Intended for healthcare professionals

Rapid response to:


Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study

BMJ 2002; 324 doi: (Published 16 February 2002) Cite this as: BMJ 2002;324:387

Rapid Response:

The cover photograph

Dear Editor,

The front cover of your journal (16th February 2002) carried the
headline 'Emergency hospital teams halve heart deaths'. The accompanying
photograph depicting a patient (sic) receiving basic life support, is more
amusing than impressive. Basic Life Support is an essential part of
training and is designed to 'maintain adequate circulation and ventilation
until action can be taken to reverse the underlying cause of the
cardio-respiratory arrest' . European resuscitation guidelines state that
the first two steps in basic life support are the adequate management of
airway and ventilation. Therefore, it is worrying that the patient in the
photograph is receiving chest compressions without any attention to either
airway or breathing.

The patient appears to be lying in the classical 'reduced level of
consciousness / obstructed airway' position. Prior to commencing chest
compressions, might it not have been prudent to ensure that an adequate
airway was secured? If the patient was judged ill enough to need chest
compressions, one might imagine their breathing would also benefit from
bag-valve-mask assistance. There is general agreement that critically ill
patients should be given high flow oxygen, and not just the fresh air on

The chest compression technique employed is unconventional. Ideally
compressions should be delivered with arms locked vertically over the
sternum. The picture shows a doctor walking alongside the trolley with
elbows flexed and hands in a curiously high position. This technique is
more likely to indent the skin than perfuse the cerebrum. In keeping with
the 1970's school of resuscitation care, a bag of clear fluid is being
delivered intravenously, placing circulation clearly before airway and
breathing. Early defibrillation is the most effective intervention for
reversing cardiac arrest, sadly the defibrillator /monitor seems to have
been left behind with the bag-valve-mask and oxygen cylinder. The person
the head is walking backwards pulling the trolley, which contravenes both
Health and Safety guidelines and common sense.

We do not suggest that photographers should loiter in corridors
genuine emergency scenes. However, fundamental skills such as basic life
support ought to be demonstrated accurately to the medical and non-medical

Yours sincerely,

Michelle Tempest, (PRHO, a&e, Addenbrooke's Hospital, Hills Road,
CB2 2QQ)

Ankur Gulati, (SHO, a&e, Addenbrooke's Hospital, Hills Road,
Cambridge, CB2

Competing interests: No competing interests

22 February 2002
Michelle E Tempest
PRHO (a&e)
Ankur Gulati (SHO, a&e),
Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