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RESUSCITATION AND TEACHING
" / would have everie man write what he knowes and no more."—MONTAIGNE
BRITISH JOURNAL OF
ANAESTHESIA NOVEMBER 1963
VOL. XXXV, No. 11
EDITORIAL
Techniques of closed-chest cardiac massage and expired air resuscitation have been widely publicized and accepted in the treatment of emergency situations, but one may wonder whether this information has simply been "noted", to use the terminology of medical board minutes, rather than acted upon. For example, Pryor (Brit. J. Anaesth., 34, 566) recommended that in addition to the institution of a teaching programme in hospitals "a whistle and some form of appliance to facilitate expired air resuscitation should be placed in a plastic bag in each ward, together with a wall instruction sheet and a photograph of the procedure". How seriously has advice of this kind been taken in the country's hospitals? Probably it is still thought by many that external cardiac massage is a poor relation of open-chest massage and that it is not really a technique which can be applied with much likelihood of success in most instances. To quote Milstein (Brit. J. Anaesth., 33, 498), however, the technique is the method of choice for the treatment of cardiac arrest, and it is incorrect to assume that it is only suitable for "non-surgical" patients. He describes how the operator, when carrying out resuscitative measures by himself must interrupt cardiac massage every minute, in order to ventilate the lungs with a few breaths by mouth-to-mouth insufflation. Expired air resuscitation is very generally accepted but, on the other hand, recent correspondence in this Journal has revealed again that there is strongly divided opinion regarding the
suitability of teaching the technique of external cardiac massage to non-medical persons. Dr. Binning (Brit. J. Anaesth., 35, 664) states that the technique is taught to a very large number of non-medical personnel in organizations such as the British Red Cross, the armed forces, and so on. Professor Lane (Brit. J. Anaesth., 35, 450) is clearly impressed by the changes in the counsel of leading opinion on the issue. The possibility that over-free use of such a method, particularly by non-medically trained persons, may result in a disproportionate amount of damage to persons erroneously believed to be in need of cardiac resuscitation, appears to prevent a unanimous and clear advocacy of such training. In a recent case of external cardiac massage carried out at a hospital it was found at autopsy that six ribs had been fractured and the liver lacerated. In this issue Drs. Redding and Pearson describe a programme for the training of medical students in the treatment of asphyxia and cardiac arrest. This bold attempt to face the problems deserves close consideration and provokes the thought that perhaps insufficient effort is at present being made to familiarize medical staff (senior, junior, and not yet qualified) with the practical aspects of resuscitation procedures. It becomes clear from their paper that, to attain proficiency, theoretical knowledge must be supplemented by practical training. The correspondence column of the Journal is open to readers who wish to state their opinions.
665
Downloaded from http://bja.oxfordjournals.org/ at University of Michigan on September 9, 2015
RESUSCITATION AND TEACHING
BRITISH JOURNAL OF
ANAESTHESIA NOVEMBER 1963
VOL. XXXV, No. 11
EDITORIAL
Techniques of closed-chest cardiac massage and expired air resuscitation have been widely publicized and accepted in the treatment of emergency situations, but one may wonder whether this information has simply been "noted", to use the terminology of medical board minutes, rather than acted upon. For example, Pryor (Brit. J. Anaesth., 34, 566) recommended that in addition to the institution of a teaching programme in hospitals "a whistle and some form of appliance to facilitate expired air resuscitation should be placed in a plastic bag in each ward, together with a wall instruction sheet and a photograph of the procedure". How seriously has advice of this kind been taken in the country's hospitals? Probably it is still thought by many that external cardiac massage is a poor relation of open-chest massage and that it is not really a technique which can be applied with much likelihood of success in most instances. To quote Milstein (Brit. J. Anaesth., 33, 498), however, the technique is the method of choice for the treatment of cardiac arrest, and it is incorrect to assume that it is only suitable for "non-surgical" patients. He describes how the operator, when carrying out resuscitative measures by himself must interrupt cardiac massage every minute, in order to ventilate the lungs with a few breaths by mouth-to-mouth insufflation. Expired air resuscitation is very generally accepted but, on the other hand, recent correspondence in this Journal has revealed again that there is strongly divided opinion regarding the
suitability of teaching the technique of external cardiac massage to non-medical persons. Dr. Binning (Brit. J. Anaesth., 35, 664) states that the technique is taught to a very large number of non-medical personnel in organizations such as the British Red Cross, the armed forces, and so on. Professor Lane (Brit. J. Anaesth., 35, 450) is clearly impressed by the changes in the counsel of leading opinion on the issue. The possibility that over-free use of such a method, particularly by non-medically trained persons, may result in a disproportionate amount of damage to persons erroneously believed to be in need of cardiac resuscitation, appears to prevent a unanimous and clear advocacy of such training. In a recent case of external cardiac massage carried out at a hospital it was found at autopsy that six ribs had been fractured and the liver lacerated. In this issue Drs. Redding and Pearson describe a programme for the training of medical students in the treatment of asphyxia and cardiac arrest. This bold attempt to face the problems deserves close consideration and provokes the thought that perhaps insufficient effort is at present being made to familiarize medical staff (senior, junior, and not yet qualified) with the practical aspects of resuscitation procedures. It becomes clear from their paper that, to attain proficiency, theoretical knowledge must be supplemented by practical training. The correspondence column of the Journal is open to readers who wish to state their opinions.
665
Downloaded from http://bja.oxfordjournals.org/ at University of Michigan on September 9, 2015
RESUSCITATION AND TEACHING