Emergency resuscitation under the COVID-19

November 24, 2021

Hokesen Letter, No 223 (English ver.), November 10, 2021
Health Care Center, Tokyo University of Foreign Studies
Yasuhiro Yamauchi, MD, PhD

Emergency resuscitation 【CPR (Cardiopulmonary Resuscitation)】 is a necessary action to save the life of a person in sudden cardiopulmonary arrest, and most importantly, to initiate resuscitation immediately. Although it is important to understand the mechanisms and procedures of resuscitation in order to save a life, it is more meaningful to start resuscitation quickly than the accuracy of the instructions. If you encounter a person in sudden cardiopulmonary arrest, perform emergency resuscitation immediately without hesitation, even with a little memory, to save a life.
Recently, the Ministry of Health, Labour and Welfare (MHLW) has released "Guidelines for Emergency Resuscitation in a Corona Crisis" for the general public, because the spread of the Novel Coronavirus (COVID-19) has been increasing and people need to be careful in an emergency. To save a life in a corona crisis, and to protect yourself from COVID-19, it is important to learn the following emergency resuscitation techniques for immediate resuscitation.
1. Check for safety.
If you witness someone suddenly fall or lain with unconsciousness, first make sure that the situation around you is safe. Your priority is to ensure your own safety.
2. Check for response.
Gently tap the injured person's shoulder and call out loudly to check for a reaction. When doing this, make sure that your face is not too close to the face of the injured person.
3. Call 119 and prepare AED device.
If there is someone nearby, ask that person to call 119. Also, if there is an AED nearby, ask someone to bring it to you.
4. Observe the person's breathing.
Watch the movement of the chest and abdomen of the injured person, and if there is no movement, determine that the casualty has stopped breathing. At this time, be careful that your face is not too close to the injured person's face. If breathing has stopped, it is cardiac arrest. If the breathing is choppy, it is also considered cardiac arrest.

5. Perform chest compression.
If you determine that the person is in cardiac arrest by observing the breathing, perform chest compressions immediately. To prevent aerosols from dispersing, cover the nose and mouth of the person with a mask, handkerchief, towel, or clothing before starting chest compressions.
Place of compression: The center of the chest, in left and right, and the lower part of sternum.
Method of compression: Place the palm of one hand on the lower half of the sternum and place the other hand on top of it. Straighten both elbows so that the weight is applied vertically, and position your shoulders directly above the compression area.
Rhythm of compression: Repeat compressions as hard and fast as possible so that the person's chest sinks 5 cm. The tempo of the compressions should be 100 to 120 per minute. The tempo of the compressions should be 100-120 per minute, continuously and without interruption as much as possible.
6. Continue chest compression resuscitation.
In case of emergency resuscitation in the corona crisis, mouth-to-mouth resuscitation should not be performed. Just keep continuing chest compression. In case of emergency in normal situation, 30 times of chest compression and 2 times of mouth-to-mouth resuscitation should be combined.
7. Use the AED.
Use the AED and follow the voice message.
Even when using an AED, continue chest compressions as constantly as possible, except when unavoidable, such as electric discharge.
8. Continue resuscitation.
It is important to continue resuscitation until you are replaced by the arriving paramedics. Do not give up, even if it seems to be ineffective.
9. After the arrival of the emergency team, wash hands and face thoroughly with soap and running water as soon as possible.
Handkerchiefs and towels that have been placed over the nose and mouth of the injured person should not be touched directly and should be discarded.

If you have any questions, please consult the Health Care Center, TUFS.

Reference：
Japanese Medical Association. Emergency resuscitation. [in Japanese]
https://www.med.or.jp/99/cpr.html
Emergency resuscitation by general people in the corona crisis. [in Japanese]
https://www.mhlw.go.jp/content/10800000/000632828.pdf
Guideline for emergency resuscitation 2015. [in Japanese]
https://www.mhlw.go.jp/file/06-Seisakujouhou-10800000-Iseikyoku/0000123021.pdf