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EXTERNAL CARDIAC COMPRESSION
CORRESPONDENCE EXTERNAL CARDIAC COMPRESSION
Sir,—I would like to draw your attention to this directive upon External Cardiac Resuscitation* which has been issued by the Electricity Supply Ambulance Centre at the Electricity Council, Winsley Street, London, W.I. This states: "The Medical Advisers to the Electricity Supply Industry wish all first aiders and students to note that in their opinion the dangers attaching to external cardiac resuscitation as applied by first aiders in the field outweigh its possible benefits. Accordingly they recommend that this emergency resuscitation technique should not be used for the treatment of the unconscious casualty in the Electricity Supply Industry. "You will receive instruction in the theory and practice of external cardiac resuscitation for examination purposes. The practice should be confined to the training model and on no account should the technique be practised on one another or performed on either conscious or unconscious patients." I need hardly say that this dictat has caused dismay and consternation to many first aiders who are associated with the electrical industry. Many of these are also members of the British Red Cross Society, and the St. John Ambulance and St. Andrew's Ambulance Associations, and also of the Civil Defence Organization, and they have seen such excellent films as "The Pulse of Life" and have had regular and proper instruction in emergency resuscitation. They know that in a case of electric shock—perhaps more than any other—they have the knowledge and the technique that could enable them to save a colleague's life. Yet their own ambulance centre forbids them to use this technique. That this dilemma is causing concern throughout the electrical industry is shown by a leading articlef that was published in the Electrical Times on February 14, 1963: Risk Worth Taking? "Although the article that begins opposite is concerned principally with preventing electrical accidents, it extends its discussion of the safety question into the action to be taken when a shock accident has occurred. Hardly anyone can now be unaware of the claims for the mouth-to-mouth method of artificial respiration, or of the essentials of its application. Indeed, the publicity given to the successes achieved with this technique may have done much to overcome the main criticism of it, the likely revulsion of the rescuer at the idea of breathing directly into a stranger's mouth. * Reproduced by kind permission of the Electricity Council. fReprinted by courtesy of the editor of the Electrical Times.
But what of another resuscitation technique, especially appropriate to electrical shock accidents, and also receiving some popular publicity? External heart massage as a method of dealing with fibrillation of the heart caused by electric shock has received some enthusiastic support from the U.S.A. It can offer a chance of keeping the brain undamaged until the heart regains its regular rhythm in circulating the blood. One leading American authority has proclaimed it as a technique suitable for the general population 'from boy scouts up'. Yet in Britain and in Europe generally medical opinion seems against permitting laymen to apply the method. The objection is simple enough; thrusting down on an unconscious man's chest 50 or more times a minute can do serious damage to the rib cage and perhaps to the organs within it. And yet is not the risk of damage worth taking if it is the only hope of survival? This question is the crux of the matter. The electrical industry needs an answer to it from the medical profession. And that answer should indicate how the layman is to decide when to risk external heart massage." The electrical industry is asking for a lead, and I suggest that it is the duty of members of the medical profession, and of anaesthetists in particular, to give this lead. REX BINNING
Hove ANAESTHESIA IN UNDERDEVELOPED COUNTRIES
Sir,—Dr. Farman is to be congratulated on his realistic analysis of the problems of anaesthesia in developing countries, and on his constructive approach to their solution (Brit. 1. Anaesth. (1962), 34, 897). I have recently visited a number of the same hospitals in Nigeria, and he should be gratified to know how happily his visits are remembered in these isolated places. I am proposing two plans, one for immediate action and the other a long-term policy to ensure that doctors at present in training do not go into practice as ill-equipped to administer anaesthetics as their predecessors. Short full-time courses at teaching hospitals are not, in my opinion, the whole answer. All mission and most government hospitals are so grossly understaffed that it is impossible for them to send a doctor away even for two weeks. Also such courses will not solve their immediate and individual problems of how to make best use of their available equipment and personnel. Teaching hospitals should employ sufficient senior staff to enable one of these to be frequently on tour visiting peripheral hospitals. Such a peripatetic anaesthetist must be versatile and widely experienced. He must not, as so often is the case with visiting specialists, be a stranger to the situation, nor must he go round with his own apparatus demonstrating
