HEALTH CARE * LES SOINS
Promote CPR courses and refresh your own skills doctors told Jill Rafuse C anada's doctors should promote basic cardiopulmonary resuscitation (CPR) training by setting a personal example and taking the course themselves, the CMA says. General Council made this clear during the association's 1990 annual meeting when it ruled that all physicians should have the knowledge and skills necessary to perform basic CPR. It also wants doctors to support actively publiceducation programs that promote healthy lifestyles, the recognition of warning symptoms and signs of heart disease, and acquisition of CPR skills. "We had a good debate on the subject," observes Dr. David Walters, the CMA's director of health services. He says council ultimately decided that because of the community-education thrust of CPR programming, physicians should take the lead and, as responsible citizens, ensure that their own emergency response skills are up-to-date. Most doctors have CPR training, Walters points out, but many do not keep their skills current; annual recertification is generally recommended for anyone trained in CPR. Refresher courses also keep trainees abreast of changes in Jill Rafuse is a freelance writer living in Ottawa. -
For prescribing information see page 1334
technique that might make resuscitation in the field easier or more effective. A standards board representing the American Heart Association and the Heart and Stroke Foundation of Canada meets about every 5 years to as-
sess medical reports and field-use studies and to make changes to training programs when warranted. In 1986, for instance, the board approved the use of abdominal thrusts in certain situations and this significantly changed the
CPR course takes 8 to 12 hours The Heart and Stroke Foundation of Canada develops national standards for CPR courses, which are then offered by a number of training agencies in communities across the country. Following is the content of the St. John Ambulance "Basic Rescuer Level C" course, which is recommended for health care professionals. It takes 8 to 12 hours to complete and is usually scheduled over a 2-day period or several evenings. Costs vary, but a St. John Ambulance spokesman says a typical fee is $40 to $50. Annual recertification is recommended. The course covers several areas: * the emergency medical services system; * legal implications of providing basic life support; * the risk of disease transmission while providing basic life support;
* risk factors for, and prevention of, coronary artery disease; * safety and accident prevention for children and infants; * normal anatomy and physiology of the cardiopulmonary system; * cardiovascular disease, including hypertension, atherosclerosis, angina and stroke; * signs and symptoms of angina, heart attack, stroke, cardiac arrest and foreign-body airway obstruction; * first aid for angina, heart attack, stroke, cardiac arrest and foreign-body airway obstruction. The course also provides the skills needed to provide one- and two-rescuer CPR, and methods for clearing an airway obstruction when the victim is conscious, becomes unconscious, or is found unconscious. CAN MED ASSOC J 1991; 144 (10)
1293
technique for clearing airway obstructions. The next reassessment will take place in March 1992. Walters says some General Council members were worried about the accessibility of refresher courses. Retraining, which usually involves the use of mannequins, is easy to arrange for hospital-based physicians but it is more difficult to organize group courses for those who work in small practices. Dr. Jan Ahuja, head of emergency medicine at the Ottawa Civic Hospital and former president of the Canadian Association of Emergency Physicians, says emergency physicians make regular use of their resuscitation skills
but physicians in other specialties likely have few opportunities to employ them. Still, says Ahuja, because of the high incidence of heart disease in North America all physicians in clinical practice should be familiar with CPR. Most Canadians do think all physicians have up-to-date CPR skills. The CMA has no statistics on how many do, Walters notes, but he hopes the General Council resolutions will encourage physicians to assess their skills and, if necessary, update them. Setting an example for the public is important, he says, but "as doctors we also have to keep rejuvenating ourselves." ---
-- 1 - --
.. ----
--
CPR training standards are established by the Heart and Stroke Foundation of Canada, which has developed programs to suit all skill levels. Marcia Mason, the foundation's national coordinator for professional education and emergency cardiac care, says the "C level" basic-life-support course is recommended for health care professionals and emergency response personnel such as firefighters, police officers and ambulance attendants. In 1989 publiceducation agencies such as the St. John Ambulance and the Canadian Red Cross Society trained more than 200 000 Canadians in these basic skills, but it is un-
1.
