Heart : More CPR Training Needed in Poor Neighborhoods

Alan Bavley, The Kansas City Star

It's a life or death situation: Your heart stops pumping blood. You need CPR to survive, but will you get it?

It may depend on the wealth or the racial makeup of the neighborhood you're in.

That is the disturbing finding of a study published today in The New England Journal of Medicine. It found that people who went into cardiac arrest in a poor, black neighborhood were half as likely to get CPR from a bystander before emergency personnel arrived as were people in middle-income or wealthier white neighborhoods.

"If you are in a black neighborhood or a poor neighborhood, it was one strike against you," said Paul Chan, a heart specialist at St. Luke's Hospital and one of the study researchers. "If you were in a poor and black neighborhood, it was two strikes against you."

Chan said it isn't race or wealth that makes people more or less willing to help save a life. It's most likely how prepared they are to do it. More and better-designed CPR training programs aimed at poorer and minority communities are needed, he said.

"There needs to be political will to do this in the schools," Chan said. "There has to be an investment and creative ways to get it into neighborhoods."

During sudden cardiac arrest, the electrical system that controls the heart malfunctions and the heart no longer can effectively pump blood. Death occurs within minutes unless cardiopulmonary resuscitation or a shock to the heart gets blood flowing again.

Emergency medical services are called to about 300,000 cardiac arrests every year in places other than hospitals. Survival rates range from 0.2 percent in Detroit to 16 percent in Seattle. Nationwide, fewer than a third of people who suffer out-of-hospital cardiac arrest get CPR from a bystander.

The new study crunches emergency medical services data on cardiac arrest from 29 locales, including Kansas City. In neighborhoods where household incomes averaged $40,000 or more and more than 80 percent of residents were white, 37 percent of people in cardiac arrest received CPR from a bystander. But where incomes were lower and more than 80 percent of the residents were black, only 18 percent of cardiac arrest cases got bystander CPR.

Higher-income integrated neighborhoods had CPR rates similar to those of the wealthier white neighborhoods, the study found. Lower incomes brought declining CPR rates in both integrated and predominantly white or black neighborhoods.

In Kansas City, about 20 percent to 22 percent of people in cardiac arrest get CPR from a bystander.

"We also consider that very poor," said Joseph Salomone, medical director of the city's emergency medical services. "That percentage should be in the 90s, not the 20s."

Upping the percentage would save a lot more lives: Overall, only about 11 percent of people who go into cardiac arrest in Kansas City survive; but when they receive CPR from a bystander, the odds go up to 40 percent.

Salomone said opportunities for CPR training may account for differences in neighborhood adoption of bystander CPR.

The data in the new study show that people were most likely to get bystander CPR when they went into cardiac arrest in places such as recreational facilities, schools or industrial buildings where it's likely that many people have CPR training.

But most cardiac arrests occurred at home, the study found. And people at home were no more likely to get CPR than people who collapsed on the street.

That suggests it's not the callousness of strangers keeping people from getting CPR, Salomone said, but rather "being afraid or not knowing what I should do."

Some people may be squeamish about touching a "dead" body, or may be afraid of hurting the person by doing chest compressions, or may fear infection giving mouth-to-mouth resuscitation, Salomone said.

Since 2006, Kansas City's MAST paramedics have been performing cardiac arrest resuscitation using vigorous chest compressions alone. Bystanders who called 911 are instructed to use this hands-only technique, which has proved as effective as conventional CPR.

"Even with that, you get folks who are resistant," Salomone said. "We're struggling with why it's been slow to catch on."

Salomone believes part of the solution for overcoming peoples' reluctance to use CPR is to bring instruction into schools.

"... The sooner you're introduced to it and the more that it's reinforced, the more likely something will happen. We know even kids can do it," he said. "It's exposure, exposure, exposure."

Several states mandate CPR training in schools. This year, Missouri lawmakers considered a bill that asked school districts to make CPR training a high school graduation requirement.

But money for such programs has been tight.

Paramedic Jeff Johnson quit his job last year with Johnson County's emergency medical services after it stopped funding his role in CPR education and training in schools and other venues.

"I personally felt it was a very important thing they should do for the community," he said.

Johnson now provides CPR training through a program sanctioned by the American Heart Association. And while heart association-affiliated programs reach thousands of people in the Kansas City area each year with free CPR instruction, "they will more often than not charge for training," he said.

The American Red Cross of Greater Kansas City charges for its CPR classes; it doesn't have the resources to provide classes for free, said Laura Jackson, who coordinates the training.

The Red Cross offers a limited number of scholarships for CPR training, but "more private foundations and companies need to sponsor scholarships for people," Jackson said.

To Salomone, charging for training is "counterintuitive to what we want to accoplish."

He said it's much less expensive to teach hands-only CPR than the conventional CPR, with both hand compressions and mouth-to-mouth resuscitation, that usually is taught in training programs. Hands-only training takes less time and requires less equipment.

Kansas City is applying for a grant from the Health Care Foundation of Greater Kansas City to equip Fire Department vehicles with education materials so firefighters can make hands-only CPR a regular part of their visits to schools, health fairs and block parties.

"The hope is that will be one more contact, one more reinforcement" to perform CPR, Salomone said. "This is quick, simple, easy, and you can save a life."

To reach Alan Bavley, call 816-234-4858 or send email to abavley@kcstar.com.

(c)2012 The Kansas City Star (Kansas City, Mo.)

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