External cardiac compression.

gives a welcome opportunity to discuss the use of external cardiac resuscitation by personnel of the Electricity Supply Industry. The dangers of this technique have been pointed out by Baringer et al. (1961) and by Clark (1962). As a result of the paper by Baringer and his colleagues, both the Lancet (1961) and the British Medical Journal (1961) carried leading articles counselling against the use of the method by first-aid personnel until more was known of its dangers. A Symposium on Emergency Resuscitation (1961), at which Great Britain was represented by anaesthetists, revealed divided views and concluded that external cardiac resuscitation should be used only by doctors, nurses and recognized lifesavers. It appears clear from reading the discussion that a distinction was drawn between first-aiders and "recognized lifesavers". Since that time opinion has remained divided. It is interesting to note that in this country the British Medical Journal, reversing its earlier counsel, has recently (1962) advocated widespread teaching. At the same time, however, in America, where the technique was at first widely hailed, a note of caution is now sounded by the American Heart Association (1962). What then is the position in the Electricity Supply Industry, which employs some 205,000 people? Thanks to an efficient organization there are in this industry only some six deaths each year from electric shock in England and Wales and from their very nature some of these will occur where there are no first-aiders. This being so, cases of collapse which may be diagnosed as circulatory arrest and treated with external cardiac massage are likely to be very little different in the Electricity Industry from those met with in other industries (e.g. electric shock cases are a small fraction of the total). Until more is known of the hazards of external cardiac resuscitation it has been decided by the medical advisers of the industry not to expose the many to its dangers in order to try to save the few. We have, sir, been deeply concerned over this. In 1960, soon after the description of this method by Kouwenhoven et al. (1960) a visit was made by one of these advisers to the Johns Hopkins Hospital, together with a medical representative of Electricity de France. More recently the subject has been discussed at a Symposium on Electrical Accidents in Paris (International Labour Organization, 1962) and by the Medical Group of UNIPEDE. Opinion is as divided …