Lightning strikes twice for Ottawa physician and nurse For the last year Ottawa ph\sIcian Tom Faloon and his wr fe nurse Judy Faloon. hav-- ac-ti ly advocated cardiopulmonary resuscitation (CPR) educatior for both laymen and heall-h care professionals. There acte solid X reasons fo- their active aU`w cv role. One was an earlv-unrng. mid-1989 appointment at haloon's office. The patient was ,I fit, active man in his mid-b(U)s who enjoyed aggressivse crosscountry skiing three times a week. He had no previc3ous history of coronary problems. Lutjust as Judy Faloon was preparing him for the examinatior he went into cardiac arrest. Hlis collapse was "conmpletel\ Lotnsuspected- and the Faloons responded as their CPR trainiing had taught them. After assessing the situation they called for an ambulance and initiated basic tworescuer CPR. Even though Faloon's family practice was near the Ottawa Civic Hospital, ambulance response was slowed 1294
CAN MED ASSOC J 1991; 144 (10)
n ccau.s
\at c ai
i ii i n. ue- passed before_ ani7 bah tasi. r1was
.rpso
iW
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i. ~
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~~ n ,t C!
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.
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:s
pv.,>£,
uspcete n a-rdiae ..az
-I
r(-ft
.
at
9.
t
tmcuI ance tfnaiin a
-rad a 0ii t ct- i otClalona. d rs attendant conttnued ('PR while the palient w-as transpor-ted to the Emergenc\ Department a; thC nCarh; Rl.ieside Hospital. This patient also survived. but the failure to get activ.e help at the shopp'ing entre. let alone help from somenone with (PR trainiin'. prompted tlh lFaloon. speaking public] r-. R tta;r if>t jeducalton. -\itho*5 Ugr0 \ fA a onet 31t
t1 t r t> |t
tithaL same da in c ar.1 1990 Judck. Faloon was siting a local shopping c-entre pharmaey whe she1 heard -a n'no1ti orn n c at: thC co(:)smet ics u-n'tec. Store staff said some-o;ne had tainrted and arn atmibu-lance had beer; called. l1t was business as usual wle hewaited Ibr assistance and eonsoled the 'ctin daughter. - . nursec r,:
fj.
.Letermining tha ~use tlQ Sh |i tiatia ns te- P inJ .i.d S ta ;(J1 .,a-. anioe a.1 'eCsI Xi d^rc tst.8tL u gai, c a A^ fitc ut5 i n spite ot he. altetem )t'. aCt assistance n ncar]i-; ci_. ro2";ward to help. tpath arin gen-eral helplessnes. w.as :.psetttr;g had faithl b)as';c .h.'ma1n rin'catuic h p ouidr ce .J-trvnone to( help noi4
lid **,
c
{89 2' }I 5 j
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:
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i,tat
LE 15 MAI 1991
m
known how many of them were versities; provincial heart and stroke foundations can provide physicians. The foundation has also de- detailed information about them. veloped an advanced-life-support The CMA also wants doctors program, which is available only to encourage nonphysicians to to health care professionals who take CPR training. Ahuja says have completed the basic rescuer emergency physicians are staunch program. It is a "cookbook" advocates of this because cardiaccourse that covers intubation, de- arrest victims need immediate, fibrillation, cardiac rhythms and and informed, attention. "A great medications, and is particularly majority of patients who arrest do useful to those working in the not- survive because bystander coronary-care, intensive-care, or CPR has not been initiated at the exercise-testing fields. In 1989 scene," he notes. training was given to 4769 care Too many people still believe providers, 313 instructors, and 14 that lifesaving measures cannot instructor-trainers. Advanced begin until an ambulance arrives courses, which usually last 2 days, or the patient is treated in hospiare often available through uni- tal. Unfortunately, brain damage
diac arrests usually don't happen in a doctor's office," says Tom Faloon. "Most happen at home, at family functions, or in shopping centres." That is why he believes laymen must be encouraged to acquire lifesaving skills. Ambulance attendants may respond quickly, and in cities like Ottawa they even carry portable defibrillators. However, if bystanders haven't started lifesaving measures, "what good is it if the ambulance tries to make it in 4 minutes? Who is maintaining these people until the ambulance arrives?" The Faloons know CPR expertise does not always save cardiac-arrest victims. A decade ago a relative of theirs collapsed at a family function and died in spite of immediate medical attention, but at least every effort was made to try and save his life. That is what CPR training can do for the public, says Judy Faloon. "If you are well versed in what to do in an emergency,
at least you don't have to look back later and say, 'if only.' " The Faloons think health care professionals, particularly physicians, should re-evaluate their own CPR skills. Even as late as the 1970s manual-resuscitation techniques were not al-
occurs within 4 minutes of a cardiac arrest; in the Ottawa-Carleton region of Ontario, the average ambulance response time for emergency calls is approximately 8 minutes. CPR training is also important because it teaches nonphysicians how to recognize warning signs and symptoms of heart attack and to respond immediately by calling for professional help. Ahuja thinks this is vital, particularly for those with family members or friends known to have heart disease. Les Johnson, training development officer and emergency cardiac care coordinator at the
ways included in university medical curricula. Tom Faloon took basic and advanced courses on his own after qualifying, and his wife learned manual CPR during orientation training at the Ottawa General
Hospital.
