To the Editor:
We have read with attention the letter signed by Dr. Fernández Bergés, and we agree with his suggestions. We would like to add some comments.
1. In spite of the fact that there is constant improvement, in Spain the training of doctors, medical students, paramedics and the general public to identify and treat a witnessed cardiopulmonary arrest is insufficient; it is neither regulated nor controlled. It could and must be improved.1,2 This same problem exists in almost all countries.
2. The correct education of the bystander who witnesses cardiopulmonary arrest and the quality and speed of the outpatient emergency systems are not sufficient to improve the patient prognosis.3 New strategies are needed that are more effective that the current ones. Among these are:
Identification and adequate treatment of high risk patients, principally through the use of myocardial revascularization, implantable defibrillators and beta-blockers.4-8
Consider all patients with precordial pain as potential immediate victims of sudden death, until the diagnosis of acute myocardial infarct is made.9 This implies immediate electrocardiographic monitoring of all the patients who come to the emergency room with precordial pain.
Instruct the public on the danger of sudden death in the setting of certain symptoms (precordial pain) and how to ask for adequate help.10,11 This strategy includes the recognition of the need to know how seek help before it is needed.
The availability of semiautomatic defibrillators in public places, together with the education of adequate medical and non-medical personnel.12 This measure, still controversial, could be converted into one of the most effective strategies in the battle against witnessed sudden death.
Some of the measures may seem extreme, but the present measures are insufficient, which is not to downplay the importance and quality of the efforts made by outpatient emergency systems, which in most cases simply cannot get there in time.