Garth Rattray
Cardiovascular disease remains our number one killer. I therefore recently joined in with a group of physiotherapists and completed a Basic Life Support (BLS) course for Healthcare Providers (certified by the America Heart Association) through the Heart Foundation of Jamaica.
Emergency Cardiac Care (ECC) begins at the community level (homes, schools, businesses and recreational areas). Except in unusual circumstances, everything that we do during Cardio Pulmonary Resuscitation (CPR) is aimed at buying time until an Automated External Defibrillator (AED) device is used to allow the heart to return to a normal rhythm.
But AEDs are rare because they cost at least US$3,000 then our Government adds up to 20 per cent import duty and compounds that with 16.5 per cent GCT!
Defibrillation within one minute of a cardiac arrest returns survival rates of 70-90 per cent. However, that falls off at a rate of seven to 10 per cent each minute that defibrillation is delayed.
LACKING ONE ESSENTIAL TOOL
So, in spite of two days of excellent tutelage by three very competent instructors wherein we acquired the academic and technical know-how to save lives, we left knowing that we lack the one essential tool needed to do so (the AED).
During the course the lengthiest and most spirited discussions revolved around the social issues and stagnant shortfalls within the system.
Here in Jamaica calling the emergency 119 number for a cardiac arrest is a virtual waste of time. Our emergency vehicles are usually taxis and good Samaritan motorists.
Ambulances are sparse. Fast responding and properly equipped ambulances are totally unavailable to the poor. All-day traffic congestion impedes emergency vehicles and AEDs are unavailable in almost all public places.
I am not a cricket fan but, from all indications, the upcoming Cricket World Cup 2007 will (hopefully) be a boon not only for our economy but also to our health sector.
Since Jamaica has been mandated to provide state-of-the-art emergency services during the event, we will have an influx of emergency training and AEDs. Why weren't we able to do this before? Only our bureaucrats (the ones who put people first) know.
And now we have a National Resuscitation Council (NRC), an administrative body set up to 'regulate and standardise emergency cardiac care (ECC) training in Jamaica'. All this is very good but the Chain of Survival has four links.
(1) Early access (which means getting help to access an AED and then advanced cardiac care).
(2) Early CPR (ventilation and chest compressions while waiting for the arrival of an AED).
(3) The application of the AED (designed to stop the heart from performing useless fibrillations and give it a chance to restart itself with a normal rhythm).
(4) Advanced Cardiopulmonary Life Support (involving the use of medications and advanced apparatuses). A chain is only as strong as its weakest link and our chain of survival will have a missing link (the essential AED) most of the time.
My wife related to me her idea of having fully-equipped and properly staffed emergency vehicles strategically placed in zones and shared by communities. This way there would be quick access and rapid transport to more advanced centres of care.
UNDER-FUNDING
Given our economic constraints, the Ministry of Health is doing the best that it can. It is stretched by under-funding and (unnecessary) violence that badly drains its financial resources.
I would like to see the powers- that-be stop taxing life-saving equipment and offer substantial tax incentives to businesses that contribute to emergency health care.
This is especially applicable to insurance companies because an efficient and strong chain of survival would save lives and reduce their payout for sudden deaths.
Dr Garth A. Rattray is a medical doctor with a family practice.