W.
Dr. Tom Faloon, wife
Judy
and
home,
daughters: Cardiac
not in
arrests
usually happen
at
doctor's office i EJ
MAY 15, 1991
CAN MED ASSOC J 1991; 144 (10)
1295
ACT Foundation
It is essential that bystanders start CPR immediately
national headquarters of St. John Ambulance, points out that manual resuscitation is only one part of the basic Heartsaver course designed for the public. It also teaches ways to keep the heart healthy, thus helping to prevent or lower the risk of heart disease. An important goal of citizen education "is to never have to do CPR,"
Johnson maintains. Most cardiac deaths occur within 2 hours of the onset of signs and symptoms; people with CPR training are taught to take immediate action by getting the victim to hospital before cardiac arrest occurs. Getting people to sign up for training can be difficult but interest in CPR is growing thanks to public-awareness campaigns by training agencies and coverage of lives that have been saved. The
Advanced Coronary Treatment (ACT) Foundation of Canada, a nonprofit organization established in 1984 and sponsored by the research-based side of the pharmaceutical industry, is actively involved in promoting CPR for nonphysicians. Executive Director Sandra Clarke says ACT would like to see one in five Canadians trained in CPR and is seeking physicians' help to reach its goal. In addition to an advertising campaign, ACT is promoting CPR through brochures and prescription pads that carry the slogan "CPR for Families of Heart Patients and Others at Risk." ACT explains why people should have the training and how and where to get it. A year ago, pharmaceutical sales representatives presented program details to
18 000 Ontario and Quebec family physicians and cardiologists. ACT wants the doctors to encourage the families of at-risk patients to take CPR training. Response to the initial program was positive; this spring it was repeated and another 12 000 to 14 000 doctors across Canada received program details. "We sincerely hope doctors won't just leave this material in their waiting rooms," Clarke says. "Physicians are the most influential members of the health care team and, if they actively promote CPR, we believe the message will get through to the families of high-risk patients." Some physicians are sensitive about encouraging laymen to learn CPR techniques, she says, but still wholeheartedly support the need to teach about healthy lifestyles, warning signs, symptoms of heart attack and ways to take immediate action. The Heart and Stroke Foundation of Canada thinks health care professionals should promote the prevention and education side of CPR courses. "Everyone needs to learn CPR," Mason says, "but the biggest push is for people to learn about heart disease and how to prevent it." The heart and stroke foundation reports that 190 000 Canadians took the basic 4-hour Heartsaver course in 1989. Courses are available in most communities and can be arranged for small groups in homes, churches or workplaces.u
@000
= I ~~ =CrownLifeI | >, ~PARTICIPACTION_ *--
r ~~CHALLENGE .ww*wV ~v~ -
1296
CAN MED ASSOC J 1991; 144 (10)
Wednesday, May 29, 1991
PiJRTICIPi7rLTIGfl LE 15 MAI 1991
Promote CPR courses and refresh your own skills doctors told Jill Rafuse C anada's doctors should promote basic cardiopulmonary resuscitation (CPR) training by setting a personal example and taking the course themselves, the CMA says. General Council made this clear during the association's 1990 annual meeting when it ruled that all physicians should have the knowledge and skills necessary to perform basic CPR. It also wants doctors to support actively publiceducation programs that promote healthy lifestyles, the recognition of warning symptoms and signs of heart disease, and acquisition of CPR skills. "We had a good debate on the subject," observes Dr. David Walters, the CMA's director of health services. He says council ultimately decided that because of the community-education thrust of CPR programming, physicians should take the lead and, as responsible citizens, ensure that their own emergency response skills are up-to-date. Most doctors have CPR training, Walters points out, but many do not keep their skills current; annual recertification is generally recommended for anyone trained in CPR. Refresher courses also keep trainees abreast of changes in Jill Rafuse is a freelance writer living in Ottawa. -
