Jumpstart My Heart is a campaign brought forward by the Malta Health Students’ Association (MHSA) and Insite Malta. Date of Publication: 28th February, 2017
Insite team
MHSA team
writers
editing & design
Nicole Borg Johann Agius Julian Chircop
Kaitlyn Byrne Christoph Schwaiger Gabriella Sutton
Kaitlyn Byrne Christoph Schwaiger Gabriella Sutton David Mangion Andrew Camilleri
Nicole Borg
video editing Julian Chircop
3
Dedicated to Charlie Gambin (28th May 1941 - 28th January 2016) who passed away due to complications of coronary heart disease. He was a loving grandfather and the inspiration to this project. Special thanks to Mr Trevor Abela Fiorentino for his help and support throughout the campaign.
5
Table of Contents What inspired Jumpstart My Heart? pg 8 Who are we? - MHSA pg 9 Who are we? - Insite pg 10 Why did MHSA and Insite team up? pg 11 What are the different aspects of the campaign? pg 12 The Heart pg 13 Coronary Heart Disease pg 15 Coronary Heart Disease and the Maltese Islands pg 17 Cardiopulmonary Resuscitation (CPR) pg 18 Survey Data Analysis pg 20 The Good and the Bad Samaritans pg 22 Prevetion for Coronary Heart Disease in Adolescents pg 24 The Way Forward pg 34 Appendix A pg 36 Appendix B pg 37 Appendix C pg 38 Appendix D pg 40 Appendix E pg 45
7
What inspired Jumpstart My Heart? Upon starting her nursing course, the Malta Health Students’ Association (MHSA) Education Officer Kaitlyn Byrne was witness to her grandfather suffering a heart attack. “I remember feeling helpless and useless at that moment in time. It was my first month into the course so we hadn’t covered first aid yet. All I could do was look and stare while my mother tried her best to give him CPR till the ambulance arrived,” she said. This experience solidified her love towards the nursing course and the want to enrich her knowledge of CPR and First Aid. “If my mother hadn’t given him CPR he would have died there and then”. Kaitlyn’s grandfather passed away on January 28th 2016 due to complications of coronary heart disease.
8
“His passing inspired me to research the topic and become more knowledgeable on it. Through this research I found out that even my own peers had minimum knowledge of CPR even though coronary heart disease is the biggest killer on the Maltese Islands.” After being elected as Education Officer, Kaitlyn decided to work on a campaign to create more awareness and try to improve the knowledge of the public on this disease and how to help save someone’s life through CPR. Insite Malta’s CEO Johann Aguis and Executive Editor Nicole Borg immediately accepted the proposal knowing it had the potential of improving the Maltese society and give a jumpstart to more awareness on the topic. As students we also feel it’s our duty felt to strive for a better tomorrow.
Who are we? MHSA The Malta Health Students’ Association (MHSA) is a senate recognized faculty based organisation representing students studying at the Faculty of Health Science, University of Malta. The Faculty of Health Sciences is one of the largest faculties of the University of Malta with a total of 1,300 registered students offering different professional courses including: Nursing, Mental Health, Midwifery, Physiotherapy, Podiatry, Speech Language Pathology, Applied Biomedical Lab Science, Food Studies & Nutrition, Radiography and Occupational Therapy amongst other post graduate courses. Today
the
MHSA
is
an
and dynamic association with an executive board made up of 12 Faculty students and five standing committees, mhsaHEALTH , mhsaEXCHANGE , mhsaEDUCATION , mhsaLEISURE and mhsa MEDIA. The MHSA is a voluntary non-profit and apolitical organisation with its main priority being the promotion of health, education and student rights. The MHSA focuses on inter- professional and academic cooperation and interaction between the different health professional courses at the University of Malta.
active
9
Who are we? Insite Malta
about social issues and current events.
Insite Malta is a student-run, non-profit, independent media organisation based at the University of Malta. The organisation’s main aim is to promote student life and to provide students with a means by which to be heard.
Apart from sustaining a news website (www.theinsiter.org), Insite Malta is also the proud publishers of the The Insiter Online a monthly publication, which is a version of The Insiter, a printed magazine which is published every October.
Insite also works to raise awareness and encourage debate amongst students, to promote their initiatives in culture and education, and to safeguard their freedom of expression. The organisation also holds social issues at heart and therefore it recently added to the team the Social Policy Office with a team that is currently working hard to help both student organisations as well as society at large to learn more
10
Why did mhsa and insite team up? Since the campaign has two sides to it: the factual and the visual, MHSA Education felt that it was fitting to team up with a media organisation that could prove beneficial for the campaign.
In the following pages, it will be explained how the campaign was planned and carried out and thus will show proof as to how fruitful this collaboration was for the campaign.
MHSA and Insite have worked together numerous times before, therefore through past experiences MHSA felt that Insite was the best choice.
11
What are the different aspects of the campaign? One of the main aims of the campaign was to give a 360 degrees feel by giving out information and also getting to know what the general public knows about Coronary Heart Disease, CPR and basic first aid. The campaign was made up of the following aspects: 1. An online survey shared on many different social media platforms as to collect a sample that is unbiased (see Appendix A). 2. Two voxpops; one at University and another at Valletta were carried out in order to see what the general public and student body thought of our proposed changes and to get a first hand feel of the public’s knowledge. The voxpops also helped us in creating more awareness on the campaign (see Appendix B).
12
3. Infographics were published online. These images included facts and information regarding the subject (see Appendix C). 4. After the online survey was closed, we released the answers in the form of another infographic so the people who answered the survey, as well as those who did not, get to know which answers were correct (Appendix D). 5. Physiotherapy students carried out research on preventative methods for Coronary Heart Disease starting from childhood. 6. The release of this publication that proposes ideas as to how we can move forward as a society with regards to this matter.
The Heart
The heart is a muscular vital organ and is the same size as an adult human fist. It is known as a four chambered heart due to having 2 atria and 2 ventricles; 1 atrium and 1 ventricle on the left side and the same on the right. Its main duty is to pump blood around the body via the circulatory system in order to supply cells and tissue with the oxygen required for them to function (Lewis, 2016). The heart does this through what is known as the “double pump� system. This means that the blood is passed through the heart twice, before it is transported to the rest of the body as oxygenated blood. De-oxygenated blood enters the heart through the vena cava into the right atrium and goes to the heart’s right ventricle. From there it enters the pulmonary artery passing from near the lungs and becoming oxygenated. The oxygenated blood then enters the heart through the pulmonary vein into the left atrium and into the left ventricle.
