CPR (cardio-pulmonary resuscitation) saves lives, and most communities periodically offer opportunities for citizens to be trained in this skill. However, the effort will be in vain unless a normal heart rhythm can be restored. For every minute that passes before defibrillation is accomplished, the survival rate decreases by about 10%. Modern technology now offers the automatic external defibrillator (AED), which requires minimal training to use. Some models even have voice prompts.
Individuals can buy an AED with a physician's prescription. A ``pre-owned'' device might cost $2,500, and a new one $3,000. If interested, try searching www.mdexpress.com on ``defibrillator.'' (It is possible that prices might come down-however, anything with a medical application carries a huge load of regulatory and liability costs, so that the price tag is sure to be much higher than that for similar technology designed for other uses.) This is an item you might want for your shelter, since there will be no paramedic ambulances available at a time that calls for sheltering. However, you would probably want to keep it in an accessible location for potential use in normal times as well.
Airports, airlines, factories, golf courses, and health clubs are buying AEDs. If you exercise at a health club, you might want to check on their equipment. Young, vigorous, health-conscious people have died or suffered devastating anoxic brain damage that might have been prevented by this wonderful technology.
Another device to wish for in your emergency kit is the Ambu CardioPump for performing active compression-decompression CPR. This is required equipment in Austrian ambulances. Information and references to the American medical literature are available (in German) at www.synmedic.ch/produkte/CardioPump.htm). If you are in the UK, you can buy one on-line for £145 (see www.traumaboard.com ). However, the FDA ``protected'' Americans by recalling 506 such devices because ``the firm was using data from an unapproved clinical investigation'' (see www.fda.gov/bbs/topics/ENFORCE/ENF00325.html). In the U.S., it is probably lawful, though less effective, to use a toilet plunger for the purpose (AAPS News, Aug 1994).
All of the above assume that someone is available to assist the patient. What can you do if you are alone when you suffer a heart attack? If you begin to feel faint because of arrhythmia, you have only about 10 seconds before losing consciousness. An article widely circulated on the Internet since 1999 advises ``cough CPR.'' You can find the article and critiques by searching on ``how to survive a heart attack when alone'' on northernlight.com.
The advice reads: ``These victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and cough must be repeated every two seconds without let up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a phone and, between breaths, call for help.''
The ViaHealth Rochester General Hospital has been cited as the original source for this article. However, Rich Sensenbach, Web Development Coordinator for that hospital, posted an ``important notice'' at www.viahealth.org, stating that ``we can find no record that an article even resembling this was produced by Rochester General Hospital within the past 20 years,'' and that the medical literature (or the hospital's staff) does not support it. Dr. Richard O. Cummins, Seattle director of emergency cardiac care, stated that the procedure could be dangerous or fatal in the setting of a heart attack that does not cause a cardiac arrest. (Ditto for the precordial thump: it might shock a fibrillating heart into a normal rhythm, but it could also shock a heart with a more benign arrhythmia into fatal ventricular fibrillation.) Neither the precordial thump nor cough CPR is taught in American Heart Association (AHA) approved courses for the lay rescuer: ``It would complicate the teaching ... by adding information that is not generally useful in the prehospital setting.''
The AHA states: ``This technique of coughing to maintain blood flow during brief periods of arrhythmias has been found to be useful in the hospital, particularly during cardiac catheterization, when the victim's ECG is monitored continuously and a physician is present. During cardiac catheterization, patients may develop sudden arrhythmias. If an arrest arrhythmia is detected within the first 10 to 15 seconds and before the patient loses consciousness, a physician or nurse may instruct the patient to cough. Repeated, forceful coughing can help the victim remain conscious until the arrhythmia disappears or is treated'' (emphasis in original, see www.cpr-ecc.org/Science/ScienceMenu.htm).
The AHA advice is to dial 911 and take an aspirin (to inhibit blood clotting) if you think you may be having a heart attack. But the fact remains: if you are alone, if your phone call takes more than 10 seconds or help is more than a couple minutes away, and if you are having a cardiac arrest, cough CPR and/or a brisk self- administered precordial thump is your only hope. (It might be possible to use an AED on yourself, but only if you have one and are conscious.)
Dr. Donald Hetzel of Washington State writes that he successfully used the technique several years ago when he had his first heart attack, before ever seeing it documented. When he first encountered a copy of the article, he began distributing it to senior care centers and friends in the medical industry; he was surprised that no one had heard of it before. In his local area, three individuals now say that they owe their lives to using this method. Are there any who died because of it? That is impossible to know.
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Dr. T.D. Luckey has put $1,000 on deposit at Radiation, Science, and Health, to be given to anyone who presents a reasonable scientific study showing significant harm from whole-body, low-dose irradiation (suicides and abortions from fear of radiation are excepted). Dr. Bernard Cohen's reward for explaining his ``discrepancy'' (see Sept 1994 issue) is also still open.
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