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If you have a heart attack, hope you're in Seattle.

More people in the United States die from heart disease than any other cause. About two-thirds of these deaths are from heart attacksclaiming more than 1,400 lives every day, one victim every minute.

But there's one city in the United States that's beating these terrible odds. In Seattle, Washington, about one-quarter of the men and women who have sudden cardiac arrests are resuscitated and eventually walk out of the hospital and back to their lives.

This remarkable survival rate is due in great part to Seattle's citiizens - ordinary people who have learned how simple it is to be a hero and bring a clinically dead person back to life!

A 60-year-old Seattle man is playing golf one sunny Sunday. Suddenly he slumps over his golf bag and falls to the ground. Ont the next fairway a foursom of high-school boys hear his partner's calls for help. Because they had a CPR course in their school the week before, they are able to run over and begin help immediately.

Seattle's Emergency Medical System Makes Every Minute Count

In the past two decades, medical technology has developed to the point that even when a victim has a heart attack, when he or she is clinically dead, it is a highly treatable condition. The most

critical factor is how long it takes to get treatment to the victim.

When a person has a heart attack, the pumping action of the heart has stopped. He or she will become unconscious in a matter of seconds. If circulation is not restarted within four minutes, the brain will suffer permanent damage. If your loved one does not have any help in eight to ten minutes, he or she will be permanently dead.

The quickness of Seattle's emergency medical system is one of the reasons it has been so successful in saving its residents from heart attacks. When someone dials 911 to report a medical emergency, at least two enmergency units are dispatched to the scene.

The first to arrive is a team from the closest fire department that's trained to administer CPR. Close on its heels is a paramedic group with advanced medical equipment. This "two-tiered" approach to sudden cardiac arrests averages a response time of less than three minutes for the CPR crew; the advanced medical backup arrives from four to seven minutes after the first phone call.

But at this point, Seattle officals faced a tough decision. They had developed an exemplary emergency-response system for heart-attack victims. But every minute the victim does not have CPR results in a significant decreast in his chance for survivial. Lowering the response time by just 30 seconds more was calculated

to require 31 new emergency-care vehicles, each costing about $43,000 per year.

A Revolutionary Idea: The Citizen to the Rescue!

The solution to this budget dilemma was so simple that it was revolutionary. The person most vital to a heart-attack victim's

survival is the one at the scene of the heart attack. If these ordinary citizens could be taught how to begin CPR right away, medical experts predicted that there could be a much better chance for survival.

So in 1971, Seattle started a remarkable program call MEDIC II. With the cooperation of fire department personnel already trained CPR as instructors, a three-hour session in CPR was offered free to the public. In those three hours, each participant would be taught how to recognize the signs of heart attack, lhow to call for help form Seattle's emerrgency-care system, and how to maintain the lvictim's breathing and circulation using CPR until trained personnel arrived.

A man playing racquetball in a Seatt;e suburb started having trouble. Although he's apparently had no history of seizures, his breathing had nearly stopped and his pulse was almost absent. A basketball player from another court rushed over and started CPR. Two mimutes later an aide crew arrived and his condition was stabilized.

Seattle's CPR was the first attempt in the Untied States to teach CPR to citizens on a citywide basis- and the city became excited. The response to MEDIC II was so overwhelming that its original goal - to train 100,000 people in CPR in three years-grew and expanded. Today, 18 years later, MEDIC II has trained more than 400,000 Seattle/ King County residents-that's about 35 percent of the total population. It continues to teach 2,000 people every month and intends to have all Seattle residents over age 12 be exposed to CPR instruction.

And are these newly trained citizens using their CPR? Well, in 1970, only 5 percent of resuscitations in sudden cardiac arrests had been started by a bystander at the scene. After ten years of community-wide training, that figure increased to 40 percent. For other cities who report such figures, the average is 20-25 percent.

The Ultimate Payoff: CPR Doubles Survival Rate

The combination of a CPR-trained citizenry with a fast emergency-care system has given Seattle the best statistic of all-a program paying off in saved lives.

