European Stars and Stripes (Newspaper) - May 1, 1990, Darmstadt, Hesse                                Cardiopulmonary resuscitation involves Clearing the Airway and maintaining breathing and circulation. Since widespread training began the technique has been changed. The head is no longer positioned in a pronounced tilt to let air in because the neck May be broken. The Chest and Back Are no longer pounded. The ratio of restorative breaths to Chest Massage has changed to two breaths to every 15 Chest compressions. Source american heart association when heart and breathing Stop changes in of a saving new York time effective life support through car by Jane e. Brody new York times 11 n 19761 completed a 12-hour course in cardiopulmonary resuscitation or car and was certified As trained to provide Basic life 11 support for someone whose heart had stopped. My motivations were simple. I did not want to have to stand by helplessly and watch someone die if there was something i could do to help. I also realized that chances Are the person in need of Rescue would be someone i knew a a Friend perhaps or a member of my family. Two years later my husband developed severe Chest pains and As i drove him to the emergency room at 2 a.m., i mentally reviewed what to do if he should lose consciousness. But it turned out that i did not have to apply my car training until a few weeks ago. I was snorkelling with some fellow travellers in the Pacific off a Remote Island and we suddenly realized one Man in the group was missing. It took what seemed like an eternity but was probably about 10 or 15 minutes to find him. He was afloat face Down with his mask in place unconscious not breathing and with no discernible pulse. As he was lifted into the Small boat someone did a Heimlich Man Uever to try to Clear his Airway of vomit and his lungs of seawater and we immediately began car. I did Mouth to Mouth resuscitation while five people took turns doing cardiac compression. The cramped quarters on the boat made one person car which is now taught As preferable physically impossible. Since i was taught to keep car going until medical help arrived or a physician pronounced the victim dead or i was too exhausted to go on we maintained our Rescue attempt for three hours As the boat raced to a Landing strip. The plane arrived just As rigor mortis made it impossible and obviously useless to continue. I Learned later that because he had been lifeless in warm water for More than 10 minutes there was probably no Way we could have saved him without severe brain damage. And without advanced life support to Shock the heart Back into action within 15 or 20 minutes the chances of his survival on car alone were slim. Though deeply saddened and drained by the traumatic event and physical Effort i also Learned a lot from the experience. I Learned that even after 14 years without a refresher course i remembered enough car to provide reasonable life support. I got air into the lungs with each attempt and Between respiration i was Able to instruct Novice volunteers to do what i believe was effective cardiac compression. Also i Learned that despite self doubts about being Able to do car on a real person when faced with a life and death emergency i did not panic faint wretch or run out of stamina. I Learned too that i could handle defeat. I did not feel like a failure because the Man died. But i also Learned that i should have taken a car refresher course Long ago. Since my initial training some of the techniques of Basic life support have been modified a for example the rate of Chest compressions is now faster a and without intervening practice i had forgotten most of the supporting facts and several of the Steps. I have now signed us for a six hour refresher course. Unfortunately while More than five million americans Are trained in car each year Only a fraction maintain their skills and knowledge through refresher courses. Studies show that even physicians and nurses forget much of what they learn about car within six months of training. To Foster longer lasting retention the techniques and method of teaching car have been simplified in recent years. And improvements have been made to increase the chances that car will maintain an adequate blood Supply to the brain and other vital organs until a machine called a defibrillator can electrically Shock the heart Back into action. Experts say car is Quot As simple As a by Quot a for opening the victim s Airway this sometimes requires a Heimlich Man Uever to remove an obstruction for breathing your own exhaled air into the victims lungs and c for inducing circulation by pressing on the victims Chest to pump blood from the victims heart. Car is readily Learned from written material and from demonstrations and practice on a mannequin which can show whether you Are doing it correctly. Most people can learn enough to save a life in one three hour session. Although at first Only physicians and emergency medical aides were taught car the importance of training Lay people soon became apparent. In most cases of sudden heart failure it simply takes too Long for a trained professional to get to the scene in time to save both life and brain function. Within four minutes of no circulation the brain begins to die. Seattle wash., the first Community to teach car to Lay people on a Large scale demonstrated in the Early 1970s that when a bystander initiated car chances of survival increased As much As fourfold. In Seattle the survival rate when car is started by a bystander is 43 percent As against 21 percent when car is not started until emergency help arrives. But Seattle also showed that it was not enough to simply train a lot of people in car. For the emergency technique to be truly lifesaving there must be a rapid response emergency medical system that can get to the scene in 10 minutes or less. In addition the emergency team must be Able to administer an electrical Shock to the heart to Jolt it Back into a Normal rhythm. In general in cities with a Quick response emergency medical system and a Large numbers of citizens who can do car the survival rate averages 25 percent As against Only 5 percent where these Are lacking. Even when car is done correctly and enables the person to survive Long enough to leave the Hospital there is a Chance of permanent brain damage. The severity of damage is determined by How Long the brain lacked an adequate blood Supply. Other risks to the victim Are usually less significant such As broken ribs from too vigorous or improperly placed Chest compressions. But the alternative to a broken rib after All is death. The risks to Lay rescuers Are considerably less. For example the chances of contracting aids hepatitis or other infectious diseases in Mouth to Mouth resuscitation Are a a extremely Low Quot and should not inhibit individuals from learning or performing car according to or. Joseph p. Ornato a member of the american heart associations subcommittee on emergency cardiac care. Ornato a cardiologist at the medical College of Virginia noted that Lay rescuers Are most Likely to perform car on someone they know not a stranger on the Street who might be infected with a dangerous organism that can be transmitted by blood or saliva. Thus far there has been no documented instance of transmission of the hepatitis or aids virus in Mouth to Mouth resuscitation. Tuesday May 1, 1990 the stars and stripes a a a Page 13