For prescribing information see page 1334
technique that might make resuscitation in the field easier or more effective. A standards board representing the American Heart Association and the Heart and Stroke Foundation of Canada meets about every 5 years to as-
sess medical reports and field-use studies and to make changes to training programs when warranted. In 1986, for instance, the board approved the use of abdominal thrusts in certain situations and this significantly changed the
CPR course takes 8 to 12 hours The Heart and Stroke Foundation of Canada develops national standards for CPR courses, which are then offered by a number of training agencies in communities across the country. Following is the content of the St. John Ambulance "Basic Rescuer Level C" course, which is recommended for health care professionals. It takes 8 to 12 hours to complete and is usually scheduled over a 2-day period or several evenings. Costs vary, but a St. John Ambulance spokesman says a typical fee is $40 to $50. Annual recertification is recommended. The course covers several areas: * the emergency medical services system; * legal implications of providing basic life support; * the risk of disease transmission while providing basic life support;
* risk factors for, and prevention of, coronary artery disease; * safety and accident prevention for children and infants; * normal anatomy and physiology of the cardiopulmonary system; * cardiovascular disease, including hypertension, atherosclerosis, angina and stroke; * signs and symptoms of angina, heart attack, stroke, cardiac arrest and foreign-body airway obstruction; * first aid for angina, heart attack, stroke, cardiac arrest and foreign-body airway obstruction. The course also provides the skills needed to provide one- and two-rescuer CPR, and methods for clearing an airway obstruction when the victim is conscious, becomes unconscious, or is found unconscious. CAN MED ASSOC J 1991; 144 (10)
1293
technique for clearing airway obstructions. The next reassessment will take place in March 1992. Walters says some General Council members were worried about the accessibility of refresher courses. Retraining, which usually involves the use of mannequins, is easy to arrange for hospital-based physicians but it is more difficult to organize group courses for those who work in small practices. Dr. Jan Ahuja, head of emergency medicine at the Ottawa Civic Hospital and former president of the Canadian Association of Emergency Physicians, says emergency physicians make regular use of their resuscitation skills
but physicians in other specialties likely have few opportunities to employ them. Still, says Ahuja, because of the high incidence of heart disease in North America all physicians in clinical practice should be familiar with CPR. Most Canadians do think all physicians have up-to-date CPR skills. The CMA has no statistics on how many do, Walters notes, but he hopes the General Council resolutions will encourage physicians to assess their skills and, if necessary, update them. Setting an example for the public is important, he says, but "as doctors we also have to keep rejuvenating ourselves." ---
-- 1 - --
.. ----
--
CPR training standards are established by the Heart and Stroke Foundation of Canada, which has developed programs to suit all skill levels. Marcia Mason, the foundation's national coordinator for professional education and emergency cardiac care, says the "C level" basic-life-support course is recommended for health care professionals and emergency response personnel such as firefighters, police officers and ambulance attendants. In 1989 publiceducation agencies such as the St. John Ambulance and the Canadian Red Cross Society trained more than 200 000 Canadians in these basic skills, but it is un-
1.
