Cardio-respiratory resuscitation in Saudi Arabia and Proposal for Arabic resuscitation council
Mohamad Said Takrouri
The issue of MEJA Oct. 1999included an article discussing the topic of cardiopulmonary resuscitation in pregnancy and childbirth.It comes in the absence of Pan Arab Resuscitation Council. The body which can adopt or recommend guidelines to be followed universally among the health team responsible for the obstetrical care. It goes without an effort to realize that it is the time for inception of Pan- Arab Council for resuscitation. It is not only the guidelines for resuscitation in childbirth are lacking, but also there is complete absence of known guidelines governing the BCLS and ACLS which take into consideration the special situation in various Middle East Arabic Countries.
Baskett1 recently (1992) dealt with the issue of the resuscitation in Europe and the inception of theEuropean Council for Resuscitation (ECR). He wrote: "In the past decade, national councils have been created, notably in Australia, Scandinavia and the U.K., the prime aim of which has been to analyze current knowledge and channel this into organized practice by the use of guidelines for both basic and advanced life support". In many ways these Councils have emulated the example set by the American Heart Association (AHA) with the National Academy of Sciences National Research Council, who have determined standards and guidelines and courses on CPR and Emergency Cardiac Care updated at regular intervals since 1966. The European Resuscitation Council representatives came from virtually all of the National and European Societies: of Anesthesia, Cardiology, Intensive Care, Accident and Emergency Medicine and Immediate Care. Their goals were enhancing the standard of practice and knowledge through Europe. Anesthesiologists are involved in this activity because of their expertise in airway management, cardiac and shock therapy. In his article, he mentioned the Canadian and Australian experiences and their reliance on the American experience in basic cardiac life support BCLS and advanced cardiac life support ACLS guidelines. Before
The Middle Eastern Countriesmay follow the steps of other countries in the world. Many of the guidelines advocated may be similar to the American Standards there remain some differences which reflect Arabic concepts. Teaching programs for lay people and professionals need to be designed around varying styles of practice and medico-legal constraints. In the U.S.A. pre-hospital care is based generally on a two-tier response from Emergency Medical Technicians and Paramedics. In the Middle Eastern countries the system is largely dependent on a single-tier response with the aim of including at least one ambulance man with paramedic training in the team. In promulgating guidelines, allowance must be made for these varying styles of practice. Data collection using multinational standard reporting forms may reveal a preferred system or aspect of a system, which can be recommended for Pan Arab practice. The ERC has adopted the journal Resuscitation as its official publication. An European editor has been appointed with additional European members of the Editorial Board. We may adopt the MEJA, as a forum platform or we may choose differently.In Europe the glossary of terms used in resuscitation are wide. Because resuscitation calls for a wide spectrum of skills from a plethora of specialties and organizations, each claiming a legitimate interest in its service and practice, it is perhaps not surprising to find considerable variation in the interpretation of the terms used in reporting experience. Simple terms such as response time, survival, basic and advanced life support and CPR have not hitherto been defined precisely and agreed. They may convey different meanings to different workers. As a consequence, there is confusion in interpreting results, which are published or presented, and comparison of systems, practice or therapy becomes impossible. We think as we witnessed in Tunisia first Pan Arab congress on Emergency medicine that the situation is not better than what was in Europe.