From the left ventricle, oxygenated blood then gets transported to the rest of the body from the Aorta. It is then lead to the pulmonary and systemic circulatory systems. The heart has a protective double-walled sac called the pericardium. Apart from protection, the pericardium also serves to anchor the heart inside the chest. As mentioned before, the heart has four chambers; one atrium and one ventricle on the right side, and another set on the left side. Atrioventricular valves separate the atria from the ventricles; the tricuspid valve separates the right atrium and ventricle and the bicuspid valve separates the left atrium and ventricle. These help prevent backflow of blood back into the atrium after it has been pushed into the ventricle. Also preventing backflow to
13
the ventricle, there are the pulmonary semi-lunar valves in the pulmonary artery and also the aortic valve in the aorta. The heart is myogenic. This means that the heart originates its beats from itself i.e. it contracts on its own. It is stimulated to contract by the nerves within the heart itself. The first impulse is originated in the Sino Atrial (SA) node. This impulse makes the atria contract pushing blood into the ventricles. The electrical conduction then travels to the atrioventricular (AV) node, which then transfers it to the Bundle of His and then to the Purkinje Fibers making the ventricles contract. The SA node is known as the natural pacemaker of the heart and is found on the upper part of the wall of the right atrium. The AV node is found in the septum of the heart. The Bundle of His is found initially in the septum and the Purkinje Fibers branch off around the ventricles. It is this electrical conduction that gets picked up from an ECG. Since the heart is also a muscle, it too requires it’s own supply of blood. The heart gets its blood supply from the coronary arteries. Two major coronary arteries branch off from the aorta near the point where the aorta and the left ventricle meet. These arteries branch off in order to supply all four chambers of the heart with the oxygen supply needed for them to function. Should the coronary arteries narrow, the oxygen demand for the heart is not reached, especially in times where there is an accelerated heart rhythm due to, for example, exercise. At first this lack of supply does not manifest itself, however, as plaque starts to build up even more, people start to complain
14
of angina and shortness of breath and some also suffer a heart attack. Coronary artery disease is when the tunica intima of the artery is damaged. The damage may be caused by various factors including; high blood pressure, high cholesterol and smoking, amongst other things. Atherosclerosis is when fatty deposits, known as plaque, made from cholesterol and other cellular waste start to build up in the artery at the site of the injury. Should it happen that the surface of the plaque breaks off, platelets will clump at the site of injury and repair the artery. This clump formed may block the artery leading to a heart attack and may also result in heart failure. Since the heart has a duty of pumping blood around the body, any defect in the heart can lead to death of tissue in many vital organs (See Appendix E). References BBC. (2014). Organs - Heart. BBC Science & Nature. Retrieved February 21, 2017, from http:// www.bbc.co.uk/science/humanbody/body/factfiles/heart/heart.shtml Khanacademy. (2014). The heart is a double pump. Retrieved February 20, 2017, from https://www. khanacademy.org/science/health-and-medicine/ circulatory-system/circulatory-system-introduction/a/the-heart-is-a-double-pump Lewis, T. (2016). Human Heart: Anatomy, Function & Facts. Retrieved February 18, 2017, from http://www.livescience.com/34655-humanheart.html Mayo Clinic Staff. (2015). Symptoms and causes. Retrieved February 18, 2017, from http://www. mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/dxc-20165314 “myogenic.” A Dictionary of Biology. . Retrieved February 27, 2017 from Encyclopedia.com: http:// www.encyclopedia.com/science/dictionaries-thesauruses-pictures-and-press-releases/myogenic
coronary heart disease
As the lumen of the coronary arteries keep on narrowing, a heart attack may progress. If this is left untreated and blood flow isn’t restored to the heart it can lead to death of heart muscle. Coronary heart disease in time may lead to serious complications such as arrhythmia and heart failure. Heart failure is a term used to describe a chronic condition where there is irreversible damage to the heart as it cannot meet the demand of oxygen in the body and itself (WebMD 1, n.d.). The heart tries to make up for the damage by: 1. Enlarging: by enlarging, the heart can fill up with more blood and contract stronger than before. However with an enlarged heart, the body starts to get fluid retention, the respiratory tract starts to get congested and arrhythmias arise. 2. Increases in muscle mass: just as any other muscle, once the heart starts pumping more, the muscles become bigger with the increase of work it is doing. Initially this lets the heart beat stronger. 3. Faster beating: in order to meet the demand of oxygen, the heart starts to beat faster to increase its output. The body itself also tries to compensate by increasing the pressure in its blood vessels by narrowing them and diverting less blood to other tissues and organs, in order to allow more blood flow to the heart and brain. These alterations do not solve the heart failure but temporarily mask them. Heart failure continues to progress till inevitably the heart cannot keep up and the body starts to experience fatigue and breathing problems.
The way the body tries to cope with the heart failure is the reason behind a condition like this going unnoticed until it is too late. This also highlights the importance of regular check ups to the doctor in order to treat these conditions before it is too late. If it is left without treatment for too long, death may result as a complication of heart failure. Symptoms of Coronary Heart Disease It is of utmost importance to recognise the warning signs of Coronary Heart Disease and visit a doctor as early on as possible. The most common symptom is angina, more commonly known as chest pain. People most commonly feel the following when suffering from angina: - Heaviness - Pressure - Aching - Burning - Numbness - Fullness - Squeezing - Painful feeling (Mayo Clinic Staff, 2015) These symptoms may commonly be mistaken for heartburn and/or indigestion. Angina may also be felt in the left shoulder, arms, neck, back and jaw. Symptoms are often more subtle in women ranging from nausea to palpitations and dizziness. It is safe to say that some people do not get any warning signs, especially in times when the coronary heart disease is brought on by atherosclerosis or collateral circulation; ie the blood vessels expandin order to allow the blood to pass (American Heart Association, 2017).