Lightning strikes twice for Ottawa physician and nurse For the last year Ottawa ph\sIcian Tom Faloon and his wr fe nurse Judy Faloon. hav-- ac-ti ly advocated cardiopulmonary resuscitation (CPR) educatior for both laymen and heall-h care professionals. There acte solid X reasons fo- their active aU`w cv role. One was an earlv-unrng. mid-1989 appointment at haloon's office. The patient was ,I fit, active man in his mid-b(U)s who enjoyed aggressivse crosscountry skiing three times a week. He had no previc3ous history of coronary problems. Lutjust as Judy Faloon was preparing him for the examinatior he went into cardiac arrest. Hlis collapse was "conmpletel\ Lotnsuspected- and the Faloons responded as their CPR trainiing had taught them. After assessing the situation they called for an ambulance and initiated basic tworescuer CPR. Even though Faloon's family practice was near the Ottawa Civic Hospital, ambulance response was slowed 1294
CAN MED ASSOC J 1991; 144 (10)
n ccau.s
\at c ai
i ii i n. ue- passed before_ ani7 bah tasi. r1was
.rpso
iW
[4~
i. ~
T\ p siSi
~~ n ,t C!
i11
*i}
'I
.
'_ '7c 'hvq.
i
uLi
e. ir icailng abLu Lre li. L_ St@isiJ F- denin h aj tri cl.i,_ o ron a1r rieatrnen' -'udaRni f fir-ppr(,.. ached F.or 1-an ai 0 asked lF.'he would be&1rr' (PR ra''-iS advoc at Pf nv ~~avme~. I-ic wa~s. n01 en;:r about iheidea. ,- aiI K
:s
pv.,>£,
uspcete n a-rdiae ..az
-I
r(-ft
.
at
9.
t
tmcuI ance tfnaiin a
-rad a 0ii t ct- i otClalona. d rs attendant conttnued ('PR while the palient w-as transpor-ted to the Emergenc\ Department a; thC nCarh; Rl.ieside Hospital. This patient also survived. but the failure to get activ.e help at the shopp'ing entre. let alone help from somenone with (PR trainiin'. prompted tlh lFaloon. speaking public] r-. R tta;r if>t jeducalton. -\itho*5 Ugr0 \ fA a onet 31t
t1 t r t> |t
tithaL same da in c ar.1 1990 Judck. Faloon was siting a local shopping c-entre pharmaey whe she1 heard -a n'no1ti orn n c at: thC co(:)smet ics u-n'tec. Store staff said some-o;ne had tainrted and arn atmibu-lance had beer; called. l1t was business as usual wle hewaited Ibr assistance and eonsoled the 'ctin daughter. - . nursec r,:
fj.
.Letermining tha ~use tlQ Sh |i tiatia ns te- P inJ .i.d S ta ;(J1 .,a-. anioe a.1 'eCsI Xi d^rc tst.8tL u gai, c a A^ fitc ut5 i n spite ot he. altetem )t'. aCt assistance n ncar]i-; ci_. ro2";ward to help. tpath arin gen-eral helplessnes. w.as :.psetttr;g had faithl b)as';c .h.'ma1n rin'catuic h p ouidr ce .J-trvnone to( help noi4
lid **,
c
{89 2' }I 5 j
~C, gei P
c
:
t { Iti\. e5S 1 ,
eXpe
i,tat
LE 15 MAI 1991
m
known how many of them were versities; provincial heart and stroke foundations can provide physicians. The foundation has also de- detailed information about them. veloped an advanced-life-support The CMA also wants doctors program, which is available only to encourage nonphysicians to to health care professionals who take CPR training. Ahuja says have completed the basic rescuer emergency physicians are staunch program. It is a "cookbook" advocates of this because cardiaccourse that covers intubation, de- arrest victims need immediate, fibrillation, cardiac rhythms and and informed, attention. "A great medications, and is particularly majority of patients who arrest do useful to those working in the not- survive because bystander coronary-care, intensive-care, or CPR has not been initiated at the exercise-testing fields. In 1989 scene," he notes. training was given to 4769 care Too many people still believe providers, 313 instructors, and 14 that lifesaving measures cannot instructor-trainers. Advanced begin until an ambulance arrives courses, which usually last 2 days, or the patient is treated in hospiare often available through uni- tal. Unfortunately, brain damage
diac arrests usually don't happen in a doctor's office," says Tom Faloon. "Most happen at home, at family functions, or in shopping centres." That is why he believes laymen must be encouraged to acquire lifesaving skills. Ambulance attendants may respond quickly, and in cities like Ottawa they even carry portable defibrillators. However, if bystanders haven't started lifesaving measures, "what good is it if the ambulance tries to make it in 4 minutes? Who is maintaining these people until the ambulance arrives?" The Faloons know CPR expertise does not always save cardiac-arrest victims. A decade ago a relative of theirs collapsed at a family function and died in spite of immediate medical attention, but at least every effort was made to try and save his life. That is what CPR training can do for the public, says Judy Faloon. "If you are well versed in what to do in an emergency,
