Medical aspects of lay resuscitations in Rotterdam.

In the Rotterdam system of prehospital care for patients with circulatory failure, the cardiopulmonary resuscitation (CPR) training programme for lay persons contributes to the first link in the chain of care, i.e. the period of time spent awaiting the arrival of professional staff. In this paper we describe some of the medical aspects of this programme. The material used was obtained in a study of 5312 trainees who had followed a CPR course. Case histories were reconstructed of 91 victims who had been resuscitated by 109 respondents. At least 20% of resuscitated persons had collapsed as a result of non-cardiac causes. In this category the longer term survival rates were relatively the most favourable. In several instances the indication for resuscitation had been incorrect, while the technical proficiency in the delivery of CPR was often inadequate. We conclude that one course is insufficient for the development of the required 'skill'. We also conclude that the courses should dwell more elaborately on the non-cardiac causes of collapse, particularly in training programmes addressing the public at large. Attention is drawn to the need of designing and implementing special courses for family members and relatives of persons known to be cardiac patients. The need for continuing evaluation, involving active contributions from lay resuscitators, is underlined.