Canadian Doctors Speak Up

Emergency-room doctors say bystanders are morally obligated to perform chest compressions on cardiac arrest victims - whether or not they have been properly trained in cardio-pulmonary resuscitation - and CPR must be considered a “life skill” for all Canadians.

Representatives of the Canadian Association of Emergency Room Physicians (CAEP) told a news conference on Thursday that too many cardiac arrest victims are dying because the person beside them doesn’t know what to do, and is afraid to act.

“It must become a moral obligation and a social expectation that bystanders will perform CPR when they witness a cardiac arrest,” the doctors said in a position statement released to reporters. “The general population must come to understand that cardiac resuscitation is much more likely to be successful when CPR is started promptly, and the victims of cardiac arrest will almost certainly die if lay witnesses do not intervene.”

Every year, more than 20,000 people in Canada suffer a cardiac arrest outside of a hospital. It is the leading cause of death in this country and fewer than one in 10 people who have a heart attack in their home or on the street will return to normal health.

The odds of survival are increased by 300 to 400 per cent if the victims receive CPR immediately. But, even though half of all cardiac arrests that occur outside a hospital are witnessed by someone in the vicinity, bystanders jump in to help just 25 per cent of the time.

Increasing that rate to 50 per cent - as is the now case in a few Canadian communities - could save 2,000 lives annually, says the CAEP.

The doctors say they realize there reasons why bystanders are reticent to intervene. Many people do not know CPR. And, among the 60 per cent of Canadians who have been trained in the procedure at least once, the skills are often rusty. That leads to “hesitation and inaction.”

But the CAEP says “all Canadians should respond and provide chest compressions (with or without mouth-to-mouth ventilation) whether they are trained or not, when an adult, child or infant suddenly collapses.” And 9-1-1 ambulance dispatchers should provide CPR instructions to all those who call to report a cardiac emergency, say the doctors.

The American Heart Association and the Heart and the Stroke Foundation of Canada updated their resuscitation guidelines last year to say that compressing the chest of a cardiac arrest victim at a rate of about 100 times a minute is most critical response to a heart attack. It is something that can be done without training.

But the doctors also argue that every Canadian should learn CPR.

They recommend that life-saving education be a considered a pre-requisite for a high school diploma, tax exemptions should be given to companies who pay for CPR training for their workers, and individuals who take a CPR course should receive a 100-per-cent tax rebate.

In addition, the CAEP says it wants to join with other like-minded organizations to spearhead a national campaign to advance the cause of bystander CPR.

It could start with wallet size cards to be handed out by physicians that explain the importance of the procedure along with a computer link and telephone number so Canadians can learn when and where courses are held, say the doctors. Seniors could be a particular focus of the campaign because they are more likely to witness a cardiac arrest than younger people.

But “there must be widespread recognition,” says the CAEP, “that CPR is a simple but vital life skill everyone should learn and then put into practice in emergency situations.”

Editor's Note: An earlier version used heart attack and cardiac arrest as synonymous terms. The CAEP's statement refers to cardiac arrest victims.