Cardiopulmonary resuscitation must be taught to everyone to save lives

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On World Heart Day, awareness is needed on the importance of initiating CPR within the first 10 minutes of a sudden cardiac arrest

Delhi, September 23, 2019: According to recent estimates, there are about 25 to 45 deaths in Delhi every day due to sudden cardiac arrest (SCA). The condition is emerging as the number one cause of mortality in India. With World Heart Day around the corner, there is a need to raise awareness on training people in essential life saving techniques such as cardiopulmonary resuscitation (CPR) and installing automatic external defibrillators (AEDs) in public places.

CPR is the most crucial and basic procedure to save a life in the event of an SCA. There is substantial evidence to suggest that CPR is effective in the first 10 minutes of cardiac arrest. After 10 minutes, there is practically no chance of recovery unless the patient is in hypothermia.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, Heart Care Foundation of India (HCFI), said, “Sudden cardiac arrest is more fatal than a heart attack given that it can lead to death in a matter of minutes. It is caused due to a sudden and complete blockage of blood flow to the various body organs. Timely help is of utmost importance in such cases and initiating cardiopulmonary resuscitation (CPR) within the first 10 minutes is important. The two pillars of community service include meaningful engagement and mindful participation. Learning the basics of CPR is community service at its best as it can help avert mortality through timely assistance, before medical help arrives. In case an ambulance reaches the patient very late or if there is an acute shortage of cardiac ambulances, an automatic external defibrillator (AED) installed at public places can help save lives in a timely manner.”

Defibrillation within 3 to 5 min of collapse can produce survival rates as high as 50% to 70%. Early defibrillation can be achieved through CPR providers using public access and on-site AEDs. Public access AED programmes should be actively implemented in public places that have a high density of citizens.

Adding further, Dr Aggarwal, said, “The CPR 10 was created so that the public could remember the process of revival after SCA. The CPR 10 Mantra is as follows: Within 10 minutes of cardiac arrest (earlier the better) for the next 10 minutes at least, compress the center of the chest with a speed of 100 compressions per minute (10×10). CPR 10 is easy to learn and easy to do and one does not need to be a doctor or be certified in this technique.”

There are three simple rules to be followed when a person suffers from SCA: Call the ambulance, check if the person is breathing or has a pulse and if not, then start chest compressions and continue for at least 30 minutes till medical help arrives. It is also imperative to not stop CPR too soon. The premise of a successful CPR is earlier the better and longer the better.

The Formula of 80 to prevent heart diseases· Keep your lower blood pressure, fasting sugar, abdominal circumference, resting heart rate and LDL cholesterol levels all below 80.

  • Walk 80 minutes each day; brisk walk 80 minutes a week with a speed of 80 steps per minute.
  • Eat less, not more than 80 gm/80 ml of caloric food in one meal. Do not eat carbohydrate–based refined cereals 80 days in a year to reduce chances of heart attack.
  • Take vitamin D through sunlight 80 days in a year.
  • Do not drink alcohol and if you drink, take less than 80 ml of whiskey in a day or less than 80 gm of whiskey in a week. Do not smoke or be ready for placement of stent costing Rs 80,000.
  • Give 80 minutes to yourself in a day.
  • When clapping, clap 80 times.
  • If you are a heart patient, ask your doctor to give 80 mg of aspirin and 80 mg of atorvastatin.
  • Donate blood 80 times in a lifetime to reduce chances of heart attack.
  • Avoid an atmosphere of more than 80 db of noise pollution.
  • While on treadmill, try to reach 80% of your heart rate.

Padma Shri Awardee Dr K K Aggarwal sworn in as the President of the Confederation of Medical Associations of Asia and Oceania (CMAAO)

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Given his diverse experience and stand on preventive and universal healthcare, Dr Aggarwal will help add value to the world healthcare landscape in this capacity

Place, Goa: Renowned cardiologist and President of the Heart Care Foundation of India (HCFI) Padma Shri Awardee, Dr K K Aggarwal, has been unanimously elected as the 37th President of the Confederation of Medical Association of Asia and Oceania (CMAAO) for 2019/20. He took over in this capacity from the Past President Dr Ravinder Naidu from Malasya the 34th CMAAO General Assembly and 55th Council Meeting held in Goa on 5th September 2019.

