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Resusci-Anne: Lifesaver extraordinaire, Linda Duevel
Resusci-Anne: Lifesaver extraordinaire
Linda Duevel describes a fascinating backstory
For educators with a love of history and learning, the backstory of ‘Resusci-Anne’ creates layers of fascination. It is a rare individual who does not recognise the CPR mannequin known as Resusci-Anne. We have encountered her face and pliable body in a physical education or health classroom, or perhaps as part of a scouting or other first-aid training course. But behind Anne’s inscrutable and enduringly calm face, there is a good story worth telling. Anne and her attached body came to life in the late 1950s in the beautiful seaside town of Stavanger, Norway.
The man behind Resusci-Anne’s creation, Norwegian entrepreneur Åsmund Lærdal, owned a factory in Stavanger producing toys and children’s books. He was particularly interested in using modern techniques in molding soft plastic materials creating more realistic figures, and successfully marketed his toy cars and dolls in the European market. He also converted his growing knowledge into creating realistic-looking soft plastic “simulated wounds” which were of assistance in training local medical staff to treat injuries (Tjomsland, 2015).
And then one day in 1954, a near tragedy created the ‘Aha Moment’ which would not only transform his life but would also create a tool to save lives far beyond Norway. Åsmund discovered his two-year old son, Tore, face down in water and drowning. The frantic father pulled his son out and worked to clear his airways of water. Luckily, Tore regained consciousness due to his father’s desperate attempts to revive him (Lærdal, 2013; Tjomsland, 2015). Following this terrifying episode, Åsmund Lærdal recognised the need for more bystanders who witnessed emergencies to know how to react in the critical first minutes, long before medical professionals could arrive. His understanding correlated with evolving work on CPR (Cardiopulmonary Resuscitation, the combination of mouth-to-mouth breathing and external cardiac compression) being pioneered by Drs Bjørn Lind, Peter Safar, James Elam and Archer S Gordon. Because of Lærdal’s earlier work with creating simulated wounds, fellow Stavanger resident Lind reached out to discuss the concept of developing a mannequin for training in this new technique (Lærdal, 2013; Tjomsland, 2015). Tore Lærdal is now head of the Laerdal family company and foundations (note that while the correct spelling of the family name is Lærdal, the official global name of the company has been anglicized to Laerdal). As Tore describes his father’s next steps: ‘Innovation is about impact. Luck often strikes the prepared mind’ (Lærdal, 2013).
Described by some as the ‘most kissed face’ in history, Resusci-Anne’s face once belonged to an actual young woman. The mannequin’s face is modeled on the death mask of an unknown Paris drowning victim from the late 19th century known as the ‘Unknown of the Seine’. Tore Lærdal (2013) referred to Anne’s face in a TedX talk as ‘The face of death to become the face of life – the face of modern resuscitation’. Developing a prototype in 1960 was not enough to know whether Resusci-Anne could successfully be used to train non-medical bystanders in the actual use of CPR techniques. To test the theory, a study amongst 6,500 children in Stavanger area schools assessed whether they would learn better from using the mannequin than from more traditional lecture techniques on first aid. Following the success of the study with the school children, Åsmund Lærdal then convinced the local savings bank association to donate 700 mannequins to all schools in the country. Norway thus became the first country in the world to have compulsory training in CPR for all students (Lærdal, 2013). That early implementation and follow-up using education effectively has contributed to Norway’s global top ranking in bystander CPR use in emergency situations. Also, a higher percentage of people suffering cardiac arrest outside hospitals will survive in Norway than anywhere else in the world (Perkins et al, 2016).
The success of Resusci-Anne as a teaching tool spread quickly, and today Laerdal is a global entity providing learning programs and equipment for life saving, long ago leaving
behind the manufacture of toys. Whilst the ‘Unknown of the Seine’ face is the most well-known, the company also manufactures Resusci-Anne with a range of different ethnic faces to best match the continent where she will be used to help save lives. According to the American Heart Association, ‘Immediate CPR can double or triple chances of survival after cardiac arrest’. In addition, ‘Globally, cardiac arrest claims more lives than colorectal cancer, breast cancer, prostate cancer, influenza, pneumonia, auto accidents, HIV, firearms, and house fires combined’ (CPR Facts and Stats). Remarkably, in her role in training at least five hundred million people in CPR since 1960, Resusci-Anne can be credited with helping to save globally at least two and a half million victims of cardiac arrest (Resusci-Anne QCPR).
