Cardiac Arrest: Means the Heart has stopped functioning and the blood supply to the vital organs has ceased. The Oxygen supply to the brain has stopped. The brain is instantly affected by this and starts shutting down. It can tolerate up to 3 minutes of no blood supply and then starts gettinginjured. At 9 minutes, there is permanent damage to the brainand a little beyond 10 minutes, the brain is completely and irreversibly damaged and the victim becomes non-salvageable.
This process can be halted or prolonged if effective CPR is commenced by any bystander until trained help arrives.
In UK, 43 % of all the Cardiac arrests receive CPR by bystanders out of hospital. The survival from this is more than 10%. That is 1 in 10 people experiencing a certain life ending event survive only because of the person next to them had the knowledge and knowhow to perform CPR in good time. This figure increases to 50% if the bystander delivers a shock from an AED (Automated External Defibrillator). Despite these figures, these countries constantly try and improve further.
Sadly, in India, less than 1% of Cardiac arrests receive any attempt of resuscitation. There is no concept of Bystander CPR. There were 28,000 deaths due to Heart attack and 1,75,000 deaths due to trauma in India last year and majority of these in the rural areas where access to tertiary level or definitive healthcare are non-existent.
There are 2 reasons for these high death rates in India:
- The Bystanders do not attempt resuscitation. They either do not have the knowledge nor skills to do it. They do not want the hassle of the regulatory aftermath (either survival or death). When India fails at this point, the next point is irrelevant.
- After-care of successful resuscitation is poor. Assuming, that a skilled bystander dared to intervene in good time and has successfully resuscitated the victim and has brought them back to life, what happens next ? There is no dramatic wake up as they show in cinemas. The brain and other vital organs which were briefly damaged because of lack of oxygen, and are now subjected to re-perfusion of bad blood transiently causing further harm. The victim remains very critical at this stage and would need the attention of an experienced ICU team, which may-not be available in the rural areas.
So how do we address these problems we have in India. Yes, the Government is doing its best by investing in building up the Health-care infrastructure, by making more hospitals. But do these hospitals have the necessary trained staff to treat, this level of critical patients. No. Not in the near future, it will need generations of Doctors churning out of Medical colleges to fulfil the requirements. The Deaths are staggeringly high and cannot be ignored. There has to be a solution, implementable NOW, than wait a few generations.
Helicopter Emergency Medical Service: HEMS. This is the answer to point number 2.
Imagine a Fully equipped ICU Helicopter kept on stand-by with a team of highly skilled doctor, paramedic and pilots. This team, capable of being deployed within 10 minutes of getting a call from a rural area’s District Medical officer for a freshly resuscitated Cardiac arrest patient or a severely injured trauma patient. The Helicopter lands within half an hour near the site and this team immediately takes over the ICU care of the victim. They further stabilize him and then, fly him back to the capital to a tertiary level hospital where definitive treatment commences addressing the cause of the cardiac arrest. The HEMS program is the only way forward for India to address the high death-rates in our country. ICATT Air Ambulance service, the only organization in the country, founded and led by 2 Critical-care specialists trained in UK, spearheading this mission. They have already Proven the concept of HEMS in Kerala during the floods in 2018. They are reaching out to all the State Governments to adopt the HEMS program for the masses, for the service to be rendered free to the deserving patients on clinical grounds.
This still leaves the point 1 un-answered.
The HEMS service will only be effective if the victim survives the initial insult. The only way the victim survives it, is if the person next to him delivers effective CPR immediately on witnessing a cardiac arrest. ICATT’s own charity wing, ICATT Foundation along with Crypto Relief and Heart & Stroke Foundation, through its Covid India Campaign, has launched a mega Resuscitation training campaign at Chitradurga, training upto 300,000 common public, CPR skills. This is a world record in itself. These 300,000 people will be capable of delivering effective By-stander CPR to any person suffering a life ending event with a proven survival of 30,000 people if each one uses this skill once. This trend delivered by ICATT Foundation, would be a platform and a template for other organizations and also the Government to make CPR skills mandatory to everyone of the 1.3 billion of us. This is the first major step towards declaring war on the massive and embarrassing Death-rate of India.
Cardiac Arrest: Its Game on !! from now….
Dr. Rahul Singh Sardar
Co-founder and Director:
ICATT Air Ambulance Service
PHEM Education Pvt Ltd