On October 30, Kamal Gautam (65), Vice-Chairman of the General Federation of Nepali Trade Union (GEFONT) affiliated with CPN (UML), was giving a speech in front of the Electricity Authority office in Bhairahawa. In the middle of his speech, he suddenly collapsed to the ground. His friends panicked and were confused when he fell unconscious. He was immediately taken to the nearby Crimson Hospital. However, the hospital pronounced him dead. The cause of his death was ‘Sudden Cardiac Arrest’, meaning the sudden cessation of the heartbeat.

Gautam, a resident of Jyotinagar, Butwal, had traveled to Bhairahawa to protest the cutting of electricity to industries due to the trunk line dispute. His health was fine before attending the demonstration, so no one could have anticipated the incident.

Cardiologist Dr. Prakash Raj Regmi says that if someone’s heart suddenly stops working outside a hospital or in a place without emergency medical services, the immediate administration of ‘CPR’ (Cardiopulmonary Resuscitation) by the people around can save the patient’s life.

CPR is defined as the emergency treatment procedure that provides artificial assistance to the heart and breathing to save a patient when the heart stops or breathing ceases.

According to Dr. Regmi, providing CPR urgently as a first-aid measure until medical treatment is available can bring an unconscious person back to consciousness. However, it appeared that none of the participants at the Bhairahawa event knew how to perform CPR. “If he could have been given CPR before being taken to the hospital, his life could have been saved,” says Dr. Regmi.

Kamal Gautam, who collapsed and passed away while giving a speech

When performing CPR following a sudden cardiac arrest, an attempt is made to pump blood by pressing on the center of the chest with the heel of the hand. CPR does not restart the heart on its own, but it attempts to maintain blood flow and oxygen to the brain by partially circulating the blood, thereby keeping the brain alive until other treatments are available.

If the brain does not receive blood for four minutes, its cells begin to die, and if it is deprived of blood for seven minutes, they die completely. Therefore, CPR is performed to keep the brain alive and to prepare the heart for the ‘electric shock’ needed to correct the heart rhythm.

According to Dr. Regmi, 25% of heart attack patients experience ‘Sudden Cardiac Arrest’. In such a state, administering CPR (pressing on the center of the chest with the heel of the hand) until the patient reaches the hospital can save some lives. There are two main reasons for the sudden cessation of the heartbeat: first, a heart attack due to the blockage of a coronary artery; and second, a sudden irregularity in the heart’s rhythm stopping the pumping of blood. “Unexpected death can be caused by a heart rhythm disorder and the cessation of blood circulation in the heart,” he states.

He adds that Sudden Cardiac Death can also occur in healthy individuals with no prior symptoms. He further states that, apart from the heart, a major clot in the lungs or other causes can also lead to sudden death. However, such incidents are rare.

Necessary caution

CPR can also be administered by individuals who are not health workers. Health workers may not be available everywhere. Cardiologist Dr. Regmi states that in such times, individuals who have been trained in CPR can immediately provide CPR to a person who has suffered a ‘Sudden Cardiac Arrest’.

According to him, there is a possibility of saving people whose heart has stopped if CPR is administered correctly until they are taken to the hospital. “If basic life support, or CPR, is done well for patients who have suffered a sudden cardiac arrest, the chances of saving a person whose heart has already stopped are high,” he says. Although there are no definite statistics on how many people whose hearts have stopped are saved in Nepal, he mentions examples of some such patients surviving after treatment.

Dr. Regmi says that as the incidents of Sudden Cardiac Arrest are increasing, many lives that could have been saved are being lost prematurely due to the lack of people with CPR knowledge.

According to him, although hospitals train their health workers, there is no such awareness at the community level.

CPR, which falls under emergency healthcare services, does not require one to be a health worker to receive training; anyone can take it. The person administering CPR must have basic knowledge of whether the patient’s pulse and heartbeat are present and if they are breathing. Dr. Regmi advises against immediately pressing the chest of a person who collapses without checking if the heart is beating, just to give CPR. “Performing CPR when the heart is still beating can stop the heart and lead to death. Therefore, CPR is only administered when the heart rate and pulse have stopped,” he explains.

Inadequate training

In many countries worldwide, CPR training is provided from the school level onwards. Such training is given to everyone from office employees to the general public. Cardiologist Dr. Regmi states that the purpose of this training is not to suggest that a person who suddenly faints will survive immediately upon receiving CPR, but that it is intended to save patients whose hearts have stopped outside of a hospital setting.

However, the practice of providing basic CPR training and knowledge is very low in Nepal. Dr. Regmi notes that while hospitals like Tribhuvan University Teaching Hospital, Shahid Gangalal National Heart Center, and Bir Hospital provide related training to their health workers and ambulance drivers, the lack of community-level implementation means that when emergencies occur on the street or in public places, people panic or remain confused.

He suggests that the government should include this subject in school and college curricula and make such training compulsory in government/non-governmental offices.

According to him, mother’s groups, political party members, and youth groups, among others, can engage in the dissemination of CPR training and knowledge.

Hospitals, the Red Cross, and social organizations have been organizing such trainings, which have not reached many places. From the government side, the National Health Training Center has implemented a community-level training program since last year. However, due to budget constraints, it has not been possible to reach all areas, says Thalindra Prasad Pangeni, Senior Health Education Officer at the Center.

According to him, the first phase provided training to health workers, and the second phase to teachers, police, ambulance drivers, women’s groups, female community health volunteers, and party members.

Pangeni explains that such training is provided to teachers, organizations, and political party-affiliated groups in places where emergency medical care is unavailable and in geographically remote locations.

He says, “Although this is a subject that every citizen should know, we have provided information to a small number of people due to limited budget.”