In a survey of people ultimately discharged from the hospital after suffering a heart attack, 43 percent who had CPR started right away by a bystander were ultimately discharged from the hospital, compared to only 21 percent of people who had to wait for CPR from the emergency medical system. Thus, bystanders who started CPR themselves were able to double the survival rate over situations where bystanders did nothing but call for emergency help.

Another obvious benefit of bystander-initiated CPR was shown in the neurologic course of resuscitated patients. At the time of hospital admission, half the patients who had received bystander CPR showed at least some form of conscious behavior. In contrast, only 6 percent of the patients for whom resuscitation had been delayed until the arrival of emergency-care personnel showed such responses at the time of hospital admission. Similarly, there was significantly less neurological impairment at hospital discharge when bystanders had initiated CPR.

A man was walking up to the entrance of a Seattle hospital when he slumped against a car and collapsed. An electrician and his friend saw the man go down. One called for help, and the other began CPR. Staff from the hospital emergency unit cam e out to aid the victim, but the citizens were doing such a good job that they were allowed to continue. Soon advanced medical teams arrived and gave the victim electric shocks. The victim woke up within an hour of the collapse and had a complete recovery.

The People Who Need CPR Most Aren't Learning It

Despite Seattle's great success in teaching CPR, MEDIC II leaders acknowledge that there is a fatal flaw in their program. While the number of people being taught CPR has steadily increased, the percentage of cardiacarrest cases in which bystanders started CPR has leveled off at a fairly constant 40 percent in the last few years. This statistic led MEDIC Il's leaders to a disturbing conclusion: the people who need CPR most are not learning it!

This conclusion is based on the fact that the average age of people trained through MEDIC II is 33, about equally divided between men and women. But the average profile of a heart-attack victim is a man, aged 64, who is at home. Therefore, the person most likelyto need to know CPR is the companion of a 64-year-old man, usually a woman aged 45 or older. These are exactly the people not learning how to administer CPR.

Mr. Smith is a 55-year-old executive in a local Seattle company. When he is home mowing the lawn, he begins having chest pains. His wife suggests he rest until dinner. Suddenly, his wife hears a crash. She discovers her husband lying unconscious on their living-room floor. She calls 911 and the local fire department arrives in 5 minutes. Mr. Smith is rushed to the hospital, but despite vigorous attempts, he cannot be resuscitated. He is declared dead 45 minutes after arrival at the hospital.

Are Doctors Failing Their Patients?

In an attempt to reach women aged 45 and older, and families at high risk for heart attacks, MEDIC II distributed brochures to physicians' offices and put up posters in grocery stores. But MEDIC II discovered that though nearly all doctors strongly believe in the importance and appropriateness of CPR training for the family members of patients at high risk for coronary disease, less than half of all physicians regularly recommend CPR training to these people.

Many reasons are possible for this unhealthy trend. Theories include the possibility that physicians may feel uncomfortable bringing up the subj ect of possible sudden death for fear it may cause a heart patient's family to suffer undue anxiety and stress.

But whatever the reason, MEDIC II feels physicians must be made a vital link in recommending CPR training to high-risk patients' families. In the meantime, MEDIC II hopes to recall these vitally important women by cooperating with Seattle's Greater Council of Churches to organize CPR training sessions for its congregations. They're also encouraging community clubs with women 45 and older to ask for free CPR training sessions for their members.

Learn How to Be a Hero Today

In the past there was little hope for those struck by sudden cardiac death. But today immediate aid, provided by bystanders and emergency medical equipment, can restore victims of heart attacks to life. However, you cannot help unless you are prepared. Go out and take a CPR course today. And have your emergency-care system phone number taped to your phone. Then, when the emergency happens, as it probably will for most Americans, you will be able to perform the simple actions that will save a life.
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Title Annotation:city has CPR-trained citizenry, fast emergency-care system
Author:Rylko, Christina
Publication:Saturday Evening Post
Date:Apr 1, 1988
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