15
Diagnosis of Coronary Heart Disease The diagnosis is done by a doctor after they have a look at one’s symptoms, family history and risk factors and following, physical exam is carried out. Diagnostic tests may include an ECG (elec trocardiogram), echocardiogram, electron beam CT scans and cardiac catheterisation amongst others. These tests indicate how severe the patient’s coronary heart disease is and help the doctor choose the correct treatment that can prove most effective (Mayo Clinic Staff, 2015). Treatment for Coronary Heart Disease Depending on the severity of the disease, treatments may range from a simple lifestyle change, to an intake of medication and, in more severe cases, even surgery procedures (medical news today). Should the disease still be in its initial stages, a change of lifestyle can suffice. By quitting smoking, avoiding processed foods, adopting a low-salt, low-sugar and low-trans-fat diet and also exercising. If it is more serious and lifestyle changes are not enough, then medication is a necessity. The drugs all depend on the individual and what the doctor thinks is the most beneficial for the stage of disease. The most common drug used is Aspirin at a dose of 75mg once a day for long term use. Aspirin helps to prevent blood clots from forming. Should the disease be at a very late stage, surgery would be one of the only interventions left. Such procedures include:
16
- Balloon angioplasty - Stent placement - Coronary artery bypass surgery All these procedures do not cure coronary heart disease but simply increase the supply of blood to the heart. References American Heart Association. (2017). About Heart Attacks. Retrieved February 26, 2017, from https://www.heart.org/HEARTORG/Conditions/ HeartAttack/AboutHeartAttacks/About-HeartAttacks_UCM_002038_Article.jsp Khanacademy. (2016). Overview of heart failure. Retrieved February 24, 2017, from https://www. khanacademy.org/science/health-and-medicine/ circulatory-system-diseases/heart-failure/a/overview-of-heart-failure Mayo Clinic Staff. (2015). Symptoms and causes. Retrieved February 18, 2017, from http://www. mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/dxc-20165314 Mayo Clinic Staff. (2016). Diseases and Conditions - Heart failure. Retrieved February 23, 2017, from http://www.mayoclinic.org/diseases-conditions/ heart-failure/basics/causes/con-20029801 NIH. (2016). What Is Coronary Heart Disease? Retrieved February 20, 2017, from https://www. nhlbi.nih.gov/health/health-topics/topics/cad SRS Pharmaceuticals. (n.d.). Ischemic Heart Disease: causes, symptoms, prevention & treatment. Retrieved February 20, 2017, from http://www. srspharma.com/ischemic-heart-disease-treatment-causes-symptoms.htm WebMD. (n.d.). Heart Disease and Congestive Heart Failure. Retrieved February 24, 2017, from http://www.webmd.com/heart-disease/guideheart-failure#1 WebMD 1. (n.d.). Heart Failure: Compensation by the Heart and Body - Topic Overview. Retrieved February 24, 2017, from http://www.webmd. com/heart-disease/heart-failure/tc/heart-failure-compensation-by-the-heart-and-body-topicoverview#1
coronary heart disease and the maltese islands Coronary Heart Disease, sometimes also known as Ischaemic Heart Disease, is the leading cause of death in Malta, the EU and worldwide. In Malta, Coronary Heart Disease is responsible for about 21% deaths, according to the NSO statistics published in 2016. This statistic places Malta in the 10th position of deaths caused by Coronary Heart Disease, out of 28 EU countries (Eurostat, 2016) and 89th in the world from 196 countries.
References Eurostat. (2016). Cardiovascular diseases statistics. Retrieved February 24, 2017, from http://ec.europa.eu/eurostat/statistics-explained/index.php/ Cardiovascular_diseases_statistics WHO. (n.d.). Data and statistics. Retrieved February 24, 2017, from http://www.euro.who.int/en/ health-topics/noncommunicable-diseases/cardiovascular-diseases/data-and-statistics
With Ischaemic Heart Disease being the leading cause of sudden cardiac arrest, the European Resuscitation Council estimates that there are roughly 350,000 to 700,000 individuals across Europe that are affected by sudden cardiac arrest, meaning 1 person in every 1,000 individuals across Europe. Taking Malta into consideration by using the World Bank estimation of our population in 2013, Malta has a population of about 423,282. Using the mentioned 21% of deaths in Malta caused by Coronary Heart Disease, this would estimate about 88,890 Maltese people dying from Coronary Heart Disease.
17
Cardiopulmonary resuscitation (CPR)
What is Cardiopulmonary resuscitation? Cardiopulmonary resuscitation, or more commonly known as CPR, is a combination of chest compressions and mouth-to-mouth that are designed to get the circulation of blood and oxygen to the brain and body until proper medical intervention happens in order to restart the heart (Medline Plus, 2015). Why is CPR important? In sudden cardiac arrest, brain damage and death can occur quickly should CPR not be initiated immediately. It is well known that the risk of brain damage increases after approximately 4 minutes of cardiac arrest without CPR. The risk of irreversible brain damage increases if CPR is not given after 10 minutes. Since the heart is a muscle, it too needs oxygen in order to survive. The amount of damage to the heart depends on the size of the area affected. This is because damage to the heart from a heart attack heals by a means of forming scar tissue. This scar tissue is vital for the heart to heal. The healing process may be lengthy and depends mostly on the severity of the damage. That being said, if blood flow is not restored to the heart within 20 to 40 minutes, irreversible damage may start to occur resulting in the permanent death of the heart muscle. The heart muscle will continue to die for the next 6 to 8 hours at the end of which the heart attack is said to be complete. Disability or death can be a result from the lengths to which the heart muscle died. Starting CPR early can be detrimental to a person’s survival as this would enhance
18
the volume of oxygen to the brain and to the heart and limits the extent of brain and heart damage and helps buy time till an ambulance arrives. A very important part of improving someone’s chances of survival is defibrillation from an automated external defibrillator (AED). The AED is a portable device that automatically diagnoses a cardiac arrest and arrhythmias of ventricular fibrillation and ventricular tachycardia in a casualty and is able to help save their life by delivering a shock to the heart; also known as defibrillation. The introduction of electric therapy helps the heart overcome any arrhythmias and encourage it to start pumping again. With its audio instructions and visual illustrations, the AED can be used by anyone safely. If resuscitation, i.e. CPR and defibrillation are not started immediately, the chances of survival decrease by 10-12% per minute. The average ambulance response time in Europe is roughly between 5 to 8 minutes, and since every ambulance carries an AED, then defibrillation is available within the next 8 to 11 minutes. Taking Malta into consideration though, it would take roughly 20 minutes for a normal vehicle to get from Mater Dei Hospital to, for example, Mellieha without traffic. Given that ambulances are given the right of way on roads, this sometimes is still not enough, especially when passing through heavily congested or narrow roads, making someone who lives in Mellieha more dependant on basic life support than someone who lives in San Gwann. There have been instances where even though the Emergency Department
would be doing their best and the whole A&E team is exerting themselves to the fullest, there could still be a lack of either ambulances or nurses in order to immediately send out an ambulance. This makes some response times take as long as 45 minutes. Thankfully as of August 2016, the Malta Red Cross have been helping the Emergency Department to cut about 5 minutes off the response time for certain locations (Caruana, 2016). With that being said, it is very important to highlight that basic life support does not take the place of professional medical care. However as mentioned before, basic life support is a necessity for a person’s chances of survival. References Berg RA, Hemphill R, Abella BS, et al. Part 5: Adult Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S685-S705. Caruana, C. (2016). Emergency response time cut thanks to Red Cross volunteers. Times of Malta. Retrieved February 26, 2017, from http://www. timesofmalta.com/articles/view/20160812/local/ emergency-response-time-cut-thanks-to-redcross-volunteers.621792 Mayo Clinic Staff. (2017). Cardiopulmonary resuscitation (CPR): First aid. Retrieved February 25, 2017, from http://www.mayoclinic.org/first-aid/ first-aid-cpr/basics/art-20056600 MedlinePlus. (2015). CPR. Retrieved February 23, 2017, from https://medlineplus.gov/ency/article/000010.htm
19
Survey Data analysis
The age segments of respondents to the survey can be delineated as follows: 16-18, 19-21, 22-30, 31-40, 41-50, 51-60, 60+ years of age, with the greatest percentage, that of 47.6%, stemming from the 19-21 age bracket. In addition to this, 73.6% of total respondents fell under the ‘female’ category. (For the
an illustrated version results see Appendix
of D)
The questions asked, together with their answers can be delineated hereunder: 1. What is the correct depth of chest compressions? The correct answer, ‘up to 5-6cm’, was only chosen by 6.4% of the respondents, with 59.2% of participants believing that the depth required is about 3 inches. 2. How many chest compressions per round should you deliver? The correct answer ’30’ was answered by 18.4% of the respondents, whilst 64% of participants chose the incorrect answer of ‘15’ chest compressions. 3. What is the correct method of opening up the airway for children and adults? The majority of respondents, 68.3%, chose the correct answer which states that the correct method is ‘tilt head backward and chin up’. 4. CPR is done to restart the heart. 16.8% chose whilst
20
of the participants the correct answer ‘No’, 60.8% opted for ‘maybe’.
