MOUTH-TO-MOUTH NOT IMPORTANT IN HEART ATTACKS.

Byline: Staff and Wire Services

Bystanders who want to help a heart attack victim are increasingly being told by 911 dispatchers to skip the mouth-to-mouth resuscitation and concentrate on giving chest compressions until medical help arrives.

Driven by medical surveys and continued public resistance to giving mouth-to-mouth, emergency medical groups across the country have either changed or are considering changing the traditional instructions given over the phone to untrained individuals helping a heart attack victim.

``If someone is going to do nothing because they are apprehensive about doing mouth-to-mouth, it is simple to tell them to find the middle of the chest and start pressing,'' said Dr. David Wald, a physician in the Department of Emergency Medicine at Temple University Hospital in Philadelphia. ``That is better than nothing.''

The reasoning is simple: A heart attack victim's chance of survival drops about 10 percent for every minute he or she does not get some type of help. Giving an untrained person instructions on performing mouth-to-mouth wastes some of those precious minutes, but it is relatively easy to tell someone how to properly do chest compressions.

Emergency officials in Los Angeles have been instructing 911 callers to perform both mouth-to-mouth resuscitation and chest compressions, but plan to adopt the new guidelines within the next 30 days.

``It's been tried in other cities informally, so we want to hop on the bandwagon and be at the forefront of this,'' said Los Angeles Fire Department Capt. Bill Wells, a paramedic in the agency's planning section.

Wells said it is more critical to perform chest compressions than mouth-to-mouth in the time it takes for paramedics to arrive.

Wald said between 1,000 and 1,500 people die of cardiac arrest every day in the United States. The chances of saving heart attack victims is ``realistically very small'' because of several factors - ranging from why the person collapsed, to how CPR is performed and how long it takes paramedics to arrive, he said.

But performing some type of cardiopulmonary resuscitation can expand by four minutes the window of time generally considered necessary for paramedics to respond and still have a chance at saving a victim, Wald said.

The changes are only for victims over age 18 whose hearts have suddenly stopped. Children and those who have stopped breathing because of such things as drug overdoses, drowning, carbon monoxide poisoning or allergic reactions still require mouth-to-mouth resuscitation.

In February, emergency medical directors in several cities - including Chicago and Dallas - decided to make the change. And last week, emergency dispatch services in 17 cities and counties nationwide began a test of instructions from the National Academies of Emergency Dispatch that advise using only chest compressions on heart attack victims.