When Åsmund Lærdal died in 1981, it was 29-year-old Tore Lærdal who stepped into his father’s role heading the company. Today, still solely family-owned, Laerdal Medical, the Laerdal Foundation and Laerdal Global Health have continued to explore and develop a range of life-saving medical devices. The company motto, ‘Helping Save Lives’, accompanies their corporate logo image of the Good Samaritan – the passer-by who stops to help someone in need (Tjomsland, 2015). The Laerdal Vision continues to guide their decision-making: ‘No one should die or be disabled unnecessarily during birth or from sudden illness, trauma or medical errors’, while their goal is ‘Helping save 500,000 more lives every year by 2020’ (About Laerdal). Whilst many of its medical devices are designed today to be used in the most modern hospital settings, the core of the company values still reflects the purpose of teaching individuals how to provide the right assistance in the crucial first moments of emergency need before trained medical professionals can arrive on the scene.
Another prime example of this concept of enabling bystanders to step into action is the AED (Automated External Defibrillator). Now commonly seen in schools, airports, train stations and shopping centres, this innovative piece of equipment is another step forward in helping Good Samaritans to do the right thing at the right time. Laerdal is one of a number of companies which produce and distribute AEDs. Wisely, the various AED manufacturers cooperated in creating a product which works the same way, regardless of brand, to eliminate any confusion for the user. Also, through its colour-coded lights, it is not even necessary to understand the language of the instructions the AED’s verbal commands share. A common misconception related to the use of an AED and its powerful electrical charge is that a potential Good Samaritan could ‘do harm’ to a victim of cardiac arrest by using it incorrectly. The opposite is true. The machine assesses cardiac activity and will only deliver a charge if there is no heartbeat. Because the window between the loss of a heartbeat and either death or permanent catastrophic loss of brain function is a short ten minutes, empathetically holding the hand of a victim rather than using either CPR or an available AED will only hasten a fatal ending. Why not take that box off the wall and get to work!
Fortunately, international school communities are amongst the most enlightened activists educating a society of current and future Good Samaritans. Through first aid training programmes and well-resourced campus environments, students and faculty members today are commonly taught how to correctly administer CPR using Resusci-Anne and have access to AEDs. Many international school mission statements refer to the goal of educating responsible future global citizens, and the correlation to learning life-saving techniques is easily understood and implemented. The same proactive thinking is practised in many government school systems around the world, sometimes through national or local mandates. Whilst life-saving training is not yet a universal requirement in all schools and countries, extensive educational research offers strong evidence about the effectiveness of instituting such programmes (Hansen et al, 2017; Fuchs, 2018; Mitamura et al, 2015; Phillips, Martin and Ellis, 2017; Salciccioli et al, 2017; VanAken et al, 2017).
Bystander CPR continues to evolve. The recent introduction of ‘Hands-Only CPR’ is seen as a method to encourage bystanders who may be hesitant to deliver mouth-to-mouth breathing. Delivering chest compressions at the speed of one hundred beats per minute has shown positive results. Too busy saving a life to worry about counting? Then just do chest compressions humming along to the beat of the Bee Gees’ song ‘Staying Alive’, which coincidentally correlates perfectly (Keep the beat).
Another evolution of the original training idea includes the introduction of ‘MiniAnne’ which is a low-cost, inflatable version of the head and torso of Resusci-Anne. Students are taught CPR on the MiniAnne in school and then they take her home to train other family members – especially grandparents – in its use. Why grandparents? Because they are at the highest risk, most cardiac arrests happen in the home, and today’s elder generation are often the least likely to have attended a training course themselves. Good progress has also been made in training emergency dispatchers sitting in the ambulance office how to walk a bystander through the CPR steps over a telephone to keep the compressions going until the medical personnel arrive to take over (Tjomsland, 2015).
As for Tore Lærdal (2013), he is following in the lifesaving footsteps of his father and has described his own ‘Aha Moment’. His ‘Aha’ came when visiting developing countries and realising steps needed to be taken to lower high childbirth mortality rates. Problems with infants breathing and with mothers hemorrhaging have cost too many lives. Every day, 7,300 newborns die and 830 mothers die globally giving birth. Of these deaths, 99% happen in low-resource settings and are potentially preventable (Helping save mothers
Tore Lærdal
and babies). Through the development of high impact, innovative and inexpensive devices to help clear the baby’s airways and stop the mother’s bleeding, the Laerdal Global Health (LGH) Foundation is involved in another important project. LGH is a not-for-profit company created to help save the lives of mothers and newborns working in collaboration with the AAP (American Academy of Pediatrics), and by early 2015 was implemented in 75 countries. The current goal is to help save the lives of 400,000 more babies and mothers per year by 2020 through training and supporting local birth attendants, often far from a hospital setting. The company plans to achieve this goal by working with partnerships to train and equip more than one million birth attendants who use ‘innovative solutions that are durable, simple, culturally adaptable and affordable’ (Helping save mothers and babies, and Tjomsland, 2015).
