by S. Todd Stolp MD
©February 2008
Public health experts often spend their waking hours contemplating disease prevention in terms of primary, secondary and tertiary prevention. “Primary prevention” represents steps that can be taken by the general public to prevent a disease from occurring in the first place in an otherwise healthy person. In heart disease, avoidance of smoking and controlling cholesterol levels by eating a healthy diet are examples of primary prevention. “Secondary prevention” involves recognizing individuals who have an increased risk of disease and intervening to lower that risk. After discovering an elevated cholesterol level on a screening blood test, instituting weight loss and/or treating the condition by taking a cholesterol-lowing medication would be considered “secondary prevention.” Finally, “tertiary prevention” is the process by which a person who has already contracted an illness can take steps to prevent the disease from becoming worse. Thus, a person who has already suffered a heart attack can undergo a cardiac catheterization and have a blocked artery reopened with a balloon and/or a tiny flexible tube called a “stent” can be placed to keep the artery open. This would be a tertiary prevention for this person’s heart disease problem. Recognizing February as American Heart Month gives us an opportunity to discuss a very important type of “tertiary prevention” that can be utilized by every person to improve the outcome of heart attacks in the general population: learn Cardiopulmonary Resuscitation (CPR).
First, a reminder about the important principles of CPR. In 2010, the American Heart Association changed recommendations to reflect the importance of cardiac compressions in CPR. Instead of the previous recommendation (A=Airway, B=breathing, C=cardiac compressions), the new protocol calls for starting with “C” (“circulation,” and “cardiac” or “chest” compressions), and THEN addressing “A” (airway and air movement), and finally “B” (breathing for the patient if air is not moving). When you witness a person who collapses in front of you, if the person does not respond or move in response to your brief check, call 911 or send someone to call 911 and see if there is an Automatic External Defibrillator (AED) in the vicinity. An AED device will usually be labeled in a box mounted on the wall, often with a first aid sign or a red cross.
Then check for a pulse or cardiac activity (Circulation). If no pulse within 10 seconds of feeling, begin chest compressions at a rate of 100 compressions per minute. For lay rescuers, only hands-on CPR without administering breaths is recommended. These 2010 recommendations changed from previous protocols because too many rescuers were delaying chest compressions to administer breaths.
If a trained individual is administering CPR and chest compressions have already been instituted, attention to the airway and breathing (Airway and Breathing) follows, depending upon the training of the professional and the equipment that is available. If the person was eating at the time or collapse or showed evidence of choking prior to collapse, remember to consider that a juicy bite of steak just might be the culprit. In this case, you may need to administer an abdominal thrust, also known as a Heimlich maneuver.
The chance of survival for a victim of sudden cardiac arrest can be doubled by the quick institution of CPR. According to 2017 Heart Disease and Stroke Statistics, only 40 to 50% of victims of out f hospital cardiac arrest receive CPR. Given that the time interval for EMS arrival is often 7 to 8 minutes or longer and that survival falls 7% to 10% for each minute without CPR, the lack of bystander CPR has a large impact on outcomes.
If given a choice, public health officials will always choose primary prevention over tertiary prevention, since prevention of disease in the first place is always a better deal. However, no good communitywide plan is complete without having a way to help victims of illness, including victims of heart attacks. One of the best gifts you can give your community may be to train yourself in the administration of CPR. As you go about your day today, consider that any one of the people you meet could be either a person whose life you might save, or perhaps they may be your rescuer.