Nau CARDIOPULMONARY RESUSCITATION TRAINING PROJECTS IN REGIONAL MEDICAL PROGRAMS The staff offers the following background material which was requested by the Council to assist them in recommending action on a number of projects of this kind and in considering the possibility of issuing a statement on the relative priority of such projects for RMP funding. BACKGROUND During the past several years, knowledge of cardiopulmonary resuscita- tion has developed to a point where an entirely new framework for the care of persons suffering from sudden and unexpected death has been provided. These advances have been the result of research and its application in clinical experience by the many medical disciplines. New techniques of airway management, the development of closed chest cardiac compression, and new devices such as defibrillators and pace- makers have come from industry and the medical profession. Recently, concerted efforts have been made to integrate this knowledge into one organized approach to the specific problems and giving proper recogni- tion to the role and value of each technique. The methods have been outlined completely and are available ina variety of training materi~ als published by the American Heart Association and approved by the U.S. Public Health Service. The American Heart Association has formed a CPR Committee to develop standards and techniques for physicians and paramedical personnel and others concerned with Cardiopulmonary Resus- citation. These sources of information concerning developments of this technique in this rapidly expanding field are readily available. A statement on heart-lung resuscitation by the Ad-Hoe Committee on cardiopulmonary resuscitation of the Division of Medical Sciences, National Academy of Sciences, and National Research Council can be obtained in the form of a reprint from the Journal of the American Medical Association, October 24, 1966. This statement has been updated and gives in detail the minim standards recommended for the technique of heart-lung resuscitation. ‘The recommendations of this Ad-Hoc Committee, the American Heart Association, and the U.S. Public Health Service should be the minimum guidelines for cardiopulmonary resuscitation proposals. Dr. Robert D. Huber, Attorney at Law and a member of the CPR Committee of the American Heart Association gives the medical-legal aspects of resuscitation. He states as follows: "Legal action in the field of resuscitation has largely been directed toward failure to perform resuscitation quickly and effectively when it is indicated. One case often cited con- cerns an ophthalmologist who failed to initiate internal or external cardiac massage because he felt unqualified to do so and sought the assistance of a surgical colleague. Car- diac resuscitation was attempted and residual brain damage resulted from the time delay and it was held that one undertak- ing to do surgery or any medical procedure should be trained in CPR. It would appear that medical practitioners and para-~ medical personnel have an obligation to prepare themselves to function effectively in the event of a cardiac emergency. HLR has reached the state such that medical, nursing, and hospital CPR Training Programs ~~ BUBUOU bey tee associations should establish a position on heart~lung resusci- tation. There is the possibility that future hospital accredi- tation include a clause requiring medical. persomel working or staff physicians practicing in that facility be qualified in CPR. Each institution has the responsibility for medical care within its walls and it should establish a CPR plan for its staff and employees. Policies and statements should be realistic and once made adhered to or modified. No litigation has come to the attention of the AHA CPR Committee against trained per- sons who, in good faith, have attempted resuscitation properly." The public is now aware that cardiac arrest need not mean death and law- suits may occur for either action or nonaction on the part of the physi- clans. REGIONAL MEDICAL PROGRAM INVOLVEMENT Funded Projects The Division is currently funding nine routine Cardiopulmonary Resusci- tation Training Programs in separate regions. The following is a brief summary of the funded and committed levels of these projects. YEARS OL C2 03 Arkansas $40,539 $32 ,085* $32 ,085% Project #5 Georgia 69,556 113,658 54 000% Project #10 | Hawaii 48,720 72,4408 75,,385% Project #7 Intermountain 63,350 59,115 76,797* Project #4 Towa 38 ,655 38 ,655* 38 ,655* Project #4 Maryland 38,240 38 , 240% 38 , 240% Project #8 New Jersey 43,396 65 ,000* 95 ,000* Project #4 North Carolina 60,861 70,169 '70,056* Project #13 South Carolina 42,774 37,845 Ay 476% Project #8 ee TOTAL $46 , O91 $527 ,207 $521 694 Committee for future support One of the projects (Intermountain) has slightly more than two years of experience and three have over one year. The nine projects requested a total. of $1,008,665 for their first year which was reduced during the review process by 55.8% to a level of $446,091. Funding approval by Council varied From 17% to 100% of the amount requested. The total potential investment including both funded and committed dollars represents $1,497,992 a an oo hs - ---e tna CPR Training Programs August 11, 1969 Requested Projects There are currently eight CPRI projects under consideration in the review process requesting total support of $1,065,690. Only two of the projects request less than three years support. The following is a brief summary of these requests and their status. . ‘Request Status 2 OL 02 03 Arizona Approved July '69 $56,775 $44,323 $45,406 Project #6 Committee at (56,775) (44,323) (45,406) requested level California Approved Jan. '69 "10,634 2,292 --- Project #26 Committee as requested (10,634) (2,292) California Approved July '69 25,815 23,700 24,444 Project #36 Committee (25,815) (23,700) (24,444) Mississippi S.V. Team recom- 72,842 63,378 65,665 Project #8 Tennessee Mid~South Project #41 Western Pennsylvania mends approval for 2 years Approved April '69 Committee as requested Approved April '69 (51,984) (46, 30,396 26, (30,396) (26, 126,842 102, 247) =a 540 27,390 540) (27,390) 946 — Project #4 Committee as requested (126,842) (102,946) ~~ West Virginia Disapproved July '69 69 ,172 64,890, 68,956 Project #7 Committee (---) (---) (---) Wisconsin Disapproved July '69 31,308 36,988 44,988 Project #14 Committee (+++) (=) LG) TOTAL Note: Figures in parentheses represent approved funding. $423,784 $365, (302,446) (246, 057 $276,849 048) ( 97,240) Of the eight projects reviewed, two were disapproved. As a result, support of these projects will approximate a total of $645,734 for all years and $302,446 for the first year. of $107,622 per project approved. General Comments This represents an average cost The applicant agency for each of the funded and requested projects is the Heart Association of the respective regions. funded and requested is in the Personnel Category with Equipment the second largest. The largest item for both In only a few instances is the Heart Association or _ CPR Training Program -4 - ‘August 11, 1969 local Health Department contributing monetary support. The majority of the projects are operating within the guidelines of the American Heart Association, CPR Committee's recommendations for training. Most are working within the community hospital setting with the priority of training physicians and nurses first, and then lay groups. Within the hospital category are physicians, dentists, nurses, allied health personnel and ambulance personnel. The lay groups are represented by rescue squads; firemen, policemen, various community organizations, industry, life guards, schools, ski patrols, teachers, and industries. The projects discuss varying degrees of evaluation mechanisms but most are concerned with pre- and post-testing of the trainees. All of the mechanisms reflect only general gathering of information. Few of the projects become involved in evaluating utilization of CPR in emergency situations and its success or failure. There is no uniform system of evaluation. The projects in most cases are only generally described, making evaluation of the whole difficult. There is little indication of actual community support of the programs. Financial support from these areas is a neces- sity if the programs are to continue following termination of RMP support. Most of these programs had some degree of support by the local Heart Association prior to submission to DRMP. In reviewing the site visit reports to the various regions, it is noted that this type of project fosters additional coordination and cooperation. However, very few of the applications and progress reports reflect this type of involvement.