An advocate of preventive and universal healthcare, Dr Aggarwal has already pioneered leading health initiatives in India. Among other multifarious roles, Dr Aggarwal has been the past national president of the Indian Medical Association (IMA) and the first vice president of CMAAO and advisor to the ethics committee, World Medical Association.

Since its inception in 1956, the objective of CMAAO has been to promote academic exchange of information on health issues and cultivate ties of friendship between member medical associations.

Speaking at the event, Dr Aggarwal, said, “It is my immense privilege and honor to assume the role of the President of CMAAO for the year 2019/20. Coming to this General Assembly feels like homecoming and a reunion of family as it resonates with my philosophy of life as a student of Vedic literature.In cognizance of the theme of the General Assembly this year – Path to Wellness – ‘One Health’ will be my priority this year. There are several public health challenges today such as vector-borne diseases; communicable and non-communicable diseases (NCDs);antimicrobial resistance (AMR); tobacco use; HIV/AIDS, etc. Violence against doctors and inequity in health are few other issues that are a concern. Attaining universal health coverage, which is affordable, accessible, available, appropriate and accountable,remains a distant goal for many of us. This can only be addressed and prioritized when we consider the concept of ‘One Health’.

Adding further, Dr Aggarwal, said, “Many of our member countries have successfully met some public health challenges.These achievements should not only inspire us to accomplish these goals, but also to help each other to attain them.For the success of CMAAO, let us give 80 seconds every day to the body and share one idea with me to make this year, one of the most vibrant years in the history of the organization.

Currently comprising 19 member National Medical Associations (NMAs), the CMAAO has been in existence for more than 50 years now. Dr Aggarwal’s appointment to the body in the current role assumes significance given his rich background and the fact that this will bring India to the center stage of discussions.

ENDS also can be regulated under COTPA

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The Health Ministry is proposing to ban Electronic nicotine delivery systems (ENDS) in the country via a draft ordinance “Prohibition of E-cigarettes Ordinance 2019” as reported in the media. The said ordinance is being examined by a Group of Ministers (GoM) comprising of the health ministry as well as finance, commerce, agriculture, chemicals and petrochemicals and the food processing ministries.

The government intends to include ENDS under the D&C Act and had issued advisories prohibiting the manufacturing, distribution, trade, import and advertisement of ENDS and like devices. However, this position of the Government was challenged in the Delhi High Court, which issued a stay on these advisories based on the contention that ENDS do not come under the definition of “drug” as cited in the Drugs and Cosmetics Act and therefore they cannot be banned under the Drugs and Cosmetics Act.

If the government desires to regulate ENDS, there is a law already existing, The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and. Commerce, Production, Supply and Distribution) Act, 2003 (COTPA), which regulates cigarettes and other tobacco products in the country. COTPA prohibits advertising of tobacco products, sale of tobacco products to minors and smoking in public places etc. and thus addresses all concerns of the government under its various provisions.

The government had withdrawn COTPA (Amendment) Bill 2015 with the intention to introduce a new Bill, which would also regulate ENDS.

Therefore, ENDS too can be included under Section 3(p) of COTPA, which defines “tobacco products”.

The President of India is empowered by the Constitution to promulgate an Ordinance during recess of Parliament (Article 123), but only if at any time, he is satisfied that the circumstances are extenuating enough to take the necessary immediate action. Also, the President can only promulgate an ordinance on matters in List I (Union list) and List III (Concurrent list) of the Seventh Schedule of the Constitution. Public Health comes under List II (State list).

An ordinance remains in force for up to six weeks when the Parliament reconvenes.

So, even if the ordinance is passed, in all probability, it may be challenged as there is no expediency or urgency necessitating such an action.

Enforcing a blanket ban on ENDS, instead of regulating them, while cigarettes and other tobacco products continue to be sold in the country under the ambit of COTPA, would violate Article 14 of India, which guarantees the fundamental right to equality and also Article 19(1)(g) of the Constitution, which allows the right to freedom to practise any profession, or to carry on any occupation, trade or business.

The Delhi High Court had stayed the government advisory to ban ENDS under the Drugs and Cosmetics Act. The matter is still under the consideration of the court. It’s only right that the government wait for the final adjudication in the matter before proceeding further.

(Personal opinion)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

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