Beirut, Lebanon: Just over 5 percent of people who suffer a cardiac arrest in the streets of Beirut are likely to survive the experience and be released from hospital, according to a new study that scientists say should spur the teaching of resuscitation techniques to the public and the improving of the city’s emergency services. “There is a treatment and the treatment is highly effective, but it is really time-dependent,” said Mazen al-Sayed, the director of Emergency Medical Services and Prehospital Care at AUB Medical Center, and the study’s lead author. “You’ve got to respond early.”
The study, published in the latest edition of the European Journal of Emergency Medicine, is an initial attempt at evaluating Lebanon’s capabilities.
Researchers looked at three years of data on adult patients admitted to the emergency department at AUB Medical Center, and identified 214 patients who were likely brought in as a result of cardiac arrest.
AUBMC’s emergency department receives about 49,000 patients per year.
Just 11 patients survived the cardiac arrests and were released from hospital, and only five left without brain damage.
In just 4 percent of the cases, a bystander tried to resuscitate the victim of the cardiac arrest.
The time taken between a person getting a heart attack and reaching the emergency room was 28 minutes, more than double the standard in the U.S. The time taken for emergency services to arrive at the scene of a cardiac arrest was 15 minutes, also much longer than international standards.
Survival rates vary widely across countries. Studies carried out in the past decade show rates as high as 30 percent and as low as near zero.
A person’s likelihood of surviving increases with the presence of bystanders who can perform CPR or use Automatic External Defibrillators – portable machines that should normally be available in high-risk areas like malls and centers – in addition to a quick arrival on the scene by paramedics.
In an ideal scenario, a patient who suffers a heart attack in public would be witnessed by a bystander who would then call the emergency services.
In advanced systems, an emergency medical dispatcher would ask a standard set of questions to determine the cause of collapse, which helps them determine who needs to respond and how fast they should get there.
While discussing the case with the caller, the dispatcher would alert a response team of which location to go to. The dispatcher would also teach a form of basic CPR to the caller – the better-trained ones can teach the technique to someone who has never done CPR before in about a minute and 20 seconds.
Ideally, automatic defibrillators would be present at the scene and used either by a bystander or police officers, who are usually the first to show up.
In Western countries, initial responders should arrive at the scene within four minutes, and more advanced medical teams with defibrillators would arrive within eight minutes of the cardiac arrest.
Patients would then be transferred to the nearest hospital.
Sayed said the results gave an indication of where improvements to the system need to be made.
The first major step is to teach basic CPR to community members, so they can recognize cardiac arrests and respond immediately.
“One day, someone might save a family member,” he said.
The second step is to improve emergency services. In Lebanon, most patients brought into emergency rooms are transported by the Lebanese Red Cross or Civil Defense, who Sayed said were doing good work with limited resources. They are also hampered by the fact that there is no single number to call in the event of an emergency.
But he said that emergency services should develop a standardized set of questions to determine the medical emergency they are responding to, dispatch ambulances that are adequately equipped and train emergency personnel to better perform CPR and defibrillation techniques. They should also focus on improving response times.
He cited a study that looked at cardiac arrests in casinos – the most ideal location to have a heart attack, since they feature extensive surveillance and often have defibrillators.
While the early use of defibrillators was associated with a much higher rate of survival, every additional minute it took to use the defibrillators meant that survival chances declined by 7 to 10 percent.
Beirut’s notoriously bad traffic also contributes to responders’ delays.
“They get stuck in traffic like any other car,” Sayed said.
The government should also make sure automatic defibrillators are available at high-risk areas such as shopping malls and airports.
Sayed himself submitted a proposal to the Health Ministry that would help establish oversight of prehospital activities and standardize training, certifications and levels of care, in addition to setting policies and regulations governing the country’s emergency response system.
Sayed said that programs teaching schoolchildren and community members how to perform CPR should be more widespread.
“The best option is for them to learn CPR, to help save a family member one day, and know what to do in a case of cardiac arrest,” he said. “It takes minimal effort to learn how to provide CPR, to learn how to use an AED.”
But beyond that, he said, the need for quality emergency response was a basic need for Lebanon’s community.
“People should expect that they get good emergency response to them if something happens, and that is the most basic need of any community,” he said.
© The Daily Star 2013Dec 2013