One Life Saved?

One of the problems with being a medical professional is that one tends to view seemingly 'obviously' good ideas with a more calculating eye.

Ideas like this one.


Are teachers trained in basic first aid?

IN SATURDAY'S Straits Times, it was reported that a Primary 6 pupil with a heart disease died in school the previous day.

What I found shocking was that a teacher called the father, who arrived minutes later and performed cardiopulmonary resuscitation (CPR) on the boy.

Why did the teacher not perform CPR first? When someone has a heart attack, every second counts.

Are our teachers not trained in CPR and basic first aid? And if not, why is this so?

First aid should be part of the curriculum for trainee teachers and teachers should be required to go for first-aid refresher courses. Training only the Physical Education teachers is not sufficient.

Goh Lee Jin


The logic seems sound and obvious:

1. Child had heart disease and died suddenly, so he must have had a heart attack.

2. CPR saves lives when it comes to heart attacks, so CPR should have saved his life.

3. The child died after CPR. But since CPR saves lives, it must be the delay in initiating CPR that prevented a life from being saved.

4. Since the teacher, who was on the scene, did not start CPR, the problem must be because teachers are not trained in performing CPR.

Conclusion?

Train all teachers in CPR and no child will die needlessly of a heart attack in schools.

Except it's not so simple.

The public has an unrealistic expectation of the efficacy of CPR, something which is often attributed to the common depiction of successful resuscitation on TV and in the movies.

Depending on the patient profile, the exact pathology, and the location of arrest, success rate of CPR will vary.

Specific to out-of-hospital arrests in the paediatric population, the overall survival-to-discharge rate can be as low as 2.6% or 8.6%, although a smaller study suggests that not only is CPR worth performing, it's worth performing for longer than 20 minutes. Presumably if they haven't had any reason to give up on you after 20 minutes, your chances are pretty good to begin with.

(Unfortunately for the 18 to 35 age group, which angry doc assumes many of his readers belong to, the evidence is not very encouraging either.)

All that is not to say that CPR doesn't work at all (it's better than nothing), but the public needs to have a more realistic idea of how often it is unsuccessful.


angry doc does not doubt that training all teachers in CPR will in the long run help save the lives of a few children (and of course it helps too when a teacher gets a heart attack), but he wonders how much it will cost.

Bear with angry doc's bad maths as he tries to count the costs...

There are some 26,382 teachers in Singapore (you can find the exact figure in the Education Statistics Digest on the Ministry's website).

The cost of a Basic Life Support Course locally is in the region of S$80 to 100. (Google 'BCLS Course fees')

Even if you take the higher estimate, it's still around 2.6 million, which is a small percentage of the total Education Budget.

But what is the cost involved per cardio-respiratory arrest? Well, how many cases of cardio-respiratory arrests in school-children occurring *in schools* have you heard of in the past year?

To be even more callous, what will be the cost per successful resuscitation?

How many of teachers, when an arrest does occur, will actually initiate CPR? One study showed that around 80% of the time bystanders may not initiate CPR, even when around half of them have been trained in it.

And what if we decided to equip all schools with automated external defibrillators (AED), which have been shown to double survival rates compared to CPR alone, and train all teachers in their use?

At the cost of S$2500 to S$4000 per AED for each of the 355 schools, and the cost of S$120 to S$200 in training, it will come up to around S$5 million.

Twice the survival rate at twice the cost, so no real bargain there.

But of course, we should never count the costs when it comes to saving children, should we?