'Doctors' orders: Everyone should try CPR

Cardiac arrest victims need help at once. Alternative is much worse

BY CARMEN CHAI AND DEREK ABMA, POSTMEDIA NEWS OCTOBER 14, 2011

You should at least try to perform CPR on someone who's suffering cardiac arrest, even if you've never been trained to do so, because the alternative for the victim is likely death.

That's the message Canada's emergency physicians delivered Thursday.

"It must become a moral obligation and a social expectation that bystanders will perform CPR when they witness cardiac arrest," said a declaration from the Canadian Association of Emergency Physicians.

"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."

The group is asking all Canadians to conduct press compression on someone who has had cardiac arrest, with or without mouth-tomouth ventilation.

Trained rescuers should provide mouth-to-mouth resuscitation after chest compressions, especially with children, infants and newborns, the organization says.

The CAEP is the national voice in emergency medicine, and develops standards and guidelines in this field.

In Canada, more than 20,000 people suffer out-ofhospital cardiac arrests each year for which some kind of resuscitation is attempted. About 85 per cent of cases occur in homes. Currently, less than 10 per cent of these people survive.

Sudden heart failure occurs outside of the hospital in more than 60 per cent of all cases, and 50 per cent of those incidents are witnessed by bystanders, the CAEP statement noted.

Out-of-hospital cardiac arrest victims are three to four times more likely to survive if they receive CPR from a bystander, but this kind of help happens in just one out of every four cases, the CAEP says.

About 60 per cent of Canadians have been trained at least once at CPR, the Heart and Stroke Foundation of Canada estimates.

"Unfortunately, CPR skills are often not practised and kept up-to-date, leading to hesitation and inaction when faced with a cardiac arrest situation," CAEP wrote.

Scott Taylor, a Toronto lawyer with Kahler, which specializes in injury law, said it's unclear whether untrained people could be liable if they accidentally cause harm to someone while attempting to perform CPR.

"I guess if it's performed negligently, theoretically or conceptually, there could be exposure to liability," he said. "But if the person has no training, I would think the [required] standard of care is going to be pretty low."

Lara Khoury, a law professor at McGill University in Montreal, said most provinces have a Good Samaritan doctrine that protects people from liability if they accidentally cause harm while trying to save a life.

"You can only be liable if you committed gross negligence ... so it's quite a high threshold," she said.

Josephine Hall, director of training and research at St. John Ambulance, a main provider of CPR education, said her group fully supports the CAEP's position.

She added that in the case of someone having cardiac arrest, it's virtually impossible to do any more harm that what the outcome will be if nothing is done.

"The person who's heart has stopped is technically dead," Hall said. "What people are often concerned about is if they're going to break ribs, or something like that. A broke rib will mend. That fact that [someone has] stopped breathing and their heart has stopped, you've got minutes to respond."

The CAEP called on governments to implement mandatory CPR education in high school.

Copyright (c) The Victoria Times Colonist