMC reg or not and registered for life where I live, one is still has to do the best to the highest clinical standards and can still be sued for any serious omission or error.

    Apparently use of the new defibrillator is self-evident and designed to be used by the lay public without any prior knowledge but I would still rather handle one before being faced with the need to use one. I read up on the latest European directives on CPR as the appear but as I haven't practised it for some years it is always better to do it under the watchful eye of a trainer and on a dummy. Hopefully with years of training and practice one knows when faced with an incident instinctively how to act but regular refreshers for professionals are recommended.

    I once did a weekend avalanche rescue course and a middle aged UK GP and friend picked me as his partner as I think he reckoned I had more experience than the rest of the group who were laypeople. Fortunately I had no difficulty with any of the exercises we were given but was totally shocked at his very limited level of knowledge of first aid! I think he had picked me to hold his hand and lead me through them all. I shouldn't have been so surprised as once we had to visit somebody in an alpine GP clinic together whose skiing accident we had witnessed. Whist we were sitting in the waiting room a young lad with a knee injury came in clutching his x-ray. my friend who was getting rather bored with the long wait asked to look at it and seemed to be starring at it rather blankly until I went over to him and found he was looking at it upside down!

    going back to the first aid, I have often heard it said that hc profis are the worst at it out in the field. from my own experience comparing myself with somebody who has had a thorough training, I wouldn't dispute that suddenly being confronted with a need for action out in the field with your bare hands is not the same as in a well equipped hospital with a crash team and other support more close at hand.

    Obviously the more people with some basic knowledge and skills in first aid and the confidence to practice them, the more life saving measures that can be undertaken before professional help arrives.

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  • I have spent years working as Resus officer, During this time we have always delivered British Heart Foundation (BHF)adult BLS training free of charge to any member of the public who attends this training..

    BHF also assists in the acquisition of an AED in many areas. If anyone is interested in obtaining an AED through BHF they might like to contact BHF to identify their local adult BLS ;train the trainer scheme;. They can then, free of charge, become 'hearstart trainers and apply for BHF support to obtain an AED.

    it always concerns me though that the brilliant publicity provided does imply a higher success rate than in reality....I always emphasise that the patient is never going to wake up and say 'thankyou' then walk away.

    That said, in a VF/VT cardiac arrest the AED really does make a difference.

    If you find an unresponsive patient you think has died suddenly, ensure ambulance called then start good quality CPR.

    You cannot kill a dead person......but you might, just might, buy some cerebral survival time for the patient.

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