5. How long should it take to deliver a rescue breath? The correct answer ‘1 second’ was chosen by 19.4% of the respondents. 64.5% of the participants on the other hand, chose ‘4 seconds’. 6. When performing CPR, for how long should you check the breathing of the patient? 4.1% of the participants chose the correct answer ‘10 seconds’ whilst 60.7% of respondents opted for the ‘15 seconds’ option. 7. When should one be performing CPR? The majority of participants (60%) chose the correct answer ‘both cardiac arrest and respiratory arrest.’ 8. How would you know if the casualty is having a cardiac arrest? The majority of participants (72.6%) chose the correct answer ‘unconscious, no breathing, no pulse.’ 9. How would you know if the casualty is having a respiratory arrest? The majority of participants (63.2%) chose the correct answer ‘unconscious, no breathing but pulse is present.’ The majority of the participants exhibited correct knowledge about when one should perform CPR, when one is having a cardiac or respiratory arrest and the correct method to open up the airway. Deviation from the correct responses
predominantly occurred when asked about the procedural details of CPR itself, which evidently supports the relevance of the ‘Jumpstart my Heart’ campaign. Gathering of preliminary data through such a survey subsequently serves as a comparative base for ancillary data collections acquired after the introduction of societal changes relevant to first aid.
21
The Good and Bad Samaritans
Good Samaritans may be people who help a stranger at a potential risk to themselves for no expected reward in return. A Bad Samaritan may be perceived to be someone who has no special reltionship with a stranger, who omits to do something to or for the stranger which could have been done without unreasonable cost or risk to the Bad Samaritan. Although a Good Samaritan’s actions may be the cause of help to a victim, it is not entirely clear whether or not a Bad Samaritan’s inactions may be classified as a cause of harm (Huckle, 2012) Good Samaritan legislation seeks to protect citizens from civil or criminal liability when they render aid. Bad Samaritan legislation seeks to punish offenders for failing to meet an assumed standard of action (Huckle, 2012). Good Samaritan laws are intended to ensure that people, acting in good faith and hoping to help a fellow citizen, cannot be sued if damages result at the scene of an accident or emergency. Good Samaritan laws are sometimes also applied to medical doctors and healthcare professionals (St. Mary, n.d.). There exist a number of issues surrounding Bad Samaritan legislation. However revolting our idea of a passer-by who declines to intervene to help a stranger, the passer-by was in no way responsible for the perilous situation the stranger finds himself in. Neither did the passer-by act to increase the jeopardy of the person in need of help; the passer-by simply fails to confer a benefit upon a stranger. Another negative consequence may be the rise of people meddling in the lives and
22
personal business of others due to fear of legal recourse (Huckle, 2012). On the other hand, Bad Samaritan laws may help remedy a culture of non-assistance. Bystanders may feel a greater responsibility to help when there is a legal infraction tied to their inaction (Popovich, 2015). If the terms within the law are carefully defined and if citizens are well informed of their rights and duties, such legislation may be put into practice as seen in countries such as France and Germany (Schiff, 2005). In Germany, failure to take reasonable action in cases in which it is required carries consequences of a fine or of imprisonment for up to one year (German Criminal Code, 1998). Recommendation The introduction of Good Samaritan legislation to encourage private citizens to give a helping-hand during emergencies is looked upon favourably. Such legislation should be intended to remove their fear of liability of a passer-by in case a stranger they are helping suffers damages as a result of the intervention made in good faith. However, in the case of gross negligence from a lay person delivering emergency aid to a stranger, said person should still be liable to criminal prosecution and/or civil lawsuits. References German Criminal Code, § 323c (1998). Retreived February 27, 2017, from https://dejure.org/gesetze/StGB/323c.html Huckle, R. J. (2012). Knowledge, First Aid and the Moral Requirements of Rescue (Unpublished master’s thesis). University of Waterloo. Retrieved February 26, 2017, from https://uwspace. uwaterloo.ca/bitstream/handle/10012/7055/
Huckle_Ryan.pdf?sequence=1 Popovich, S. (2015) California’s Good Samaritan Law: Correcting Ambiguities to Induce Action. ExpressO. Retrieved February 26, 2017, from http://works.bepress.com/sara_popovich/1/ Schiff, D. (2005). Samaritans: Good, Bad and Ugly: A Comparative Law Analysis. Roger Williams University Law Review, 11(1), article 2, 77-141. Retrieved February 27, 2017, from http://docs. rwu.edu/cgi/viewcontent.cgi?article=1344&context=rwu_LR St. Mary, G. (n.d.). Advantages of Good Samaritan Laws. Retrieved February 26, 2017, from http:// legalbeagle.com/8615145-advantages-good-samaritan-laws.html
23
Prevention of Coronary Heart Disease in children and adolescents – to reduce risk later on in life by Andrew Camilleri and David Mangion
Introduction Coronary Heart Disease (CDH) is one of many heart conditions which fall under the group of cardiovascular diseases (CVD), a collection of diseases of the heart, vascular diseases of the brain and blood vessels. These are non-communicable diseases, that is, they are not infectious and, therefore, non-contagious. Some common names are: - Rheumatic heart disease - Deep vein thrombosis - Pulmonary embolism - Cerebrovascular disease - Congenital cardiovascular diseases - Peripheral arterial disease - Coronary Heart Disease
disorders (World Health Organisation, 2011). Assmann et al. (1999) includes personal and family history of CHD and divides all the above into modifiable and non-modifiable conditions. Aim In this article we will attempt to bring to light the severity of this issue on a local scale, and the importance of early prevention, primarily of atherosclerosis, a precursor to CHD. We will target the modifiable part of CHD, in an effort to provide adequate information with regards to prevention. This is done with the aid of statistics, physiotherapeutic inventions and various other sources. Statistics
Did you know that CVD is the biggest killer worldwide, with more than 17.3 million deaths per year? 3 million of which occurred before the age of 60 and could have largely been prevented (World Health Organisation, 2011). CHD (a precursor to heart attacks) is a disease which involves the arteries supplying the heart with blood. In a normal cardiac system, the heart receives all the blood (including oxygen) that it needs in order to supply the body and itself, through the aorta and coronary arteries respectively. However, this changes in CVD and leads to heart attacks (MI) and strokes (cerebrovascular disease). One major underlying condition of this is termed atherosclerosis seen in childhood, as well as later in life. Common risk factors are smoke inhalation (including cigarettes, physical inactivity, unhealthy diets, alcohol abuse, hypertension, diabetes, raised blood lipids (cholesterol), advancing age, gender (more common in males), genetic disposition, and psychological
