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Nov
26

Basic Life Support at the University of Birmingham

One of the most pleasant (and I have to say most surprising) experiences as Dean is to witness first-hand the great things Students get up to outside “working hours”. Two weeks ago it was my own 30-year reunion back at Edinburgh Medical School and with it the opportunity to meet up with old friends. We had a great time for sure but I cant ever recall our year being so actively involved in extracurricular activities. Perhaps the most inspiring of these in Birmingham, is the Birmingham Life Support Scheme (BLS).

About a year ago I went to my first BLS meeting – on a rainy Monday evening in the Medical School – and was quite frankly overwhelmed with what I saw. Peer-led teaching of the highest quality (overseen by Professor Julian Bion and Dr Jonathan Hulme), organised brilliantly, that was delivering essential life support training for College Students. I was so proud of what I had witnessed – and wearing my hat as a British Heart Foundation trustee – that we began the process of endorsing BLS activity by the British Heart Foundation (BHF). BHF had invested in an advertising campaign led by Vinnie Jones highlighting the merits of hands only CPR.(http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr.aspx#&panel1-1) and their enthusiastic support – with financial backing – for BLS as part of a wider community outreach programme has been most welcome.

All of this then became a reality in late August when Professor Kate Thomas called me urgently about one of our 4th year Medical Students who had sustained a cardiac arrest…

‘Out of hospital cardiac arrest’ describes a condition of sudden collapse and loss of effective cardiac output when outside of a hospital environment, and requires immediate intervention to prevent loss of life. It is a medical emergency affecting 37.72 out of every 100 000 people each year.1

This condition has been in the public spotlight over recent months following thousands witnessing the sudden collapse of Mr Fabrice Muamba, the Bolton midfielder, whilst playing in an FA cup quarter final match on a seemingly normal Monday evening.2 Immediate advanced medical care including cardiopulmonary resuscitation (CPR), rapid defibrillation, and expert treatment at the London Chest Hospital resulted not only in his survival, but his discharge from hospital just 30 days later following an ‘incredible recovery.’3

Whilst a remarkable story for many of us, for a group of healthcare students here at the Medical School this emergency situation recently also became a startling reality. Earlier this year Rajan Chaudhry, a fourth year medical student, suffered an out of hospital cardiac arrest whilst in the company of his friends. Thanks to their rapid intervention through provision of Basic Life Support his life was saved, and he has kindly allowed us to share with you his incredible story:

“On 14th of August this year, I was participating in a Bhangra dance class which I was frequently involved in. Like any other day, I felt completely normal and seemed it to everyone else. From what I have been told, I collapsed unexpectedly halfway through the dance routine. At this point, I was lucky to have friends trained in BLS present as fellow dancers. They promptly began BLS, and the ambulance arrived within 3-4 minutes. I had gone into ventricular fibrillation and subsequently had a cardiac arrest. I was defibrillated by the ambulance crew and taken to City Hospital, where I remained sedated on the Critical Care Unit for 5 days. After a couple of further weeks of tests and transfer to the QEHB, all investigations into the reason behind my event came back clear, and it was decided that an implantable cardioverter-defibrillator (ICD) should be fitted. Now I am recovering, having taken a year out from the medical course.

Given the situation, I cannot say what it was like to witness what my friends described as, “the worst experience of their lives.” However, the ambulance crew told them that the BLS which they performed and the decisive action which they took, bought me the valuable minutes I needed to survive. I cannot commend my friends enough for their quick-thinking and composure and there are obviously no words to describe how important their actions that day were to me. I was told my chances of surviving were less than 10% in my situation, and I owe them in a way I can never repay. Having been through this experience, I now truly count BLS as one of the most important things I have ever learnt, as it is the reason I am still here and able to write about what happened to me.”

The result of the actions that Rajan’s friends took cannot be overstated. Evidence shows us that chances of survival can be more than doubled in cardiac arrest victims who receive prompt, effective bystander CPR whilst awaiting the arrival of an ambulance.4, 5 Unfortunately survival rates for cardiac arrest victims still remain low, partly because too few people are adequately trained in life support techniques such as CPR and therefore unable to help those like Rajan when they are most in need of skilled intervention.