The representatives from the AHA, ERC, the Heart and Stroke Foundation of Canada and the Australian Resuscitation Council met to establish uniform terms and definitions applying particularly to out-of-hospital resuscitation practice. Eventually a consensus was reached and the results have been published recently as the Utstein styles.Before even the European experience the Saudi Heart Association was founded by a group of Saudi doctors among them Prof. M.A Seraj and Prof. M. Al- Nouzha. The introduction and inception of Saudi Heart Association (SHA), in affiliation with American Heart Association (AHA) occurred 15 years ago 2-4. Experience of Cardiopulmonary Resuscitation (CPR) in the Kingdom of Saudi Arabia is worthy of study and repetition in the other Arab countries. The details regarding the scope and domain of initiating training facilities certification of medical staff and the public in CPR is fascinating. Prof. Seraj is known to be the "Father of CPR in the kingdom". He is so much motivated and motivating that you can not imagine the field without him. Since he is actively involved in designing, educating, and certifying individuals in CPR.In a very rare moment, I witnessed him even asking the stewardess in an airline while we were traveling for a congress on emergency medicine, about what facilities do they have on board in case of cardiac arrest. The confident lady tried to answer but it seemed her answer was not satisfying even to herself. So she asked him to meet the captain in the cabin. The discussion did not end he inspected the policy and procedures of the airlines regarding that topic. When we came back he was convincing Saudi Airlines to train all flying and ground personnel on performing CPR. He then conducted the first workshop in Jeddah. The courses organized by him are helped to expand as the years passed by many factors including awareness, acceptance and hospital accreditation. The expansion is helped not only by holding courses but also by organizing and conducting workshops on CPR for local and international symposia: -
Saudi Dental Association (SDA) Congress, 1997 - Riyadh, Saudi Arabia, Pan Arab Congress on Anesthesia, Intensive Care and Pain Relief 1997 - Cairo, Egypt, and 1st Organ Transplant Congress, 1998 – Abu Dhabi, United Arab Emirates.
It is known that SHA has issued 84,486 certificates in CPR. These certificates are the products of all forms of CPR courses (Providers, Instructors and re-certification) organized and conducted over the last 15 years. The numbers of certificates issued in Riyadh are understandably higher than other regions of the kingdom. They are 66555 certificates as compared to 17931. We tend to think that this is as an achievement in view of limited resources, the lack of appreciation of the importance of CPR mastering. The introduction of hospital Accreditation and Quality Assurance schemes although lately introduced may help in improving the situation. In recent conference on cardiac anesthesia Prof. Seraj delivered a paper explaining his high expectations. On the light that there are 124089 medical personnel working in health care delivery systems. The number of certificates issued should be 372267. Considering the rate of re-certification as 3 times in the past 15-years. Also, if all 13500 of the students in the medical field plus only 10% (9612) of the personnel working in the health care delivery system are re-certified twice over the span of 15 years, the total number of certificates issued to students and other personnel should be 46224 certificates. Therefore, the lecturer conservative estimate is 418491 certificates would have been issued during the past 15 years. This does not include any programs of CPR offered to the community; therefore the number indicated above may approach half a million certificates.
The Saudi experience is a unique experience in the Middle East. On many occasions we asked the SHA to extend its expertise and know how to other countries in the Middle East. This request was not fulfilled because of the logistics. But more communications and through the Pan Arab congresses, professional medical societies and educator cooperation the "chain of survival" can be extended to various Arab countries.
Let us create the Pan Arab Resuscitation Council for the Middle Eastern arabic Contries
In his argument we raise several questions and tentatively put several recommendations for future plan: General public recognition of the value of learning the skills of CPR. The establishment of more Basic cardiac life support (BCLS) centers in all hospitals in the Middle East, and Advanced Cardiac Life Support (ACLS) centers for every health region. Supporting BCLS, ACLS and Advanced Trauma Life Support (ATLS) education by issuing certification by Arab Medical Council for Health Specialties.
What we think that is especially important recommendation is the inclusion in all-medical and dental colleges of BCLS, ACLS and ATLS as part of the curriculum. The introduction of Basic First Aid and BCLS as part of the High School curriculum. Implementation of first aid and CPR as part of obtaining a driving license. All allied health personnel (police forces, fire brigade, Lifeguards, security personnel…etc) should have a valid BCLS certificate as well as First Aid. Citizen CPR for the public at large should be initiated. A wide spectrum of media coverage and an annual campaign on CPR and first aid.
Mohamad Said Maani Takrouri M.B. Ch.B. FFARCS(I)
Department of Anesthesia,
COLLEGE OF MEDICINE, KING SAUD UNIVERSITY
King Khalid University Hospital (KKUH)
Riyadh 11461 P.O. Box 2925
Tel 009661 4671595