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Heartline Magazine April - June 2003
Chain of Survival
Heart disease is the number one killer in the hemisphere.
Doctors have done well in treating the disease, but not enough has been done at
the medical or community level in caring for the dying heart.
A strong chain of survival, being able, for example, to
recognize the signs and treat in the critical first minutes until emergency
medical services arrive, can improve chances of survival and recovery for
victims of heart attack, stroke and other emergencies
The Heart Foundation of Barbados (HFOB) is very active in
this area, providing training for medical and paramedical personnel and across
the community, through its Emergency Cardiac Care (ECC) programme.
Dr. Brian Charles, who is director of the programme at the
Heart Foundation, explained that the ECC training course is divided into two
parts, in order to cater to different levels of participants. They are: Basic
Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS).
The BCLS is intended for lay persons, such as business
people, as well as ambulance workers, nurses, members of the various services,,
even family members, explained Dr. Charles. They are taught prudent heart
living, risk factors and how to modify them. The aim is to help them recognize
an emergency to the heart and to act upon it. Such emergencies may include heart
attack, stroke, choking, or any other cause of heart arrest.
The BCLS course also gives instruction in CPR for ages 8
years and over, child CPR for ages 1 to 8, and infant CPR for babies from birth
to 1 year old.
The basic Heartsaver is a 1-day course, and a fee of BDS$50
is charged. The full BCLS course for health care providers is also conducted
over 1 day and the fee is BDS$75. BCLS courses are held every week or so at the
Heart Foundation of Barbados building, Ladymeade Gardens, Jemmotts Lane, St.
Michael.
The Advanced Cardiac Life Support (ACLS) is an intensive
2-day course that is more suited to medical and paramedical personnel. It
provides a higher level of instruction and includes recognition, intervention
and prevention of periarrest conditions such as lethal arrhythmias, myocardial
infarction and stroke, along with their complications. It also teaches advanced
airway management, arrhythmia recognition, defibrillation and cardioversion and
cardiac pharmacology.
The cost of this course, which is also held at the Heart Foundation every 2 to 3 months is BDS$400.
Dr. Charles noted that the BCLS and the ACLS courses
essentially covered the various links in the chain of survival. At the BCLS
level these include early recognition (being aware of the signs), early access
(making that important and timely call for help), early basic life support
(having the knowledge and confidence to do something about it), and early
defibrillation (getting the heart functioning again).
Early advanced cardiac life support and early rehabilitation
(the Heart Foundation's CDP & R programme) are the links covered by the ACLS
course. An essential component of the BCLS is training in the use of the
Automated External Defibrillator (AED). Roughly the size of a laptop computer,
and portable, the AED is a device that basically restarts the heart after it
stops during sudden cardiac arrest. "The good thing about the AED" said Dr.
Charles, " is that it can be used by anyone, even after just four to six hours
of training. It must be understood that if you don't correct the ventricular
fibrillation (when the heart stops beating) within four to eight minutes, the
patient is going to die. So the AEDs are useful and important to those having
cardiac arrest."
Dr. Charles, who is head of the Emergency & Accident
Department at the Queen Elizabeth Hospital, heads a committee of dedicated
volunteer professionals who play a key role in organizing and managing the ECC
programme. These include project coordinator Mrs Gina Pitts, and executive
secretary to the Board of the HFOB, Ms Shirley Jones, who coordinates the
instructors of the ECC within the Heart Foundation.
Mr Errol Maynard is the Chief Basic Cardiac Support
Instructor, and is responsible for the Basic Life Support programme, while Dr.
Charles is himself responsible for the Advanced Life Support programme,
including the training of instructors.
Altogether there are 14 BCLS instructors, including
laypersons, paramedics, ambulance workers, nurses and firemen. The eight ACLS
instructors are doctors, nurses and specialists. All have been trained at the
HFOB.
To date there have been approximately 125 persons trained in
ACLS over the past two years. They have largely come from medical and service
institutions. Both the BCLS and ACLS courses are certified by the HFOB, the
InterAmerican Heart Foundation (IAHF), and the American Heart Association (AHA).
The ECC programme has moved into regional expansion and has
trained doctors, nurses and laypersons in numerous Caribbean territories
including Trinidad & Tobago, Jamaica, St. Maarten, Tortola, St. Croix, Guyana ,
and St. Lucia. These overseas courses are certified by the AHA and use the
materials and exams of that body. The course completion certificate is from the
AHA, the advantage of this being that persons who do the course are recognized
worldwide.
Come September the HFOB will launch a new training
initiative - Formal First Aid courses. Held at the HFOB, these will be one-day,
intensive courses and will also be AHA certified. Designed to be part of the ECC
programme, it will deal with the initial management of potential emergencies.
The course will be targeted to those in the community and the workplace.
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