Given this, many organisations are attempting to reduce mortality following cardiac arrest through education. The British Heart Foundation’s HeartStart training scheme has, for instance, trained 2.6 million people to date in how to respond to a cardiac arrest and other potentially life threatening conditions.6

As the healthcare professionals of the future, we should all have a role in leading the drive to increase survival following cardiac arrest. Here at Birmingham we recognise the importance of training students at an early stage to deliver basic life support (BLS) so that – whether in a hospital environment or out with your friends – you can act proficiently in emergency situations.

This is why if you are a first year medical, dental or physiotherapy student at Birmingham, you will take part in the College’s innovative and widely acclaimed BLS course over the coming academic year. This unique course, started 17 years ago by a group of third year medical students, is the only in the country which is completely peer led, assessed and tutored, and is the largest of its kind in Europe. This means that you will not only be taught by your senior student colleagues, but that you will also be examined by them. Each year almost 700 students are taught in this manner, over a 4 week programme leading to a European Resuscitation Council (ERC) accredited BLS/AED qualification. You will be taught how to deliver CPR, how to defibrillate patients using an automated external defibrillator, and how you should treat other life threatening conditions such as bleeding, choking and shock to develop the same key skills that Rajan’s friends were taught only a few years ago on the same course, and which they depended upon in extreme circumstances this last summer. We will also provide you with teaching on the very latest automated feedback manikins, so that we can ensure you leave us with an unrivalled early ability to save lives and care for ill members of the public.

Those who are interested may then join us for further training so that they can return in their second year of study as qualified ERC instructors to instruct the new first year cohort. A number of these students will subsequently be invited to return as examiners, whilst others may be provided with the opportunity to help in the running of this course as committee members and to conduct research on BLS guidance, teaching and techniques. This provides opportunity for these students to publish their novel findings in high ranking journals, and to travel to present these – we have for instance recently presented findings from six research projects at the Resuscitation Congress in Vienna, have previously presented in Porto, Portugal and will soon present a summary of our course at a major conference here in Birmingham.

We are proud at Birmingham of the world-class BLS training that we deliver. We believe that we provide the opportunity not only for students to become proficient BLS providers, but to grow and progress as teachers, assessors, leaders and researchers in a course designed so that it can better itself, update itself and be of the best use to the students that it teaches. We hope that if you are a first year here you will enjoy your time on the course, and that it will equip you with skills that will not only benefit you throughout your career, but that may benefit you tomorrow.

We look forward to seeing you on the course, and we hope that you enjoy learning these vital skills from our excellent team of student teachers. We hope too that this time next year you will be joining us to conduct research that shapes and alters resuscitation guidelines that are utilized across Europe.

The Basic Life Support Committee
Resuscitation for Medical Disciplines
College of Medical & Dental Sciences
University of Birmingham

Congratulations to all involved and living proof that everyone’s efforts around BLS makes a tangible difference. It really does save lives!

- Paul Stewart

(Particular thanks goes to to Rajan Chaudhry for sharing his experiences, and I know you will all join me in wishing him every success in the future)

The faculty, committee, examiners and instructors of the RMD Birmingham Basic Life Support course 2012-13.

References

1Atwood C et al. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005; 67; 1; 75-80

2BBC News. Bolton’s Fabrice Muamba collapses on pitch [online]. Accessed 2/8/2012. Available from URL: http://www.bbc.co.uk/news/uk-17418794

3BBC Sport. Fabrice Muamba: Bolton midfielder discharged from hospital [online]. Accessed 6/8/2012. Available from URL: http://www.bbc.co.uk/sport/0/football/17733022

4Ritter G et al. The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims. Am Heart J 1985; 110; 5; 932-7

5Gallagher EJ et al. Effectiveness of Bystander Cardiopulmonary Resuscitation and Survival Following Out-of-Hospital cardiac arrest. JAMA 1995; 274; 24; 1922-5

6BHF. Heartstart training [online]. Accessed 6/8/2012. Available from URL: http://www.bhf.org.uk/heart-health/how-we-help/training/heartstart.aspx

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