1. Pre-hospital Resuscitation K.S. Chew School of Medical Sciences, Universiti Sains Malaysia What’s new after “Guidelines 2005”?

2. Introduction (Cummins et al. 1991) Chain of Survival Early ALS Early Defibrillation Early CPR Early Recognition and Activation of EMS

5. Another piece of evidence? But…does it fit??

6. Four Main Key Points

11. Early Recognition

14. Early Activation of EMS

15. www.999.gov.my 991 – Civil Defense Dept; 994 – Fire and Rescue By January 2008, all calls to 991 and 994 will be re-routed back to the 999 emergency call center

16. Prank Calls In 2006, 98.9% of all emergency calls received turned out to be prank calls Section 233, Communications and Multimedia Act 1998 - the penalty for misuse RM50 000 fine, and/or one year's jail The STAR, 25 th October 2007

17. Early CPR

23. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 2007; 369 (9565):920-6.

24. Lancet 2007; 369 (9565):920-6 72% 18% 11%

31. Ultimately our aim is to get more public member to perform bystander CPR!!! Not just knowing.. but willing

33. SOS-KANTO Study

34. Early Defibrillation

36. Introduction: BIPHASIC Trial (Stiell et al. 2007)

38. BIPHASIC Trial

39. BIPHASIC Trial If only a single shock is required, NO DIFFERENCE either using a lower or higher energy level

40. BIPHASIC Trial When multiple shock required, then higher energy escalating level is better

43. Back to square one?

44. Question we may need to answer in the future is Should we start with ONE, SINGLE, HIGHEST energy level for biphasic waveform? And what is that level of energy?

45. Early ALS

53. Results

55. Wasting Of Resources In Transporting A so called “Futile” Cardiac Arrest Case? REALLY???

57. Can Our Paramedics Be Reliably Depended Upon To Terminate Resuscitation and sending the patient to mortuary? … or even to start resuscitation?

59. Conclusion

60. What Would The Future Be In The Area Of Pre-hospital Resuscitation ? Within the Malaysian context?

61. Looking At Things From Different Angles Improving ambulance response time Upgrading paramedics status Educating the public regarding CPR through campaign in mass media Purchasing new equipments – airway gadgets, CPR devices, etc Organize more BLS course A single universal access number Simplify the technique of effective CPR Placing more AEDs in public

64. Termination of resuscitation in the field? That I am not so sure! Most probably still a long way ahead

65. A Tale of Our Very Own

69. Visit http://emergencymedic.blogspot.com/ or http://perubatankecemasan.blogspot.com/