LIFE SAVING

Manawatu Times, Volume 61, Issue 44, 22 February 1936, Page 9

LIFE SAVING

SCHAFER METHOD THE BEST ROYAL SOCIETY’S FINDING. RESULT OF AN ENQUIRY. Boxing the last few months, the attention of life-savers in the Dominion hS been attracted by articles in the Press explaining the new Holger Ni sen method of resuscitation and statin that it is. considerably more efficient than the Schafer method generally in The claims made on behalf of the Nielsen method greatly interested the Central ; Executive of the Royal LiteSaving Society, and its vice-chairman spent a week' in Copenhagen last November to study the new system. A sub-committee was setup to consider it, and after due deliberation this committee of four has decided in favour oi the Schafer method. The grounds for the decision are fully explained ui a letter sent by Mr. A. C. P. Handover, a vice-president of the society, to Mr. K. Bassott, hon. secretary of the New Zealand Council. “The sub-committee met recently to discuss the Holger Nielsen methid iu full detail,” says the letter. “Steadily certain features emerged and led >9 to recommend ' that the Holger Nielsen method be not accepted for tuition by the society.,'’ Only one reason will be stated- officially for its non-acceptance, and that in the briefest wording which I will expand since you are so interested.

Nielsen Method’s Drawbacks. “In cases of drowning the smaller bronchioles and especially the air-sacs are blocked by a churned froth of water and mucus. As the air-sac is the only area of the lung capable of providing for the exchange of oxygen and carbon dioxide, these mast be cleared to allow of recovery. Such air-sacs a" remain' sealed from the focus frr ‘secondary pneumonia,’ a common complication after drowning. “A consideration of the Holger Niel- , sen method (and I am assuming that you are cognizant of its details) shows that'its- chief emphasis is on inspiration. This intake of fresh air is due to increased chest capacity, but the air is chiefly taken into the upper air passages from which diffusion is made difficult by the sticky froth blocking the finer branches. The following shoulder pressure expels this extra air just taken in, leaving the air-sacs little or no bette- off. Thus we feel that there is but slight chance of the vitiated air in the aiveoli being quickly purified and the tubes cleared. Especially is this so for those alveoli in distant parts of the lungs, as at the border of the diaphragm. The stronger inspiration with the weaker expiration would tend to slo.v up drainage of the bronchial tubes.

Some Notable Departures. ■ ' <‘ln the Schafer method the emphasis is on pressure-causing expiration so that the contents of the lungs are forced out and later air flows in. This diaphragm pressure is exerted on the pliable substance of the lung (i-e., the material forming the airsacs) and hence directly helps to clear the airsacs. The figures quoted in the article published recently in the Press are likely to cause some concern until their corrected values are known. Perhaps the following three points will show the value of the figures in the article:— “ (1) The Prone-pressure Method Used.—From Danish articles- on the Holger Nielsen method it became evident .to me that the Schafer method used in Denmark varied from our own. Hence I asked our representative to ask to see it done and report on it. This report showed that the hands were placed on the back of the chest, high up towards the shoulder blades, higher up even .than in our old hand-book; this materially lessens the efliciency of the method in air-exchange. Even then the ventilation per respiration quoted for Schafer in Danish medical reports is given as-750 c.c. whereas tidal air requirements average 100c.c. For the Holger Nielsen method the average figure quoted is 1100c.c.

“(2) Speed of Working. From Schafer’s original work it became established that the ventilation per minute was a very important factor. Thus the speed of working must be considered. The article gave the speed for Schafer at 9.4 per minute, and the results were calculated upon that. But the older form of Schafer Was to be done at 15 per minute and on the depth per respiration given in. the newspaper article this gives the Schafer ventilation per minute as 9.4 times 15, or 141 per minute. Thus is equals the Holger Nielsen method in ventilation oh their own figures. The modern position of the hands advocated by me to- the late Professor Sir E. S. Schafer arid accepted by him in our new hand-book is more efficacious, and its increased time of .three seconds on inspiration pressed for by me f o allow for deeper diffusion of pure air has a speed of 12 per minute. There is no authority for a speed of 9.4 per minute as quoted in the paper.

“(3) Imitation of Natural -Breathing.—Since normal breathing is recognised in every text book as being chiefly by use of the diaphragm with very little use of the ribs, it is evident that Schafer fulfils this requirement far more satisfactorily than does the other method. Hence natural recovery of normal action ,is more posible with Schafer. Schafer’s speed of 12 per minute and also its air-exchange are each more in accordance with natural working than Hclger Nielsen ’3 method of 7.S per minute. I am not entering into debatable'poinis on carbon dioxide concentration as affecting recovery.