Basic life support care

As all Malaysian private doctors know, we have a new Private Healthcare Facilities and Services Act 1998 and Regulations 2006, effective 1st May 2006. One of the regulations (Regulation X) deals with giving basic emergency medical care. The equipment requested of the GP includes ECG, Defibrillator, IV drip sets, and urinary catheter. We have been in negotiation with the Ministry of Health, to amend the regulations to require only Basic Life Support (BLS) care. This is of course what is required if someone should collapsed outside the clinic or by the roadside.

What is BLS ? It is the therapy instituted, to revive the cardiovascular and respiratory system. A cardiac collapse occurs when the circulation suddenly stops. Should that occur near you, you should quickly establish the situation by feeling the pulse, and also observe if the respiration is OK. Needless to say, that when the CVS stops, the respiration also stops.

Once you have established that the subject has no pulse and respiration, quickly lie the patient flat raising the lower limbs if possible. Even as you lie him/her flat, remove his shirt. While doing so, summon for help, including passer-bys or nurses nearby. Call for the nearest ambulance. After removing his shirt, thump the chest with a stiff blow to the mid-sternum using the ulnar aspect of the hand. This sometimes restarts the heart. If still no response, we should begin mouth to mouth respiration, with intermittent chest compression. Maintaining airway is of utmost importance. I like a one to one ratio, between breathing and chest compression. Go on for about 10-15 mins at least. If there is no response and his/her pupils are dilated and unresposive, then abandon the BLS. Sometimes we go on for about half an hour. If he/she should respond, then admit him to intensive care ward of the nearest medical center (government or public) for further medical and nursing care. Please phone to inform the medical center ahead that an ill patient is on the way. It is important to "pass the case" over.

In line with the new PHCFS act and regulations, all clinic should have a tank of oxygen with an appropriate size oxygen mask, and a set of oro-pharyngeal airway. REMEMBER maintain airway, restore circulation through chest compression. BLS is actually quite easy. Of course, for those not familiar with BLS, the PMPASKL will be holding workshops. It is true that if all GPs can do BLS, that will be a step forward in raising the healthcare standards of Malaysia.