24
Malta is one of the 3 countries with the highest mortality rate from cardiovascular disease, with other Mediterranean countries having significantly lower mortality rates. The Pie Chart below shows local mortality figures from 2013. A staggering 40% of Maltese fatalities occur due to Circulatory related diseases making it the largest killer by a margin of 13%. That is approximately 5130 deaths each year (National Statistics Office, 2014).
Teaching and encouraging the general population to adopt and maintain a healthier lifestyle could result in preventing and decreasing the incidence of coronary heart disease. Results from a Maltese study show that ‘’given sufficient opportunity and information, people are willing to be screened and to alter their lifestyle to reduce their level of risk of developing coronary disease.’’ (Borg, 1990) Awareness Following on with these alarming statistics it is imperative that the general public is made aware of: the disease itself, what can be done after the onset of the disease and most importantly, what can be done in order to help prevent such a disease from occurring in the first place. The challenge in this does not rest in procuring the information as this is already available in the form of literary and scholarly articles; the problem lies in trying to get the information across to the general population in a relatable and understandable way that will encourage people to change their lifestyle to a more sustainable one, that will benefit the quality of life of both themselves as well as their families. At present one of the greatest readily available sources of information that can be exploited rests with health care professionals, mainly those professionals who undertake specific training in relation to cardiac fitness, such as physiotherapists. Physiotherapists are able to advise persons on both a personal as well as on a community basis about the general aspects of maintaining a healthy coronary system, as well as prescribe specific exercises and training
techniques in and maintain
order to increase myocardial fitness.
When it comes to educating children it is necessary that you one not only targets the children themselves but also aim at educating the parents and caregivers. This is important as changing a child’s perspective on maintaining a healthy lifestyle will do little good if the people that make up the support system do not also adhere to these beliefs. It is for this reason that educating the care givers about maintaining a healthy lifestyle with the aim of preventing CHD may result in an even greater beneficial effect than solely educating the child. This would allow for the ability to relay the information to their children in their own informed style and find a way of integrating such a lifestyle into their daily lives. It is possible to raise awareness on these conditions by making information and statistics readily available to the general public. It was noted that most informative and support groups were predominantly made up of female attendees with only 7% being males. This was put down to males generally finding it harder to accept advice from others. Instead males were found to prefer finding information from online sources and other news outlets, thus it is also in the best interest of our nation to target online and Television campaigns with regards to preventative techniques in relation to CHD. A current ongoing study in Singapore led by Dr Wang is investigating the plausibility of using an application to relay information about CHD to the public; the initiative is appropriately named ‘care4heart’. Should the study prove to be successful, Wang would have effectively created
25
an accessible educational program for the working population in Singapore which can be used to promote knowledge and positive heart-related lifestyle changes in order to help prevent coronary heart disease. There are various other applications that can be used to monitor one’s physical activity throughout the day, which if combined with the appropriate knowledge and guidance (such as that provided by a physiotherapist) can be used as an incentive to accurately reach and maintain an efficient level of daily exercise. Prevention According to the WHO (2013), Malta is one of the leading countries where obesity prevails throughout all ages. Amongst 6-year-olds in Malta, 34.3% of boys and 29.3% of girls were overweight and 14.7% and 11.7%, respectively, were obese. 41.3% of boys and 26.3% of girls among 11-year-olds were overweight. Among 13-year-olds, the corresponding figures were 36.8% for boys and 29.2% for girls, and among 15-year-olds, 28.2% and 23.2%, respectively. A high percentage of these groups have a self-reported BMI that is greater than 25 (normal values range between 18.5 – 24.9). In response to these statistics, it is clear that prevention has to start as early as possible and to be included in the daily routine of every child and adolescent in a consistent and effective manner. Screening, BMI readings, fitness assessments and waist circumference data can aid into targeting individuals in need of attention. Rea, Marshak, Neish, and Davis (2004) in their study - The Role of Health Promotion in Physical Therapy identified that physical therapists are needed to lead,
26
assess and develop health promotion plans and strategies in the work force, however this is done at unsatisfactory percentages. The Lunchbox Campaign 2015 (Health promotion and disease directorate, 2015) is an initiative where the Health Promotion and Disease Prevention Directorate is working in conjunction with the Education Authorities to encourage healthier lunchboxes that include fruit and vegetable as opposed to foods containing high trans fats and sugar. This campaign is a very good example on how to provide healthy eating during school hours, and together with “School’s on the Move” and “Summer on the move” with Sport Malta (Sports Malta, 2016) children and adolescents are encouraged to engage in physical activities during their break. However, statistics show that obesity is still on the rise leading to a greater incidence of CHD at later stages of life. The prevention techniques must extend beyond the school environment and adequate advice and guidelines can be issued by consulting health care professionals in the prevention field. Once again, physiotherapists through their training are well positioned to take on this role. By extending importance outside of the school setting, responsibility falls onto the family. Children must engage in physical activities other than the weekly PE lessons at school and the occasional exercise performed during the break time in order for a significant physiological change to occur. This can be done by reducing hours spent on current social media technologies that promote a sedentary life style and the substitution of sedentary hobbies with various initiatives.
