911 INSTRUCTIONS Skipping mouth-to-mouth for chest compression

Experts say people are reluctant to give mouth-to-mouth resuscitation.
KANSAS CITY, Mo. (AP) -- Bystanders who want to help a heart attack victim are increasingly being told by 911 dispatchers to skip the mouth-to-mouth resuscitation and concentrate on giving chest compressions until medical help arrives.
Driven by medical surveys and continued public resistance to giving mouth-to-mouth, emergency medical groups across the country have either changed or are considering changing the traditional instructions given over the phone to untrained individuals helping a heart attack victim.
"If someone is going to do nothing because they are apprehensive about doing mouth-to-mouth, it is simple to tell them to find the middle of the chest and start pressing," said Dr. David Wald, a physician in the Department of Emergency Medicine at Temple University Hospital in Philadelphia. "That is better than nothing."
The reasoning is simple: A heart attack victim's chance of survival drops about 10 percent for every minute he or she does not get some type of help. Giving an untrained person instructions on performing mouth-to-mouth wastes some of those precious minutes, but it is relatively easy to tell someone how to properly do chest compressions.
Small chance
Wald said between 1,000 to 1,500 people die of cardiac arrest every day in the United States. The chances of saving heart attack victims is "realistically very small" because of several factors -- ranging from why the person collapsed, to how CPR is performed and how long it takes paramedics to arrive, he said.
But performing some type of cardiopulmonary resuscitation can expand by four minutes the window of time generally considered necessary for paramedics to respond and still have a chance at saving a victim, Wald said.
The changes are only for victims over age 18 whose hearts have suddenly stopped. Children and those who have stopped breathing because of such things as drug overdoses, drowning, carbon monoxide poisoning or allergic reactions still require mouth-to-mouth resuscitation.
In February, emergency medical directors in several cities -- including Los Angeles, Chicago and Dallas -- decided to make the change. And last week, emergency dispatch services in 17 cities and counties nationwide began a test of instructions from the National Academies of Emergency Dispatch that advise using only chest compressions on heart attack victims.
The American Heart Association also is studying the issue and will decide by January whether to change its guidelines.
Seattle study
Many proponents of the change cite a 2000 study done in Seattle that compared compression and mouth-to-mouth resuscitation with compressions alone. It found the difference in survival rates was not statistically significant, but compressions took less time and was the preferred method of bystanders inexperienced in CPR.
"What the study found was that bystanders started the compressions about 11/2 minutes earlier and it was easier to follow the instructions," said Dr. Paul Pepe, chairman of emergency medicine at University of Texas Southwestern Medical Center at Dallas. "It's just intuitive to know that it is easier to do one thing in that situation than trying to do both."
Circulates oxygen
Compressions -- in which a person pushes down on a breastbone and then releases about every second -- help circulate the oxygen that remains in the body after the heart stops. Stopping the compressions to breathe into the mouth slows that circulation. But after four to six minutes, some mouth-to-mouth is necessary to get more oxygen into the victim.
"The issue is, can you provide the oxygen for the tissues for four to six minutes until the paramedics get there?" said Dr. Jeff Clawson, of the National Academies of Emergency Dispatch.
"Eventually you have to recharge the empty oxygen tank by breathing."
The academies' new protocols tell bystanders to give the victim about 400 compressions before beginning mouth-to-mouth.
Wald said the concern about contracting a disease while giving mouth-to-mouth is "completely unsubstantiated," but the fear still exists, especially when a stranger is involved.
"People are just very apprehensive about touching someone they don't know," he said.