In 2015, the United Nations cited the Helping Babies Breathe project as one of ten transformative innovations in global health. In 2013, Laerdal Global Health was awarded the INDEX: Design to Improve Health Award. The largest award of its kind, the 100,000 Euro prize was donated by Laerdal to the ICM (International Confederation of Midwives), to continue to train and equip birth attendants in developing countries (Helping save mothers and babies). The Helping Babies Breathe and Helping Mothers Survive initiative (now also including the third generation of the Laerdal family) is the newest chapter of the fascinating story from the southwest coast of Norway demonstrating ‘Innovation is about impact’.
No one knows the real identity of the young girl whose body was pulled out of a river in Paris over a century ago. Considering how many positive repercussions can be directly connected to the ‘Unknown of the Seine’, she truly has been globally impactful.
References
[All online sources accessed April 2019] About Laerdal – Resources, product demos & more. Available at: https:// www.healthysimulation.com/laerdal/ Åsmund S Lærdal: Modeling & simulation hall of fame. Available at: www.simulationinformation.com/hall-of-fame/inductees/asmund-slaerdal
CPR facts and stats. Available at: https://cpr.heart.org/AHAECC/ CPRAndECC/AboutCPRECC/CPRFactsAndStats/UCM_475748_CPRFacts-and-Stats.jsp Fuchs S (2018) Advocating for life support training of children, parents, caregivers, school personnel, and the public. Available at: https:// pediatrics.aappublications.org/content/141/6/e20180705.abstract Hansen, Zinckernagel, Ersbøll, Tjørnhøj-Thomsen, Wissenberg, Lippert, Weeke, Gislason, Køber, Torp-Pedersen and Folke (2017) Cardiopulmonary resuscitation training in schools following 8 years of mandating legislation in Denmark: A nationwide survey. Available at: https://www.ahajournals.org/doi/full/10.1161/JAHA.116.004128 Helping save mothers and babies. Available at: https:// laerdalglobalhealth.com/ Keep the beat, learn hands only CPR. Available at: www.youtube.com/ watch?v=O-xBqakqJ-M Lærdal T (2013) Collaboration breeds innovation. Available at: www. healthysimulation.com/6170/tore-laerdal-tedx-talk-collaborationbreeds-innovation/ Mitamura, Iwami, Mitani, Takeda and Takatsuki (2015) Aiming for zero deaths: Prevention of sudden cardiac death in schools–Statement from the AED committee of the Japanese Circulation Society. Available at: www. jstage.jst.go.jp/article/circj/79/7/79_CJ-15-0453/_article/-char/ja/ Perkins, Lockey, de Belder, Moore, Weissberg and Gray (2016) National initiatives to improve outcomes from out-of-hospital cardiac arrest in England. Available at: https://emj.bmj.com/content/33/7/448 Phillips, Martin and Ellis (2017) A national survey of automated external defibrillator provision and training at secondary schools in Wales. Available at: www.thelancet.com/journals/lancet/article/PIIS0140- 6736(17)33004-0/fulltext Resusci-Anne QCPR. Available at: www.laerdal.com/sg/products/ simulation-training/resuscitation-training/resusci-anne-qcpr/ Salciccioli, Marshall, Sykes, Wood, Joppa, Sinha and Lim (2017) Basic life support education in secondary schools: a cross-sectional survey in London, UK. Available at: https://bmjopen.bmj.com/content/7/1/ e011436.abstract Tjomsland, N. (2015) Saving more lives – together: The vision for 2020. Stavanger, Norway. Van Aken, Hessler, Brinkrolf, Bohn, Gottschalk (2017) Resuscitation training for schoolchildren worldwide: Kids save lives. Available at: https://journals.lww.com/anesthesia-analgesia/Fulltext/2017/04000/ Resuscitation_Training_for_Schoolchildren.47.aspx
