Professor Paul Middleton Prevent Unnecessary Deaths Interview

Professor Paul Middleton Prevent Unnecessary Deaths Interview

Sliced fingers from carving the Christmas ham, eye injuries from glitter, falls from erecting Christmas decorations, over-indulgence in alcohol and rich food, heart attacks, car accidents and drowning are some of the wide range of Christmas ordeals that can lead to the hospital emergency department.

"The Christmas holiday season is the busiest time of the year in Australian hospital emergency departments, yet we can all learn how to prevent unnecessary deaths, especially from heart attack and cardiac arrest," says emergency medicine expert and Chair of the NSW branch of the Australian Resuscitation Council, Associate Professor Paul Middleton.

"We see an increase of accident and emergency admission of around 9% in hospital emergency departments during the summer holiday period with this increasing dramatically over Christmas and New Year. While some of these can be explained by GPs closing over this time, most of the visits are due the increased likelihood of accident, injury and heart attack at this time of the year," says Professor Middleton.

"Christmas Day and New Year have a significant association with increased deaths, particularly from heart attack. This has been documented in medical journals for years," says Professor Middleton.

"It's not uncommon for people having a heart attack to think they're suffering from 'indigestion' perhaps from eating too much, but chest pain with no obvious cause has to be taken seriously, because it may quite possibly be a heart attack, when the blood supply to the heart is blocked off."

Cardiac arrest, when the heart actually stops beating, is most commonly caused by a heart attack.

"Being treated for a heart attack in hospital has an average 83% chance of survival compared with a survival rate of less than 10% for out of hospital cardiac arrests."

"Ambulance arrive remarkably quickly in Australia, but if the heart stops a person has less than four minutes to live unless the person near them starts immediate CPR, and no ambulance can arrive that fast."

"Tell tale signs of a heart attack include pain or heaviness in the centre of the chest, which comes on for no known reason and doesn't go away when resting. Other symptoms can include the pain spreading to arms, neck or back, shortness of breath, sweating and feeling sick. If someone collapses and is not responsive and have stopped breathing, they are having a cardiac arrest."

People suffering cardiac arrest have the best chance of survival if they receive immediate CPR. But so many people in the community are afraid they don't know how to do it because are fearful of further harming the victim. "The truth is that if someone collapses and is not breathing, they are or soon will be dead, so worrying about hurting them should come a long way behind trying to save their lives," says Professor Middleton.

"If we remember two simple but important steps we can save their lives. Firstly, call 000 and secondly, start immediate, continuous and effective hands-only CPR, pushing hard and fast about twice a second in the centre of the chest. Keep this up until the paramedics arrive", says Professor Middleton.

"Don't be afraid of getting involved and performing hands-only CPR; any CPR is better than no CPR."

The Chair of the NSW Branch of the ARC is calling for free state-wide program of CPR training as those that are trained in CPR are more likely to take action than those are not trained.

Interview with Professor Paul Middleton

Associate Professor Paul Middleton is Chair of the NSW branch of the Australian Resuscitation Council and a specialist in emergency medicine.

Question: Why is the Christmas season is the busiest time of the year in Australian hospital emergency departments?

Professor Paul Middleton: There are numerous reasons as to why the Christmas season is the busiest time of the year in Australian hospital emergency departments. The first is the least important and it is because the GP offices are closed and people have less accessibility to health care. Secondly, and more importantly, people have more things happen to them at Christmas for a few reasons; it is a holiday so people are relaxing and doing things, when they get together with family and friends, which they may not do normally; especially when they have had a few glasses of beer or wine. Alcohol means people end up doing things that they normally wouldn't do if they were sober or in less of a party mood; activities such as playing in the garden with the kids to climbing ladders and all sorts of activities that they wouldn't normally do and this means the emergency departments receive more trauma injuries such as falls. There can be a rise in arguments between strangers and family members around the Christmas period which can also lead to problems.