These include swimming, dancing classes, community based exercises, HIIT (High intensity interval training), circuit training and any kind of sports that encourages physical exertion above moderate intensity with the underlying goal to prevent and reduce future problems related to CHD. It should be noted that individuals with sedentary jobs or lifestyles must include adequate level of exercise in their daily routine. Physiotherapists, as the experts of movement, have the knowledge of health and disease and can address issues on an individual and community setting with regards to public health. With the calculation of exercise, the use of METS and energy expenditure, assessment of fitness, informed prescription of good quality exercise, nutritional advice and various other tools, physiotherapists are able to provide a holistic and efficient plan in preventing obesity, promoting fitness within the general public and improving the quality of life of the population. According to the NICE (National Institute for Health and Care Excellence) guidelines for the prevention of excess weight gain, (NICE, 2015) it included a report from the Chief Medical Officers for England, Wales, Scotland and Northern Ireland which sets out physical activity recommendations for different groups. For adults: ‘over a week, activity should add up to at least 150 minutes (2 1⁄2 hours) of moderate-intensity activity, in bouts of 10 minutes or more’. One way to approach this is to do 30 minutes on at least 5 days a week. Children and young people should take part in moderate- to vigorous-intensity physical activity for at least 60 minutes and up to several hours every day.
Diet Along with adequate amounts of exercise, informed nutrition is essential in the maintenance of health and prevention of disease namely CHD. Many food surveys were conducted since the 1990’s both on a local and international setting. The Dietary Guidelines for Maltese Adults (Pace, 2016) provided various sources of evidence suggesting to where and how major imbalances occurred. (Bellizzi M., 1993) studied the changing eating habits of the Maltese; and (Tessier S, 2005) in their study of Factors determining the nutrition transition in two Mediterranean islands: Sardinia and Malta, both had shown that food patterns had drifted away from the traditional Mediterranean diet. A decreased consumption of vegetables and fruit, legumes and whole meal and wholegrain cereals, and a coexisting shift towards an increased consumption of energy-dense foods and relatively nutrient-poor, HFSS (Foods and drink high in fat, sugar and salt) foods (Department of Health, 1990) was seen. This is evident in many countries in the Mediterranean region (Da Silva R, 2009) , (Vareiro D, 2009) and (Belahsen, 2014). Low consumption of fruit and vegetables and a high intake of saturated fats and salt with prevalence to obesity is clearly illustrated in the - Nutrition, Physical Activity and Obesity Profile of Malta by the WHO (WHO, 2013). It is often reiterated that many conditions are linked to an excessive intake of foods high in saturated fat, refined sugars and/or salt; together with an inadequate intake or lack of foods such as legumes, vegetables, wholegrain cereals and fruit; known to provide vitamins and minerals, dietary fibre and
27
protective phytonutrients thish Heart Foundation ,
(Brin.d.).
The Healthy Plate initiative and the Dietary Guidelines for Maltese Adults has been drafted by a national multidisciplinary group of experts with the aim of providing better advice to the Maltese public on how to consume a healthier diet (Pace, 2016), (Parlamentary Secretariat For Health Ministry for Education and Employment, 2015)). This, combined with knowledge of the food pyramid suggests adequate information is readily available to the general public through various online channels. However “Despite an increased effort to educate the general public about nutrition and exercise, data support that a considerable gap remains between public health recommendations and actual health practices (David M Morris, 2009).’’ This might be due to misinformation, financial issues, uncontrolled cravings, unavailability of healthy food such as a good variety of local fruit and vegetables at affordable prices and more. The farmers market in Ta` Qali provides such produce at reasonable prices; however, limiting such markets to one locality does not necessarily provide access to parts of the population residing in areas not in the vicinity of the said location. The problem can be countered via the introduction of similar markets available at strategically selected localities across the island. Since proper nutrition is an important pre-requisite in the up keeping of a healthy lifestyle and critical in the prevention of a substantial amount of diseases, namely CHD, further advice must be provided to push into the right direction the local population.
28
Subsequently it is the duty of physical therapists to promote healthy lifestyles, wellness, and injury prevention and acknowledging the fact that proper nutrition is critical to health. Logically it follows that physiotherapists should advise their patients on proper nutrition and lifestyle information. The American Physical Therapy Association (APTA) is endorsing this view. (APTA, 2017), furthermore, at the APTA House of Delegates in early June 2015, a landmark motion passed - RC 12-15: The Role of the Physical Therapist in Diet and Nutrition (Susan R. Griffin, 2015) further consolidating its stance on the importance of physical therapists on nutritional advice and exercise prescription. As our profession advances towards a more integrative model, this motion symbolizes an acknowledgement of a physiotherapist’s broader role as a health care provider. We, as physical therapists, are uniquely positioned to offer patients a more comprehensive lifestyle-related education including the discussion of nutrition. Both the World Health Organisation (WHO, 2008) and the Physical Therapy Summit on Global Health (Dean, 2014) have called upon all health care providers to stand in unity to help the public with epidemics of lifestyle-related diseases; the APTA has given its approval as well. Further recognition to the leading role of physiotherapists in preventing, reversing and managing-life styles is given by various academics and institutions worldwide: 1. Physical therapists have much to offer a dynamic health care system in the area of rehabilitation but also in the areas of disease prevention and health promotion (Harro, 1999). (Katie Marie
Shumpert,
et
al.,
2005).
