The A (& E) Team
by Marika Azzopardi
Dr Mary Rose Cassar and Dr Anna Spiteri are two female doctors with multiple roles. They are the first two female registrars at the Casualty Department of St Luke’s Hospital, practicing what is a relatively new specialization. They are also members of the two year old Malta Resuscitation Council, making headway into an area they feel strongly about.
In a bid to promote resuscitation training in Malta, not only within the medical profession but also for lay people, they are working to see that basic life support is taught as far and wide as possible.
“Basic life support is fundamentally about saving the lives of cardiac arrest sufferers, also with the use of defibrillators. Whilst many people believe this apparatus is only operated in a hospital setting, this is far from true. If we look abroad, defibrillators are placed in public places and may be used by an initial witness of collapse. In the United States, cardiac sufferers are encouraged to possess the apparatus themselves and have a next of kin trained in its operation.” Dr Cassar proceeds to comment how once the heart stops, the patient is facing a critical first five minutes that may cost his or her life. Whilst ambulances are at least five minutes away and heavy traffic generally impedes an immediate arrival, those precious five minutes of time are especially valuable.
The Malta Resuscitation Council is specifically concerned about the high rate of cardiac arrests witnessed in emergency departments and the ensuing rate of deaths caused by heart attacks – an estimated one fourth of all deaths are due to cardiac arrest, per year. This substantial statistic indicates an urgent need to give this problem due attention.
Whilst coronary disease is on the increase in Malta, training people in life saving strategies can be extremely cost effective, if only because it could save lives.
“In our work we are finding that high cholesterol levels are increasing the incidence of heart attacks in people who are still in their thirties. We’ve seen cases where youths as young as 18 years suffer heart attacks. The typical ‘dolce vita’ of Mediterranean living is being overcome by extremely high levels of stress that is acerbating the situation.”
“People trained in basic life support are extremely valuable. We have so far delivered five 5-hour courses during 2006 in BLS/AED (Basic Life Support/Automated External Defibrillator). We are now planning two more by end of April 2007. The course targets GPs, physiotherapists and lay people. Eventually we aim to go to the Police and Rescue personnel, all of whom recently voiced their interest and requested the delivery of a specific course for their staff.” The ultimate aim is to conform to EU standards which indicate that life support trainees and apparatus be present in any location where people may converge.
Dr Spiteri emphasizes that courses are maintained as simple as possible, “This is especially true where they are aimed at lay people. We want to help people retain their skills to be effective life savers. For the moment, our present situation only allows for a two-day course to be delivered once yearly, mainly because of logistic restraints. In fact, we would be facing a considerable problem once we decide to organize more frequent courses.
Another recent accomplishment was the delivery of the EPLS – European Paediatric Life Support – course which stretched for a week and was indicated for staff working with children in a hospital environment.
The two doctors are also proud of the fact that during November 2006, a pilot course was held in Malta which was chosen as an ideal country to host it on a European basis. “The course was very popular and its results were published in international medical journals. It was indicated for doctors working in hospital trauma settings such as emergency doctors, anaesthetists and surgeons. Following the success of the course, which is definitely the most advanced of its genre to be presented ever, it is going to be repeated in other European countries.”
Malta is facing a situation which calls for an urgent standardization of the available resuscitation methods in order to ensure the appropriate care for all patients.
Future plans include the organization of further specialized courses being offered to more people, more often. However the biggest hurdle to overcome remains the financial one. Ideally this type of training would be available in Malta, and the council is working towards a scenario which sees Maltese-trained personnel delivering courses on a nation-wide basis. “In some cases we had to bring in 10 externals to run one particular course, and that makes for extremely high costs. We do receive the occasional sponsorship by government to cover part of the costs, but it is not always enough. This means that many local doctors still have to shoulder high expenses to travel abroad and be trained elsewhere. Ideally it would all be available here – widening the life-saving potential on our Islands, reducing financial burdens to the cardiac department and eventually, why not, exporting the training and skills elsewhere.”
For further information on the Malta Resuscitation Council check out www.resus.org.mt or call 25954033/25952096.