Confidence to care in an emergency
Members of the general public in Pakistan are often reluctant to try and help someone suffering a sudden cardiac arrest (a potentially fatal heart condition where the heart suddenly stops due to an abnormal rhythm) or similar medical emergency not because of a faulty moral compass but because of the ever present fear of litigation, explaining the situation to the police and the ensuing visits to the courts, should the casualty not survive.
The result is that in most cases the public will adopt a hands-off approach and play the role of silent bystanders or worse, amateur paparazzi. In the event of a sudden cardiac arrest, time is of the essence and according to the guidelines published by Resuscitation Council (UK) in 2010, it is advised that ambulance clinicians may stop resuscitation if all the following criteria are met:
- 15 minutes or more have passed since the onset of collapse
- No bystander provided CPR before arrival of the ambulance
- There is no suspicion of drowning, hypothermia, poisoning/overdose or pregnancy.
- Asystole (no cardiac electrical activity) is present for more than 30 seconds on the ECG monitor screen.
Considering the average response time of Pakistan’s main emergency ambulance service (rescue 1122) is seven minutes or less, it is important to note that without any resuscitation attempts the casualty is likely to suffer from Anoxic Brain Damage (injury to the brain due to lack of oxygen) and without sufficient oxygen brain cells will begin to die after four minutes.
According to the 2004 statistics published by the WHO; in Pakistan sudden cardiac arrest accounts for more than 80,000 deaths per year, that’s more than 200 deaths every day and 1 every minute! Often it is the victim(s) or witnesses of an accident or medical emergency that are in a position to provide immediate aid. The resulting delay in emergency care could mean the difference between life and death of a casualty.
In many parts of the world lawmakers have understood the importance of citizen first response and developed “Good Samaritan” laws. These laws protect people who voluntarily help someone in an accident or medical emergency with the provision of basic care such as first aid or CPR.
The only law in Pakistan that provides a volunteer immunity against certain liabilities is the Punjab Emergency Services Act of 2006, wherein article 19 states:
- An act or omission committed by an employee of the Service, or a volunteer, shall not, if committed in good faith for the purpose of exercising the functions of or assisting the Service, subject such employee or volunteer personally to any legal action, liability, claim or demand.
- All actions, proceedings and claims against any such employee or a volunteer in relation to any act done or omitted to be done in good faith, shall be defended and indemnified by the Service.
- Subject to the rules, any information received by the Service shall be deemed to be the privileged communication between the informer and the Service: Provided that the Director General may, in a special case and by order in writing, waive such privilege.
It is important to note that the above privilege only applies to volunteers of the Rescue service and not to an ordinary member of the public. Whilst the services provided by agencies like Rescue 1122 are outstanding, there will never be enough ambulances or EMTs to answer every call that comes in.
Given the present safety and security conditions of Pakistan, it is vital for public safety that the Pakistani emergency services and law makers consider proposing a bill similar to the “good Samaritan” laws worldwide; which would provide legal cover / immunity to citizens who voluntarily and in good faith, without malice or ill intent provide care to the sick and injured, prior to professionals arriving on the scene.
With legal cover provided, the local emergency services and non-governmental organisations/community based organisations could provide training/capacity development to equip people with basic knowledge of what to do should an emergency occur. An example of these simple steps are;
- Dynamic Risk Assessment
- What number to dial
- What information to give the emergency dispatcher
- What immediate actions to take
- Basic CPR, First aid and safety measures.
This would not only create an environment where people would have the confidence to care, but would also help promote civic pride and citizenship among the general masses of Pakistan and help save precious lives. It would also take alleviate pressure from the strained emergency services of the country.