2. Physical Therapy Summits on Global Health (2007; 2011) highlighted the need for Physical Therapy to reflect 21st century health priorities. This is further consolidated in a more recent Physical Therapy Summit in Singapore (2015) (Dean, et al., 2015). 3. Physiotherapists should possess clinical competencies which include assessment of health, lifestyle behaviours, and risk factors, together with interventions to promote health and well-being in every client or patient (Dean, et al., 2015). 4. (APTA, 2017): The physical therapist’s broader role as a health care provider: Physical therapists are uniquely positioned to offer patients more comprehensive lifestyle- related education including discussion of nutrition. And ment
the
APTA (2015)
Position states
Statethat:
“Diet and nutrition are key components of primary, secondary, and tertiary prevention of many conditions managed by physical therapists. It is the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapy practice. This includes appropriate referrals
to nutrition and dietary medical professionals when the required advice and education lie outside the education level of the physical therapist.� It is clear that physical therapists not only provide rehabilitation in a hospital setting but also play a major role in providing a solution in the prevention facet of public health. Nutritional advice and life style changes coupled with exercise prescription towards children and adolescents, but not limited to, is just a fraction of the overall impact physiotherapists can have in the reduction of cardiac disorders such as CHD. Obesity Obesity in childhood has been known to affect both physical and psychological health during later stages in life. Obese children have been found to be predisposed to a greater risk of developing conditions such as: hyperlipidaemia, hypertension, infertility and other cardiovascular and digestive diseases. A direct correlation has also been noticed between obesity and depression. The table below makes reference to the statistics concerning the obesity of the Maltese population in relation to other European countries. Once again we must note that Malta is among the leaders in this field.
29
A study by the world health organisation revealed that approximately ‘64.3% of the adult population (> 20 years old) in Malta were overweight and 28.8% were obese.’ It also showed that ‘the prevalence of overweight was higher among men (68.4%) than women (60.4%).’ The HBSC (Health Behaviour in schoolaged Children) report highlighted how obesity is also a major problem in children and adolescents. This is shown with the following obesity rates: - 11 year old: - 41.3% of boys - 26.3% of girls
out the imbalance loric intake and
In addition to this, according to WHO estimates around 72.5% of the Maltese population are insufficiently active and fail to reach the previously stated daily minimum exercise quota of 60minutes of moderate to vigorous intensity exercise. Consequently, obesity is the result of both over-consumption and reduced physical activity. Prevention could be the best way of tackling the high obesity percentages; this can be interpreted in three ways: 1.Primary
- 13 year olds - 36.8% for boys - 29.2% for girls - 15-year-olds - 28.2% for boys - 23.2% for girls This shows that obesity can be found throughout the spectrum of ages and is also not gender specific. Setting aside pathologies such as hypothyroidism and other metabolic stresses, the question of why obesity occurs is fairly simple to understand. The main aetiology for obesity is when the calorific intake of an individual is greater than their calorific expenditure. Put plainly this boils down to people either eating too much or not eating a balanced diet. This is where people could greatly benefit from the professional opinions of nutritionists who could work alongside the individual in order to provide them with a sustainable, beneficial and balanced diet which would even
30
between caexpenditure.
prevention
of
obesity.
2. Secondary prevention i.e.: not regaining weight following weight loss. 3. Avoiding weight increase in already obese people struggling to lose weight. It is important to start influencing children into attaining a healthy lifestyle from a young age, as once unhealthy or poor habits are obtained they can be hard to get out of. Schools must be used as the vehicle to influence the proper food and physical activity of children however this will be to a limited degree; it is the after-school events led by parents, carers and social circles that have to instil the lifelong habits leading to the benefits of a healthy life style in Children and adolescents. A child’s support system (generally include parents/guardians, school and the local community) plays an integral role in the shaping of a child’s life style and level of physical activity. The greatest of these being the
home environment as this is where the child’s main support system is present, thus having a pivotal role on the child’s belief system with regards eating behaviours and physical activity. It is generally difficult to reduce excessive weight in adults, therefore it may be advantageous to start off preventative measures in the young in order to nip the problem in the bud. This can be achieved via a variety of interventions including maintaining an active environment, physical activity and diet, which can be introduced to prospective parents during maternity classes for example: it was noted that ‘overweight children tend to have overweight parents and are themselves more likely to grow into overweight adults than normal weight children’ (Mahshid Dehghan, 2005) Preventative measures should focus on reducing sedentary behaviour and other obesogenic activities. One could also target this by promoting active modes of transport to and from school; this can be in the form of walking, cycling, public transport and even a walking bus. However such measures would require support from both the community and the government to ensure designated safe transport routs for all commuters. In addition, advertisements for unhealthy food could also be reduced or restricted to not be aimed at children. This could be replaced with healthier food options being endorsed on TV. Clear and accurate nutrition labelling on food stuffs could also be of a potential benefit with regards to obesity prevention by ensuring that the general public is informed of the food that they are eating.
‘‘Signposts’ such as logos that indicate that a food meets certain nutrition standards might help consumers make choices of healthy foods. An example is the ‘Pick the Tick’ symbol program run by the National Heart Foundations in Australia and New Zealand made it easier for consumers to identify healthier food choices’’ (Mahshid Dehghan, 2005). Finally one could introduce an initiative to include information with regards to the child’s general fitness and weight on school report cards in order to make the parents aware of their children’s potential weight problem. It is important to note that Obesity is not a definite pre requisite for CHD, thus despite being at a higher risk than others not all obese people will develop CHD. Likewise people who are not obese are still at risk of developing this disease. Conclusion One must bear in mind that although this lifestyle change will have the greatest effect if started from a young age, it is never too late to start taking care of your body in order to help increase longevity and the quality of life. It is of our understanding that a significant amount of non-communicable diseases such as CHD and CVD could be prevented if the general population were to adopt a heathier life style. This could be achieved by making the informed decision to start eating healthier and exercising more frequently, however one cannot impose their beliefs on others. The best that we can hope to achieve in such a scenario is to increase awareness and allow the general public to understand the long
31
term repercussions of not heeding the above and not giving prevention the importance that it is due. In the true essence of the phrase, the message we are trying to relay is that prevention is in fact much better than the alternatives (considering that there is no cure to such diseases). References APTA, 2017. American PhysicalTherapy Association. [Online] Available at: https://www.apta.org/ Default.aspx [Accessed 19 February 2017]. Assmann, G. e. a., 1999. Coronary Heart Disease: Reducing the Risk. Journal of the American Heart Association. Belahsen, R., 2014. Cultural diversity of sustainable diets. Nutrition transition and food sustainability. The Proceedings of the Nutrition Society, August, pp. 385 - 8. Bellizzi M., B. S. (. e. ,. L. F. (. e. ,. M. L. (. e., 1993. The changing eating habits of the Maltes e. Options Méditerranéen nes : Série B. Etu des et Recherches, pp. 55- 70. Borg, A., 1990. Coronary heart disease -- Prevention and control. Maltese Medical Journal, Volume Vol. 2(2), pp. p. 31-32. Brenda L Rea, H. H. M. C. N. N. D., June 2004. The Role of Health Promotion in physical therapy in California, New York and Tennessee, s.l.: American Physical Therapy Association. Brithish Heart Foundation , n.d. Brithish Heart Foundation. [Online] Available at: https://www.bhf.org.uk/hearthealth/preventing-heart-disease/healthy-eating/ fats- explained [Accessed 19 February 2017]. Da Silva R, B.-F. A. R. Q. B. B. G. V. d. A. M. S.-M. L., 2009. World variation of adherence to the Mediterranead diet in 1961 - 1965 and 2000 2003. Public Health Nutrition , 12 September , pp. 1676 - 84 .
