Simpler method for CPR adopted; Cities move to chest presses only
In what could prove to be the biggest shift in emergency care of cardiac arrest in 40 years, cities across the USA are leading a move away from the familiar practice of mouth-to-mouth resuscitation.
In its place, the cities are recommending simple chest compressions -- pushing down repeatedly on the victim's chest -- to mimic a steady heartbeat. The emergency medical directors who are behind the shift say research in Seattle and Richmond, Va., suggests it will save many lives.
The movement became a full-fledged national trend last week at a meeting of emergency medical services (EMS) medical directors from 21 of the nation's largest cities. Doctors from a dozen cities, including New York, Los Angeles and Chicago, decided to make the switch. They join at least seven other cities that already are advising 911 callers to do chest compressions without mouth-to-mouth.
For now, the shift applies primarily to untrained bystanders, the group most likely to reach victims in the first critical minutes. In such emergencies, lives generally are saved or lost within six minutes. The emergency directors agreed that trying to talk 911 callers through mouth-to-mouth procedures was doing more harm than good because it wasted time. But chest compression appears on its way to becoming the primary response to cardiac arrest in all circumstances.
The American Heart Association is reviewing research that suggests mouth-to-mouth resuscitation is ineffective in the first few minutes after a collapse. It is considering changes to guidelines that support mouth-to-mouth; a decision is due in 2005. In the meantime, the association is encouraging the cities' shift. "We strongly support this," says Mike Bell, vice president for emergency cardiovascular care programs. "This gets something done."
Larger cities say it will take weeks, perhaps months, to make the change. "We want the fire department and the legal folks to look at it," says Neal Richmond, deputy medical director in New York.
Smaller cities are acting now. "This is the appropriate thing to do," says Corey Slovis, EMS medical director in Nashville, where new instructions will begin within two weeks. El Paso changed Monday.
Several medical directors said they were taking action before the heart association does, partly in response to findings from a USA TODAY series published in July. The 18-month investigation by the newspaper found that at least 1,800 people die needlessly each year in the nation's 50 largest cities because EMS care is fragmented, inconsistent and slow.
Mouth-to-mouth resuscitation followed by chest compression has been standard practice since the 1960s. It was called into question in 2000, when Seattle -- statistically the national leader in emergency response -- found that more lives were saved by advising compressions alone. Richmond, Va., later found that after 911 callers were told to apply chest compressions, arriving rescuers reported a tenfold increase in patients receiving the simplified treatment.