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Gauging the risk, benefit of CPR

Experts say the majority of cardiac arrests occur at home and the risk of contracting a disease during mouth-to-mouth resuscitation is low.

By SHARON TUBBS

© St. Petersburg Times, published May 31, 2000


A man puts his hand on his chest, then collapses in a restaurant. He's having a heart attack.

Mr. Good Samaritan is sitting nearby. He scurries to the stranger's aide, giving mouth-to-mouth resuscitation and pumping the victim's chest with his hands.

It looks good on TV.

In reality, medical workers say, Joe Citizens who see strangers in the throes of a heart attack often refuse to save them if it means their lips have to touch.

They will call 911. They will tell paramedics what has happened. But when the paramedics suggest guiding callers through the step-by-step CPR process, a large number say no, said paramedic Bill Scott, who routinely answers calls from the 911 dispatch center in Largo.

"They're afraid that they'll catch a disease or something," Scott said.

Some medical professionals say they don't blame them.

"I wouldn't do it either," said Ed Monroe, a paramedic for the county's Sunstar ambulance system for 17 years. Like other medical professionals, Monroe has special oxygen pumps and other protective gadgets that eliminate the need for direct contact. "So I don't have to do mouth-to-mouth."

The local sentiment supports one study that said bystanders do not perform CPR in almost half of witnessed cardiac arrests, according to an article in the New England Journal of Medicine. The article outlined a recent study from researchers at the University of Washington that found doing chest compressions, without mouth-to-mouth resuscitation, was at least as effective as doing both until paramedics arrive.

Local professionals question the findings, however, saying they will still encourage people to do both mouth-to-mouth and chest compressions.

"A trained rescuer is very likely going to increase the chances of survival by doing mouth-to-mouth along with chest compression," says Jerry Potts, director of science for the American Heart Association's emergency cardiovascular care programs.

"However, we do realize that some people are not able or willing to do mouth-to-mouth. Regardless, people should be taught both components of CPR and be able to respond quickly if someone near them has cardiac arrest."

Some people are afraid to do CPR for fear of causing the victim more harm, while some are simply too shaken to perform CPR, medical workers said. But the fear of contracting a disease, such as AIDS, tuberculosis, hepatitis or herpes, also plays a role.

"It could be risky," said Largo Fire Rescue's Lt. Steve Bourne. "There's just so much out there anymore."

Take, for instance, the prison crew working near a roadway, Bourne said.

"If one passed out, would you give him CPR?" he said. "Not that they're any different than anybody else."

About 20 years ago, as Bourne was trying to revive a car accident victim with mouth-to-mouth resuscitation, the person vomited in Bourne's mouth.

"That's the last time I did that," Bourne said, noting that from then on he has always worn some type of protective gear or used devices that allow for CPR without mouth-to-mouth contact.

Contracting a disease through mouth-to-mouth contact would be rare, said Dr. Charles Sand, a member of the board of directors of the American Heart Association's Florida-Puerto Rico Affiliate and an emergency room physician at St. Joseph's Hospital in Tampa. He has not heard of one case in which someone was infected with HIV, the virus that causes AIDS, by giving mouth-to-mouth.

So, would Sand administer CPR without protection?

"If it's a friend or a neighbor or someone I know, I would do something if I thought it was advantageous to do so," Sand said. "But if it's a stranger, I could understand people's concerns."

It's not really an issue for him, though: Everywhere he goes, the doctor carries a special key chain with a protective mask inside, he said.

Paramedics on the emergency phone line can use detailed instructions to guide people who have not had previous training through CPR, Monroe said. If paramedics believe the victim is having a cardiac arrest, they ask whether the caller wants to be walked through CPR.

In cases where the victim is unknown to the caller, Monroe said, "Most people just don't do it."

Some have said, "I don't know this guy," Monroe recalled.

When the questions about contracting disease come up in CPR training courses -- and they always do -- instructors tell people the choice will be theirs to make.

Gordon Yaudes, deputy chief of safety and training for Clearwater Fire & Rescue, has performed CPR without protection.

"I had to make a decision. Everybody's different," Yaudes said. "I place a high value on life. If that was my loved one there, I'd want someone to save them."

The incident in which Yaudes gave unprotected mouth-to-mouth was 20 or more years ago. If faced with the dilemma today, Yaudes said, he would still perform mouth-to-mouth if no protective gear were available.

So would George Castrataro. "The risk is so nominal," said Castrataro, health and safety director for the American Red Cross' Tampa Bay area chapter. People take risks everyday, he said. Theoretically, you could catch a disease by drinking out of an unclean glass at a restaurant, he said.

Besides, experts say, the overwhelming majority of cardiac arrests occur at home. And people are far more likely to perform mouth-to-mouth when loved ones are involved.

Otto Sandleben, a Largo paramedic and CPR instructor, said concerns of contracting disease often come up in training classes. While he tells people there are risks and encourages them to keep protective devices handy, Sandleben points out that the likelihood of passing a stranger in cardiac arrest is not as great as finding a loved one in need of CPR.

In 1998 and 1999, 58 percent of cardiac arrests occurred inside a home, said Jeff Barnard, executive director of the office of the county medical director. Nationally, 80 percent of cardiac arrests occur in homes, according to the heart association.

In 38.5 percent of county heart attack cases in the 1998-1999 fiscal year, Barnard said, CPR was already in progress when paramedics got to the scene. "I would say that's substantial for a large, urban EMS system," he said.

In recent months, Barnard said, the county has begun collecting information from paramedics that will help determine whether people are willing to give CPR and whether the phone teaching technique is effective.

To learn more

For information about CPR and available protective devices, call the American Red Cross at (877) 741-1444 or the American Heart Association at (877) 242-4277.

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