32
David M Morris, P. P. E. M. K. M. R. E. C. D. P., 2009. Strategies for optimizing nutrition and weight reduction in physical therapy practice: The evidence. Physiotherapy Theory and Practice, 5-6(25), p. 408–423. Dean, E. e. a., 2014. The Second Physical Therapy Summit on Global Health: Developing an Action Plan to Promote Health in Daily Practice and Reduce the Burden of Lifestyle-related Conditions. Vancouver, Canada, University of British Columbia. Dean, E. et al., 2015. World Confederation for Physical Therapy. Singapore, lWCPT Congress Singapore. Health promotion and disease directorate, 2015. Health.gov.mt. [Online] Available at: https://health.gov.mt/en/health-promotion/Pages/campaigns/2015/lunchbox- campaign-2015.aspx [Accessed 18th February 2017]. Katie Marie Shumpert, M., Barry Hunt, E. D. & Michael E. Hall, P. D., 2005. An Examination of the Role of Health Promotion in Physical Therapy. Magazine of Physical, 9(13), pp. 42-46. Mahshid Dehghan, N. A.-D. A. T. M., 2005. Childhood obesity, prevalence and prevention. Nutrition Journal, 4(24). National Statistics Office, M., 2014. Malta in Figures. NICE, 2015. Preventing excess weight gain. s.l.:NICE. Pace, L. e. a., 2016. The Dietary Guidelines for Maltese Adults. s.l.:Parlamentary Secretariate for Health Ministry for Education and Employment . Parlamentary Secretariat For Health Ministry for Education and Employment, 2015. Dietry Guidelines for Maltese Adults - Healthy Eating. s.l.:Parlamentary Secretariat For Health Ministry for Education and Employment. Sports Malta, 2016. Sports Malta. [Online] Available at: https://www.sportmalta.org.mt/ programmes/onthemove-summer [Accessed 18th February 2017].
Susan R. Griffin, P. D. M. G. R., 2015. 2015 House of Delegates Packet I, Background Papers, and House of Delegates Handbook. s.l., American Physical Therapy Association. Tessier S, G. M., 2005. Factors determining the nutrition transition in two Mediterranean islands: Sardinia and Malta. Public Health Nutrition , 8 December, pp. 1286-92. Vareiro D, B.-F. A. R. Q. B. B. I. B. G. V. d. A. M. e. a., 2009. Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas.. Public Health Nutrition , 12 September , pp. 1667 - 75 . Wang, W., 2015. Improving awareness, knowledge and heart-related lifestyle of coronary heart disease among working population through a mHealth programme: study protocol. JAN. WHO, 2013. Nutrition, Physical Activity and Obesity Malta. World Health Organisation, 2011. Global Atlas on cardiovascular disease prevention and control. Geneva: World Health Organisation.
33
the way forward
Looking at the results of the survey it is clear that there is a lack of education on CPR and basic life support. While most people interviewed, both in Valletta and at the University of Malta, might have an idea of what is done when giving CPR, they still had no idea how to properly perform it or they lacked the confidence to because they never learnt it properly. MHSA and Insite believe that one way to help increase the knowledge of CPR amongst the Maltese public is to include a simple basic life support course in Secondary schools, specifically forms 4 and 5 since the students would be at the right age to take the topic seriously. With coronary heart disease being the biggest killer not only in Malta, but also in the rest of Europe, countries like Poland and also Belgium have adopted a similar system being proposed here by teaching basic life support in High School. Secondly, we also believe that more information should be available for the public in order to help them recognise the warning signs of a heart attack. Moreover, bigger efforts need to be given to the promotion of first aid courses offered by third parties such as the Red Cross and St Johns Ambulance.
Finally, MHSA and Insite will also be looking into improving the knowledge of basic first aid within the University of Malta. In fact, we are currently looking into setting up a first aid course will be made available for all university students at a discounted price. This will be done through an international organisation called Emergency First Response1. All students will be awarded a certificate proving the completion of the course. Mr Trevor Abela Fiorentino, who is a lecturer at the Faculty of Health Sciences and a registered first aid teacher with Emergency First Response, will be leading the courses. This course can also be listed down on the final transcript awarded to graduates due to the course being recognised by Degree+. Final Remarks Awareness is key. Something as simple as being qualified as a first aider may save a life.
MHSA and Insite also believe that there needs to be more emphasis on education on preventive methods starting from children of a young age and also their parents. Prevention is always better than cure, especially since damage from a heart attack can be irreversible. The Good Samaritan act may be introduced in order to encourage first aiders to provide first aid when needed.
34
1.
http://www.emergencyfirstresponse.com
35
appendix a
What do you know about CPR? 1. What is the correct depth of chest compressions in an adult?
a. As deep as possible b. Up to 5-6cm c. Between 2-3cm d. About 3 inches
2. How many chest compressions per round should you deliver?
a. 20 b. 10 c. 30 d. 15
3. What is the correct method of opening up the airway for children and adults?
a. Tilt head forward and chin up b. Tilt head backward and chin down c. Tilt head forward and chin down d. Tilt head backward and chin up
breathing of the patient?
a. 5 seconds b. 10 seconds c. 12 seconds d. 15 seconds
7. When should one perform CPR?
a. Cardiac Arrest b. Respiratory Arrest c. Both
8. How would you know if someone is having a cardiac arrest?
a. Unconscious but is breathing b. Chest pain but breathing c. Unconscious, no breathing, no pulse
9. How would you know if someone is having a respiratory arrest?
a. Having trouble breathing b. Unconscious, but is breathing c. Unconscious, no breathing, but pulse present
10. How old are you? 4. CPR is done to restart the heart.
a. Yes b. No c. Maybe
5. How long should it take to deliver a rescue breath?
a. 1 second b. 2 seconds c. 4 seconds
6. When performing CPR on an adult male, for how long should you check the
36
a. 16-18 b. 19-21 c. 22-30 d. 31-40 e. 41-50 f. 51-60 g. 61+
11. Gender.
a. Female b. Male c. Other
appendix b
37
appendix C
38
39
appendix D
40
41
42
43
44
appendix E
45