Life is why, isn't it?



Day before yesterday, just before my shift was about to finish in the evening, an ambulance arrived. Before the patient was shifted, the bystander showed me a referral letter. He also showed an ECG that was obvious ventricular fibrillation. The hospital that referred the patient was about 20 km away.

I immediately ordered to shift the patient inside, knowing full well that the prognosis was grave. Ventricular fibrillation is a condition where the heart has stopped pumping blood effectively. The patient will have no pulse. CPR was initiated and the patient was intubated. But it was too late. The 74 year old lady was in asystole and despite our efforts, she could not be revived.

There was nothing that we could do. To have any chance of revival from a VF cardiac arrest, you need high quality CPR and early defibrillation. Unfortunately, this patient received neither during the 45 minute transport.

This is not a rare incident in Kerala. Few hospitals have a defibrillator. Vast majority of ambulances are just glorified vans. Ambulances with ACLS trained staff are scarce. Primary health centres, community health centres, district hospitals are ill-equipped to efficiently deal with a patient presenting with cardiac arrest. Most small clinics are the same.

So unless you are fortunate enough to have an arrest near a Medical College or a posh private hospital, your chances of survivals are non-existent. This lady lived in a rural area, too far from a hospital that could have effectively managed her condition in time. This is what is so frustrating to me.

It's frustrating because I care. I want to help people, I want to save lives if I can. That's why I took courses in BLS and ACLS. The motto of the AHA is "Life is why". Everything we do, we do in order to save lives. But what can doctors do when the system itself appears to be ignorant.

Cardiac arrest and heart attacks are the number one killer in the world. Things that we can do to give people with an arrest some sort of a fighting chance of survival are not properly taught or properly implemented. Why aren't the public taught about the importance of CPR? So much information is spread on communicable diseases, mosquito control, the importance of a balanced diet and exercise but absolutely nothing is taught about CPR. Nothing.

CPR can and will save lives and it doesn't need to be done by a medical professional in order to be effective. It should be taught to kids in high schools. Any CPR is better than no CPR at all.
But unfortunately, even most medical interns are not entirely certain of the protocols in a cardiac arrest because it is simply not given enough important in the MBBS curriculum.

The government should do more. It is not simply about investing money arbitrarily. It is about investing money in things that will save lives. ACLS ambulances will save lives. Defibrillators will save lives. Training medical staff on cardiac arrest protocols will save lives.

And finally, we need more people to care. Look at every patient like a family member. Rich or poor, every life matters.

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