The relationship between first aid and emergency health

First aid is the terminal implementation method of the emergency health system in emergency risk scenarios, and the construction of the entire chain of emergency health is the core prerequisite for the role of first aid. The two are by no means separated from "rescue in case of emergency" and "prevention in ordinary times". They are a symbiotic system covering the entire cycle of individual health risks - without either end, it is a tightrope walk with life.

Last year, I was giving an emergency lecture in an old community in Gongshu District, Hangzhou. During the break, someone suddenly shouted that an aunt had collapsed in the pavilion downstairs. When I ran over, Uncle Zhang, who lived in Building 3, was already doing chest compressions for the aunt. He said that he just learned it in the emergency health class in the community last week, and he still remembered to press to a depth of 5-6 centimeters and maintain a frequency of 100-120 times per minute. There was an aunt next to him who had put the nitroglycerin she brought with her under the tongue for the patient. By the time 120 was reached, the electrocardiogram had already measured the autonomous heart rhythm. Later, during a follow-up visit, I learned that my aunt had an acute myocardial infarction. If she had been two minutes later, she might have died.

An almost identical incident happened in this community three years ago. An old man in the pavilion suffered a heart attack in the summer evening. No one in the circle dared to take action, and no one knew to give nitroglycerin first. By the time 120 arrived, the golden rescue time had already been missed. At that time, the community had not yet begun to carry out systematic emergency health construction, and there was not even an AED. Everyone's understanding of first aid was still "that is a doctor's business."

The industry has always had different emphasis on the relationship between the two. Among the colleagues I have contacted, there is a group of people who firmly believe in "first aid priority" and believe that all resources should be invested first in popularizing public first aid skills and installing AEDs in public places. After all, the data is here: public data from the American Heart Association shows that 4 minutes after a cardiac arrest occurs is the golden rescue time. For every 1 minute delay, the survival rate drops by 7%-10%. If rescue is performed after 10 minutes, the survival rate is almost 0. This school’s view is very practical: No matter how good the prevention is beforehand, there is always the risk of slipping through the net. At the moment of an accident, whether there is first aid and whether there is equipment is the difference between life and death. Shenzhen is taking this path now. By the end of 2023, more than 26,000 AEDs have been installed in public places. One can be found on average within a 5-minute walk in the city. In the past two years, the success rate of cardiac arrest treatment in public places has more than tripled, which is a real result.

But there is another group of friends who work in public health who don’t see it that way. They feel that spending money on terminal first aid is essentially “making up for leaks after the fact” and is too low in cost performance. Last year, I followed the CDC team to the old community I just mentioned for a baseline screening. Among the permanent residents over 60 years old, 32% had hidden coronary heart disease and were not even aware of it. 68% of patients with hypertension did not regularly monitor their blood pressure. Many people thought chest pain was an "old problem" and got over it. The "White Paper on the Prevention and Treatment of Sudden Cardiac Death in China" released by the National Center for Disease Control and Prevention in 2023 also mentioned that among the cases of sudden cardiac death that occur every year in our country, more than 70% of the causes are underlying diseases that have not been controlled for a long time. If the emergency health port can be moved forward, health monitoring, lifestyle intervention, and disease early warning science are usually provided to high-risk groups. Perhaps 80% of sudden risks will not reach the point of requiring emergency treatment at all.

To be honest, I used to believe in giving priority to first aid, but I changed my mind when I encountered a case the year before last. That year, I went to a company in Tongzhou, Beijing, for first aid training. A young man came over during the class and asked, saying that he often worked overtime until early in the morning recently and occasionally felt chest tightness. If he needed to prepare some medicine. I asked him to go to the hospital for a checkup at that time, and it was found that the coronary artery was 70% blocked. The doctor said that if he stayed up for another two months, he would most likely have a heart attack while working overtime. Even if his colleagues knew how to give first aid, they might not be able to save him. You see, if I had only taught them CPR and not given any health warning in advance, something might have happened to this young man.

Nowadays, many people have misconceptions about these two things. They either think, "I'm not a doctor, so learning first aid is useless." Or, they think, "Emergency health is just measuring blood pressure on a regular basis, and it has nothing to do with saving people in the event of an accident." Some people say, "I don't dare to do first aid. If the rescue fails, I have to take responsibility." In fact, these questions are originally part of emergency health science popularization. Now the "good person clause" of the Civil Code has long been clear. If the rescuer voluntarily performs first aid and causes damage to the recipient, the rescuer will not bear civil liability. When we usually do science popularization, we will also make it clear in which situations you can take action and in which situations you only need to call 120 and help find an AED. There is no need to bear any psychological burden.

A few days ago, I had dinner with Team Li from the Municipal Emergency Center. He has been doing first aid for 21 years. He said that in the past, 9 out of 10 times when the police were dispatched, people would be surrounded by people at the scene and no one dared to move. But now it is different. Often when I arrive at the scene, there are already people doing standard chest compressions. There are also people who help measure blood sugar and find medicines for patients with underlying diseases. Most of these people are students in emergency health classes in communities and companies. “What do you mean by first aid and emergency health? When you get to the scene, you can't tell the difference at all. If it can save lives, it's a good thing. ”I think he's right.