How to deal with cardiac arrest according to the US model... Prof. Radosveta Wells in front of FACTS

Four doctors from the Emergency Department and four cardiologists from the Cardiology Clinic of UMBAL “ Tsaritsa Joanna – ISUL“ completed a course in cardiopulmonary resuscitation for medical personnel. The initiator of the training is the head of the Cardiology Clinic of UMBAL “Tsaritsa Joanna - ISUL" Art. cor. Prof. Dr. Asen Gudev and the Department of Emergency Medicine of MU-Sofia at the hospital. The Bulgarian medics were trained by two lecturers from overseas, among them the Bulgarian Assoc. Dr. Radosveta Wells, who is the program director of emergency medicine at Texas Tech University Health Sciences Center El Paso. Here is what she shared with FACTS.

- Prof. Wells, how important is it for an emergency physician to be able to recognize the state of cardiac arrest in order to provide adequate care?
- It is extremely important because the first 5-10 minutes decide whether that person will survive or not. One way to make this possible on a mass scale is to implement a standardized approach.

- What are the symptoms that the emergency medic should see to know what it is?
- In the US, all doctors, nurses, paramedics, pharmacists, medical students who have contact with patients who may or are in cardiac arrest go through standardized training, through a course that we had the pleasure of conducting in 2 days in ISUL. This course is mandatory for us.

- You mean in the US…
- Yes, on such a course knowledge is renewed every two years.

- And how are things in Bulgaria?
- I can't say exactly how it is in the whole of Bulgaria, because now the course we held is being held for the first time. In the USA, it is organized by the American Heart Association and now we - with my colleagues - had to request permission from the American Heart Association to conduct this standardized course in Bulgaria.

- What do you pay attention to and what is of interest to Bulgarian colleagues?
- The first is recognizing the emergency of cardiac arrest or conditions that can lead to cardiac arrest, trying to prevent cardiac arrest, and also what should be the immediate intervention in cardiac arrest in a standardized approach and with algorithms that memorize and practice practically in a simulated environment in the course. And the ability to work in a team is important, so that everyone who has this knowledge can organize a team to take life-saving action within minutes.

- How is cardiac arrest recognized?
- The first steps an emergency physician can take to help save a person in cardiac arrest is to recognize that the person is unconscious, that there is no or no pulse, and to immediately begin cardiopulmonary resuscitation, with chest compressions and to immediately find a way to find a defibrillator. It is important to say here that the more automatic defibrillators there are in public places, the more people know how to do chest compressions, the more lives can be saved.


- We saw this clearly at the time of the last European football championship, when the Danish football player Christian Eriksen collapsed on the field. Only the quick reaction of the medical teams saved him…
- Yes. The people who gave him first aid were not only trained, but also knew how to work as a team and what to use. That saved him. And in this course, which we held at ISUL, for which I am very grateful to Professor Grudev and Professor Kinova, and also to the Bulgarian Cardiology Society, for the opportunity to do it, this is exactly what we taught.

- How many more people who go into cardiac arrest do you see in your practice?
- This is a difficult question because there are regional differences. What we do know is that through these interventions, especially in in-hospital cardiac arrest, when these algorithms are followed, the chance of survival is much greater, and not just survival, but discharge from the hospital for a person who has had a cardiac arrest. arrest. When a person has a cardiac arrest outside the hospital, it is much more difficult to survive. And this is the reason why a program is being developed to train paramedics who are trained to provide first aid. Again, I'll go back to the fact that it turns out to be extremely important to have an adequate response in the first 5 to 10 minutes. They decide human survival.

- Heart disease is affecting more and more people. Why does this happen, what is the reason for this?
- There are many factors and they are regionally determined. There are people who are not treated for diabetes, hypertension, cholesterol, smoking, stress... All of these things are risk factors for developing cardiovascular disease. Also not recognizing the first symptoms of a potential emergency. If the patient does not seek help in time, later the intervention has a lower chance of success.

- When it is said that a person has high blood pressure, people do not take it very seriously. What advice would you give? How often is it good for a person to have a preventive examination to monitor the condition of his heart and keep in good condition?
- At least once a year it is good to have a preventive examination. Checking blood, pulse, etc. What is important here is the age of the patient. If we're talking about 20-year-olds, it's one thing. If we are talking about a person over 50, it is different. Especially after 50 years, it is good to have blood tests. It is difficult to say after how many years a person needs to pay more attention to his health, because there are areas where people over 30 already have heart problems. In other areas, people do sports, don't smoke, eat properly, and there we have a completely different epidemiology of the disease. There are standardized approaches, but in each country and each region they are different.

- Once a year to a cardiologist. So let's understand…
- At least let the personal doctor examine us. And if he or she already considers that there is a need for more serious intervention by a specialist – either cardiologist, urologist, gastroenterologist, to guide us.

- Are you seeing an increase in heart disease in the area you work in the US?
- Again, I will share that it is difficult to say, because where I live, there are many migration processes, many people move often, many people change jobs every few years. Also important, in the US, as elsewhere, the COVID pandemic has lowered life expectancy. This was not only related to COVID, but also to other factors, including the fact that prevention decreased.

- People stopped going to the doctor…
- Yes. In all age groups, the incidence increased because children's immunizations were missed because many people did not have their routine examinations. The pandemic has had a very big impact and we are still in the process of recovery.