Other issues are that people tend to ignore medical problems till they get too serious whereas in normal life they may call an Ambulance or go to an emergency department if they had head or chest pains whereas at Christmas time they don't want to leave the party or make a fuss and they find other things to blame the pain on such as indigestion from the turkey and Christmas pudding. People don't attend the emergency department or call an ambulance as quickly as they should so things can get worse.


Question: How can we prevent basic injuries within our own homes, this Christmas?

Professor Paul Middleton: There are two things; one is to do the same sort of things that you would normally do, don't take risks just because it is Christmas especially because you're on holiday and the family are coming around and you want to get something finished. Don't do things you wouldn't normally do whether that is climbing up to the top of a wobbly ladder to try and put the Christmas decorations or fairy lights up - if you have to do certain activities, take care and make sure you're safe by having someone else help you.

Secondly, even though everyone loves Christmas and everyone enjoys a glass of alcohol and being in a party mood, you have to take care and not do things you wouldn't normally do because you've had a few drinks. Sometimes people's judgment is impaired when they've had a few drinks and the most trivial injuries can happen because people haven't got the same judgement they'd have if they were sober.


Question: How can we prevent unnecessary deaths, especially from heart attack and cardiac arrest?

Professor Paul Middleton: Heart attacks apply to some groups of people more than others, the typical people are middle-aged men who are overweight and those who smoke however it also applies to older women as well. The really important thing about a heart attack is that if you get a pain in the chest that appears without any obvious cause (you haven't banged into something to cause trauma) which feels heavy like 'an elephant sitting on your chest', you feel sick and sweaty or you have a pain that goes into the left arm, neck or jaw you should be alerting someone to call 000 immediately. Although these symptoms could relate to something else, the most likely thing is a heart attack and if you leave a heart attack, it can only get worse and in the end heart attacks can lead to death.


Question: What should family and friends do if they suspect a heart attack?

Professor Paul Middleton: If a family member or friend complains of chest pains and looks pale or sweaty then the most important thing, even if it is Christmas day, is to call an ambulance or go to hospital emergency department to see someone like me because we can sort it out. The survival rate of getting to hospital after having a heart attack and being treated in hospital is really good, it is at 80-90%. If you don't act and it is left until they go into cardiac arrest or when the heart actually stops, rather than having a blockage of the arteries, the chances of surviving a cardiac arrest in Australia are a bit less than 10%.


Question: Whilst waiting for an ambulance what should family and friends do for the patient?

Professor Paul Middleton: A heart attack and cardiac arrest are separate but a cardiac arrest can come from a heart attack. If you think a family member is having a heart attack the most important thing to do is sit them down and open their clothes so they can have air. If there is any aspirin in the house then they need to take an aspirin because even a simple aspirin has been shown to save lives in a heart attack as the heart attack is treated earlier as the aspirin helps treat the problem.
If someone goes into cardiac arrest then that is very scary but it is a lot simpler than it used to be. If anybody in the home collapses and they are not responsive and they're not breathing properly that is a cardiac arrest. It is much simpler now as you do not have to check a pulse all you need to do if they are not responsive and they're not breathing properly is immediately begin CPR whilst another person calls an ambulance (000). The brain desperately needs oxygen, it has four minutes before the brain starts to get damaged, damage it cannot recover from and therefore within seconds (if possible) somebody needs to start doing those CPR chest compressions.


Question: Has the CPR method changed recently? What are the basics?

Professor Paul Middleton: Nowadays chest compression CPR only without mouth-to-mouth is perfectly acceptable and the right thing to do. The rate is 100 chest compressions per minute. You can't hurt somebody who is in cardiac arrest by just doing the chest compressions.


Question: What is your number one message to Australians in regards to injuries, this Christmas?

Professor Paul Middleton: The number one message is to take care and don't do things that you normally wouldn't do or take extra risks. If you have any unusual aches or pains, do something about it, don't wait till after Christmas.


Interview by Brooke Hunter