at least you don't have to look back later and say, 'if only.' " The Faloons think health care professionals, particularly physicians, should re-evaluate their own CPR skills. Even as late as the 1970s manual-resuscitation techniques were not al-
occurs within 4 minutes of a cardiac arrest; in the Ottawa-Carleton region of Ontario, the average ambulance response time for emergency calls is approximately 8 minutes. CPR training is also important because it teaches nonphysicians how to recognize warning signs and symptoms of heart attack and to respond immediately by calling for professional help. Ahuja thinks this is vital, particularly for those with family members or friends known to have heart disease. Les Johnson, training development officer and emergency cardiac care coordinator at the
ways included in university medical curricula. Tom Faloon took basic and advanced courses on his own after qualifying, and his wife learned manual CPR during orientation training at the Ottawa General
Hospital.
W.
Dr. Tom Faloon, wife
Judy
and
home,
daughters: Cardiac
not in
arrests
usually happen
at
doctor's office i EJ
MAY 15, 1991
CAN MED ASSOC J 1991; 144 (10)
1295
ACT Foundation
It is essential that bystanders start CPR immediately
national headquarters of St. John Ambulance, points out that manual resuscitation is only one part of the basic Heartsaver course designed for the public. It also teaches ways to keep the heart healthy, thus helping to prevent or lower the risk of heart disease. An important goal of citizen education "is to never have to do CPR,"
Johnson maintains. Most cardiac deaths occur within 2 hours of the onset of signs and symptoms; people with CPR training are taught to take immediate action by getting the victim to hospital before cardiac arrest occurs. Getting people to sign up for training can be difficult but interest in CPR is growing thanks to public-awareness campaigns by training agencies and coverage of lives that have been saved. The
Advanced Coronary Treatment (ACT) Foundation of Canada, a nonprofit organization established in 1984 and sponsored by the research-based side of the pharmaceutical industry, is actively involved in promoting CPR for nonphysicians. Executive Director Sandra Clarke says ACT would like to see one in five Canadians trained in CPR and is seeking physicians' help to reach its goal. In addition to an advertising campaign, ACT is promoting CPR through brochures and prescription pads that carry the slogan "CPR for Families of Heart Patients and Others at Risk." ACT explains why people should have the training and how and where to get it. A year ago, pharmaceutical sales representatives presented program details to
18 000 Ontario and Quebec family physicians and cardiologists. ACT wants the doctors to encourage the families of at-risk patients to take CPR training. Response to the initial program was positive; this spring it was repeated and another 12 000 to 14 000 doctors across Canada received program details. "We sincerely hope doctors won't just leave this material in their waiting rooms," Clarke says. "Physicians are the most influential members of the health care team and, if they actively promote CPR, we believe the message will get through to the families of high-risk patients." Some physicians are sensitive about encouraging laymen to learn CPR techniques, she says, but still wholeheartedly support the need to teach about healthy lifestyles, warning signs, symptoms of heart attack and ways to take immediate action. The Heart and Stroke Foundation of Canada thinks health care professionals should promote the prevention and education side of CPR courses. "Everyone needs to learn CPR," Mason says, "but the biggest push is for people to learn about heart disease and how to prevent it." The heart and stroke foundation reports that 190 000 Canadians took the basic 4-hour Heartsaver course in 1989. Courses are available in most communities and can be arranged for small groups in homes, churches or workplaces.u
@000
= I ~~ =CrownLifeI | >, ~PARTICIPACTION_ *--
r ~~CHALLENGE .ww*wV ~v~ -
1296
CAN MED ASSOC J 1991; 144 (10)
Wednesday, May 29, 1991
PiJRTICIPi7rLTIGfl LE 15 MAI 1991
