A 54-year-old man clutches his
chest, gasps for air and then collapses in the middle
of a busy street in New York. His face is red and beads
of sweat drip from under his thinning hairline. He stops
breathing. A young woman calls 9-1-1 on her cell phone
and the emergency dispatcher instructs her on how to resuscitate
the man. The phone cradled between her ear and shoulder,
she begins chest compressions, but is told to skip the
usual mouth-to-mouth.
Similar scenarios are becoming
the norm in cities across the US, as changes to emergency
dispatch medicine move towards getting rid of the mouth-to-mouth
step in cardiopulmonary resuscitation (CPR). The National
Academy for Emergency Dispatch in the US ushered in
the new protocol in February spurred by the public's
growing reluctance to perform mouth-to-mouth and by
an increasing number of studies that show the benefit
of the compression-only technique.
Will these changes make their way into the Canadian
emergency medicine landscape? "I'm not aware of
a plan to make changes to the way CPR is taught or the
way dispatchers give telephone instruction," says
Dr Dan Cass, chief of Emergency Medicine at St Michael's
Hospital in Toronto.
"Of note," he adds, "is the fact that
this principle was used in the setting of last year's
SARS outbreak." Dr Cass explains that the protocols
were instated because of the high risk of contamination
when manipulating the airway of a SARS patient. As doctors
and nurses needed to wear protective equipment to give
mouth-to-mouth, compression-only resuscitation was first
performed on patients, buying enough time for other
healthcare workers to get their gear on before leaning
in for the kiss of life.
Regardless of the fact that the protocols have been
used in an emergency setting in Canada, there's no move
to make this new technique the standard. "To date
we haven't been notified by the Heart and Stroke Foundation
that we should modify our teaching materials regarding
the use of ventilations and compressions in the provisions
of cardiopulmonary resuscitation," explains Les
Johnson director of client services at St John Ambulance.
But the possibility of instating these techniques may
not be that far away. Marc Gay, an emergency medical
services technician with Urgence SantŽ in Montreal,
member of the Emergency Cardiovascular Care Policy Advisory
Committee for the Heart and Stroke Foundation of Canada
and the president of the International Academy of Emergency
Medical Dispatch, is part of an international task force
that advocates the new protocols. "There's evidence
that during the initial minutes of the arrest if we
did compressions first we could have better outcomes,"
says Mr Gay. But he stresses that this technique should
only be used in cases where there isn't a respiratory
arrest. "We will never prevent anybody who needs
mouth-to-mouth from getting it."
For the moment resuscitation protocols in Canada remain
unchanged. But will we follow the Americans' lead? To
find out, watch for the new CPR guidelines that come
out in 2006.
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