Imagine the following scenario: one day, you go out for a walk along a path which overlooks a pond. You look out at the pond, noticing that a child has fallen in and is in danger of drowning. No-one else is coming to their aid; however, you’re wearing your brand new (and very expensive) Adidas exercise gear, and rescuing the child is certain to ruin it. Should you save the child? Almost everyone introduced to this thought experiment – made famous by philosopher Peter Singer in a classic argument for foreign aid – says ‘Yes’ when asked the same question. No item of clothing, no matter how expensive, is worth more than a human life.
Let’s alter the scenario somewhat and see if your answer changes. The child in the pond is now an old man, suddenly overcome by cardiac arrest in a car park. The key distinction between this situation and the other is that here, it is not your willingness to save a life but your capacity that matters. Immediate application of CPR could save this man’s life, but if you don’t know how to perform CPR, all you can do is call an ambulance and hope they arrive in time. What is at stake for you in this instance is not the value of your exercise gear in the present, but the cost of becoming trained in CPR in the past, the element which makes you capable of saving lives.
In contrast to the relative rarity of children drowning in ponds, out-of-hospital cardiac arrest (OHCA) is alarmingly common. According to the Victorian Ambulance Cardiac Arrest Registry 2015-2016 report, 5,899 instances of OHCA were attended to by Victorian ambulances, putting the rate of OHCA at just over 99 events per 100,000 people. This average obscures the gap in occurrences between metropolitan and rural Victoria, with incident rates of 89.7 per 100,000 and 128.6 per 100,000 respectively. Dr. Ben Beck, writing on behalf of the Managing Committee of the Australian Resuscitation Outcomes Consortium (Aus-ROC), points out that a culture of continuous improvement in the care of OHCA patients has emerged, and with it a re-evaluation of the effectiveness of care methods. Bystander CPR has amassed considerable evidence for its efficacy under this scrutiny: OHCA sufferers who received bystander CPR both survived the event (29%) and were discharged from hospital alive (12%) at rates significantly higher than those who didn’t (23% and 6%), and were 11 times more likely to present with a shockable rhythm (which is associated with higher survival outcomes).
Despite the effectiveness of bystander CPR for improving the prospect of surviving OHCA, only 40% of OHCA sufferers receive bystander CPR. Significantly, recent research by Monash University academics indicates an association between areas with lower bystander CPR rates and lower levels of CPR training. Of those surveyed who were not trained in CPR, most cited two reasons for not undergoing training: 1) never having thought about it, and 2) lacking the time to do it. However, just under half of these respondents indicated that they were willing to learn CPR through training kits. The researchers conclude from these considerations that increasing rates of CPR education will potentially exert a positive influence upon OHCA survival rates. This is unsurprising, given that bystander CPR is recognised by many professional bodies as an ‘early link’ in the ‘chain of survival’; bystanders intervening with CPR upon recognising OHCA increases the likelihood that the patient can undergo defibrillation (as aforementioned), which thereby increases their likelihood both of surviving the incident and leaving medical care alive. If that early link is severed, the likelihood of those which follow it occurring falls away too.
Almost all who read this recognised at the outset that the cost of a ruined tracksuit is worth a human life saved. The cost of becoming trained in bystander CPR, therefore, pales into insignificance when you consider both how often OHCA occurs and how effective bystander CPR is at preventing it from resulting in death. The benefits go beyond the individual; the more people who know how to administer CPR, the higher the general chance of survival for OHCA sufferers. Learning this key skill is a very small way of making a major impact upon the world.