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Sir,—I would like to draw your attention to this directive upon External Cardiac Resuscitation* which has been issued by the Electricity Supply Ambulance Centre at the Electricity Council, Winsley Street, London, W.I. This states: "The Medical Advisers to the Electricity Supply Industry wish all first aiders and students to note that in their opinion the dangers attaching to external cardiac resuscitation as applied by first aiders in the field outweigh its possible benefits. Accordingly they recommend that this emergency resuscitation technique should not be used for the treatment of the unconscious casualty in the Electricity Supply Industry. "You will receive instruction in the theory and practice of external cardiac resuscitation for examination purposes. The practice should be confined to the training model and on no account should the technique be practised on one another or performed on either conscious or unconscious patients." I need hardly say that this dictat has caused dismay and consternation to many first aiders who are associated with the electrical industry. Many of these are also members of the British Red Cross Society, and the St. John Ambulance and St. Andrew's Ambulance Associations, and also of the Civil Defence Organization, and they have seen such excellent films as "The Pulse of Life" and have had regular and proper instruction in emergency resuscitation. They know that in a case of electric shock—perhaps more than any other—they have the knowledge and the technique that could enable them to save a colleague's life. Yet their own ambulance centre forbids them to use this technique. That this dilemma is causing concern throughout the electrical industry is shown by a leading articlef that was published in the Electrical Times on February 14, 1963: Risk Worth Taking? "Although the article that begins opposite is concerned principally with preventing electrical accidents, it extends its discussion of the safety question into the action to be taken when a shock accident has occurred. Hardly anyone can now be unaware of the claims for the mouth-to-mouth method of artificial respiration, or of the essentials of its application. Indeed, the publicity given to the successes achieved with this technique may have done much to overcome the main criticism of it, the likely revulsion of the rescuer at the idea of breathing directly into a stranger's mouth. * Reproduced by kind permission of the Electricity Council. fReprinted by courtesy of the editor of the Electrical Times.
But what of another resuscitation technique, especially appropriate to electrical shock accidents, and also receiving some popular publicity? External heart massage as a method of dealing with fibrillation of the heart caused by electric shock has received some enthusiastic support from the U.S.A. It can offer a chance of keeping the brain undamaged until the heart regains its regular rhythm in circulating the blood. One leading American authority has proclaimed it as a technique suitable for the general population 'from boy scouts up'. Yet in Britain and in Europe generally medical opinion seems against permitting laymen to apply the method. The objection is simple enough; thrusting down on an unconscious man's chest 50 or more times a minute can do serious damage to the rib cage and perhaps to the organs within it. And yet is not the risk of damage worth taking if it is the only hope of survival? This question is the crux of the matter. The electrical industry needs an answer to it from the medical profession. And that answer should indicate how the layman is to decide when to risk external heart massage." The electrical industry is asking for a lead, and I suggest that it is the duty of members of the medical profession, and of anaesthetists in particular, to give this lead. REX BINNING
Hove ANAESTHESIA IN UNDERDEVELOPED COUNTRIES
Sir,—Dr. Farman is to be congratulated on his realistic analysis of the problems of anaesthesia in developing countries, and on his constructive approach to their solution (Brit. 1. Anaesth. (1962), 34, 897). I have recently visited a number of the same hospitals in Nigeria, and he should be gratified to know how happily his visits are remembered in these isolated places. I am proposing two plans, one for immediate action and the other a long-term policy to ensure that doctors at present in training do not go into practice as ill-equipped to administer anaesthetics as their predecessors. Short full-time courses at teaching hospitals are not, in my opinion, the whole answer. All mission and most government hospitals are so grossly understaffed that it is impossible for them to send a doctor away even for two weeks. Also such courses will not solve their immediate and individual problems of how to make best use of their available equipment and personnel. Teaching hospitals should employ sufficient senior staff to enable one of these to be frequently on tour visiting peripheral hospitals. Such a peripatetic anaesthetist must be versatile and widely experienced. He must not, as so often is the case with visiting specialists, be a stranger to the situation, nor must he go round with his own apparatus demonstrating
391