Providing immediate help can raise cardiac-arrest survival rates from 14% to 50%. SGH initiatives such as the Dispatcher Assisted first Responder (DARE) programme to raise cardiac-arrest survival rates in Singapore.
Original title: Doc on mission to boost CPR training
Ten minutes. What happens in this small window of time after a heart stops beating can mean the difference between life and death.
But often, it takes that amount of time, or more, for help to reach a cardiac arrest victim outside a hospital. The statistics are shocking.
More than 2,000 people a year suffer from out-of-hospital cardiac arrests here, when the heart suddenly stops pumping blood around the body, starving it of oxygen.
And that number is rising due in part to an ageing population, said Associate Professor Marcus Ong, a senior consultant at the
Singapore General Hospital's department of emergency medicine.
Now, only 13.8 per cent of these victims survive.
But immediate application of chest compressions and an automated external defibrillator (AED) – a portable device that can send an electric shock to the heart to try to restore normal rhythm – can lead to survival rates as high as 50 per cent.
That is why Prof Ong is Singapore’s biggest advocate for cardiopulmonary resuscitation (CPR) training.
Over the last decade, the 48-yearold has pushed for more people to be trained in CPR, including spearheading training sessions in schools, offices, community clubs and religious organisations through the Dispatcher Assisted first Responder, or Dare, programme.
The programme stems from the belief that only a well-oiled emergency system that links up the community, paramedics and hospital will help a victim survive.
“If you can get to the patient early, you can start CPR, you can start some blood flow to the brain or heart, you can use a defibrillator to help restart the heart, and the patient has a good chance of survival,” he said.
“On the other hand, every minute you delay, your chance of success decreases by 10 per cent, which means if your system is not working well, the patient has almost no chance of survival in 10 minutes.
“It is not an issue of the correct drug or device to use. There are multiple factors that need to line up.”
Since the Dare programme providing simplified CPR training was started in 2014, some 71,000 people have been equipped with life-saving skills.
With the help of Singapore Civil Defence Force dispatchers who give instructions over the phone, the percentage of bystanders performing CPR has risen from just 22 per cent of cardiac arrest cases in 2011 to 54 per cent in 2015.
Uncovering weaker links within healthcare systems and using scientific evidence to come up with solutions have been the core of his research over the past 20 years.
Prof Ong, who is also director of the Unit for Prehospital Emergency Care in the Health Ministry (MOH), initially wanted to be a lawyer.
But he was lured to medicine by the prospect of saving lives.While in national service after graduation, he enrolled in emergency medicine as a speciality.
He soon realised that some healthcare issues were systemic, and that he could help only one patient at a time as a doctor.
That was when he caught the research bug, as a way to reach many patients at a time. Now, 70 per cent of his time is spent in research. He also supervises students at Duke-NUS Medical School and advises MOH on prehospital emergency care.
To be effective, policies and the structure of healthcare services have to be evidence-based, he said.
“There needs to be a dynamic process where you collect data, evaluate evidence, implement (programmes) and re-evaluate them to see if they are making a difference,” he said.
He has led studies aimed at improving survival rates of out-of-hospital cardiac arrest victims, which include the trial of a technique that cools the body of someone who has suffered cardiac arrest to below normal body temperature.
When the cells are cooled, they do not need as much oxygen, which reduces the damage.
The “therapeutic hypothermia” treatment more than triples the odds of surviving, according to preliminary results.
Now his goal is to translate research into policy, and then into practice. “The last step is to get the man in the street to understand the motivation behind it,” he said.
Using CPR as an example, the father of three said people are told that they can be a hero or a good Samaritan if they learn CPR.
But the reality is that 70 per cent of cardiac arrests happen at home, said Prof Ong. “If you learn CPR, it is not for a stranger but for your loved ones. You are protecting your family, your colleagues and your friends,” he said.
His army-inspired method of sealing head wounds now used worldwide
As a trainee doctor about 20 years ago at Singapore General Hospital’s emergency medicine department, Associate Professor Marcus Ong often spent Friday and Saturday nights patching up people injured in drunken brawls.
Some would turn up with deep gashes in their scalp, having taken a glass bottle to the head. The patient would need his head shaved on both sides of the wound before local anaesthetic was applied and the wound stitched.
“The patient ends up with a bald patch – a souvenir from the night,” said Prof Ong, 48, who is now a senior consultant at the department.
Then he stumbled on something while reading an army handbook on medical emergencies in the jungle. He learnt that in the absence of medical equipment, a scalp laceration could be closed by tying a knot using hair from both sides of the wound.
He tried the method on a patient.
But the knot of hair and dried blood had to be cut after the wound healed, which still left a bald patch.
Using just tissue glue to close the wound prevented the hair from growing out properly, which also resulted in a bald patch.
So Prof Ong came up with another method – twisting the hair together over the wound and then holding the hair in position with glue. This allowed the wound to heal and the hair to grow out naturally, thus avoiding stitching and shaving. The degradable tissue glue could later be washed away.
A randomised controlled trial of 200 patients – half treated with the new technique and half with stitches – found that those treated with Prof Ong’s method healed faster and their wounds were less likely to develop infections.
The results were published in the Annals of Emergency Medicine, the first paper from Singapore to be published in the journal.
The technique, developed in 2001, was coined the Hair Apposition Technique or HAT. Today, it is used in emergency departments worldwide and taught to medical students.