Cardiopulmonary resuscitation must be taught to everyone to save lives

Health Care, Heart Care Foundation of India, Medicine No Comments

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.

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

The Healthcare Service Personnel And Clinical Establishments (Prohibition Of Violence And Damage To Property) Bill, 2019

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Cases of violence against doctors show no signs of abating. About 4 days back, resident doctors of Safdarjung Hospital went on strike after two residents were assaulted by the attendants of a patient, who died during treatment.

But, the limit was reached when Dr Deben Dutta aged 73 years was brutally attacked by workers of Teok Tea Estate in Assam’s Jorhat district on Saturday. Dr Dutta later succumbed to his injuries at the Jorhat Medical College and Hospital.

The medical fraternity has for long been demanding a stringent central act for violence against doctors and to make acts of violence against doctors as non bailable offences.

On Monday, the Health Ministry has released the draft Bill “The Healthcare Service Personnel And Clinical Establishments (Prohibition Of Violence And Damage To Property) Bill, 2019”.

The Bill is reproduced below. Are the provisions in it enough? Will it serve the purpose?

Comments are invited.

THE HEALTHCARE SERVICE PERSONNEL AND CLINICAL ESTABLISHMENTS (PROHIBITION OF VIOLENCE AND DAMAGE TO PROPERTY) BILL, 2019.

A BILL

to prohibit violence against healthcare service personnel and damage or loss to property of clinical establishments and for matters connected therewith and incidental thereto

WHEREAS, acts of violence causing injury or danger to life of healthcare service personnel and damage or loss to the property of clinical establishments are on the increase in the country creating unrest among healthcare service personnel resulting in hindrance to healthcare services in the country;

AND WHEREAS, to protect healthcare service personnel and property of clinical establishments against violence, it has become necessary to prohibit such acts of violence, to provide for punishment by making such acts of violence as cognizable and non-bailable offence and to provide compensation for injury to healthcare service personnel or for causing damage or loss to the property of clinical establishments;

BE it enacted by Parliament in the Seventieth Year of the Republic of India, as follows:

CHAPTER I

PRELIMINARY

1. Short title, extent, application and commencement —

(1) This Act may be called the Healthcare Service Personnel and Clinical Establishments (Prohibition of violence and damage to property) Act, 2019.

(2) It extends to the whole of the India.

(3) It applies to clinical establishments as defined in clause (a) of section 3 and registered under the Clinical Establishments (Registration and Regulation) Act, 2010 or under any State Act for the time being in force.

(4) It shall come into force on such date as the Central Government may, by notification in the Official Gazette, appoint.

2. Application of other laws not barred- The provisions of this Act shall be in addition to, and not, save as otherwise expressly provided, in derogation of any other law for the time being in force.

3. Definitions— In this Act, unless the context otherwise requires—

(a) “clinical establishment” means-

i.a hospital, maternity home, nursing home, dispensary, clinic, sanatorium or an institution by whatever name called that offers services, facilities requiring diagnosis, treatment or care for illness, injury, deformity, abnormality or pregnancy in any recognized system of medicine established and administered or maintained by any person or body of persons, whether incorporated or not; or

ii.a place established as an independent entity or part of an establishment referred to in sub-clause (i), in connection with the diagnosis or treatment of diseases where pathological, bacteriological, genetic, radiological, chemical, biological investigations or other diagnostic or investigative services with the aid of laboratory or other medical equipment, are usually carried on, established and administered or maintained by any person or body of persons, whether incorporated or not;

and shall include a clinical establishment owned, controlled or managed by –

A. the Government or a department of the Government; or a Public Sector Undertaking or Autonomous Body of the Government;

B. a trust, whether public or private;

C. a corporation (including a society) registered under a Central, or Provincial or State Act, whether or not owned by the Government;

D. a local authority; and

E. a single doctor,

Explanation:

i.For the purposes of this clause, an ambulance or a mobile medical unit shall be deemed to be a clinical establishment if such vehicle is fitted with medical equipment and is used for providing healthcare service.

(b)”healthcare service personnel- in relation to a clinical establishment, shall include-

i.A registered medical practitioner, possessing a recognized medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956, and enrolled in a State Medical Register as defined in clause (k) of that section;

ii.a medical practitioner registered for practising in any other system of medicine which is recognized under any law for the time being in force;

iii.a registered dentist, registered dental hygienist and registered dental mechanic as defined in clause (I) of Section 2 of the Dentists Act, 1948;

iv.a registered nurse, midwife, auxiliary nurse-midwife and health visitor who is registered as such under section 15A of the Indian Nursing Council Act, 1947;

v.a medical student who is undergoing education or training in any system of medicine recognized by any law for the time being in force;

vi.a nursing student who is undergoing education or training in nursing profession;

vii.a para-medical workers, para-medical student and diagnostic services provider; and

viii.ambulance driver and helper,

(c) “section ” means a section of the Act;

(d) “violence” means an act which causes or may cause….

i.harm, injury, hurt, grievous hurt, intimidation to, or danger to the life of, a healthcare service personnel in discharge of duty, either within the premises of a clinical establishment or otherwise; or

ii.obstruction or hindrance to a healthcare service personnel in discharge of duty, either within the premises of a clinical establishment or otherwise;

iii.loss of or damage to any property or documents in a clinical establishment;

(e) Words and expression used herein and not defined, but defined in Indian Penal Code or in the code of criminal procedure, 1973 shall have the meanings respectively assigned to them in those Codes.

CHAPTER II

OFFENCES AND PENALITIES

4. Prohibition of violence- No person shall indulge in any act of violence against a healthcare service personnel or cause any damage or loss to any property in a clinical establishment.

5. Offences and penalties: (1) Whoever commits violence or abets or incites commission of violence against any healthcare service personnel or abets or incites or causes damage or loss to any property of a clinical establishment, shall, upon conviction, be punished with imprisonment for a term which shall not be less than six months but which may extend to five years, and with fine, which shall not be less than fifty thousand rupees but which may extend to five lakh rupees;

(2) Whoever, while committing violence as referred to in sub-section (1), causes grievous hurt as defined in section 320 of the Indian Penal Code to any healthcare service personnel, shall, upon conviction, be punished with imprisonment for a term which shall not be less than three years, but which may extend to ten years, and with fine, which shall not be less than two lakh rupees, but which may extend to ten lakh rupees.

6. Information of offence- Notwithstanding anything contained in the Code of Criminal Procedure, 1973, upon a written request of the aggrieved healthcare service personnel, it shall be mandatory for the person in charge of a clinical establishment to inform the officer in charge of the concerned police station of the commission of an offence under this Act.

7. Offence to be cognizable and non-bailable- Notwithstanding anything contained in the Code of Criminal Procedure, 1973, an offence punishable under this Act shall be cognizable and non-bailable.

8. Investigation of offence-Notwithstanding anything contained in the Code of Criminal Procedure, 1973, any case registered under this Act shall be investigated by a police officer not below the rank of Deputy Superintendent of Police.

9. Compensation for acts of violence –

(1) In addition to the punishment provided for the offence under section 5, the convicted person shall be liable to pay, by way of compensation

(i) an amount, twice the amount of fair market value of the damaged property or the loss caused, as may be determined by the court;

(ii) (ii)one lakh rupees for causing hurt to healthcare service personnel and five lakh rupees for causing grievous hurt to healthcare service personnel.

(2) If the convicted person does not pay the compensation granted under sub-section (1), the said sum shall be recovered as an arrear of land revenue under the Revenue Recovery Act, 1890.

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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