Basic Life Support (BLS) makes dead alive again

Index Home

Basic Life Support or BLS is a sequence of actions, that attempt to bring life back, after it has seemingly ceased. When heart stops, or lungs fail to breathe, we have moved closer to death. However, all is still not over. We still have a few more minutes to make heart to beat or lungs to breathe. In these precious minutes, we try to pump chest from outside, and to breathe air into the lungs. Miracle it is, when a heart starts beating, and lungs can breathe, again and on their own. At this time, we can declare that we have resuscitated heart and lungs. In medical lingo, this process is cardio-pulmonary resuscitation or CPR.

This 2008 postage stamp from Malaysia shows two rescuers performing CPR. One rescuer is pumping chest from outside, and another one is blowing air into the lungs
How did it all begin

CPR as we know today, was born in 1962. However, it had some predecessors. In 1856, Marshall Hall suggested that rolling a body from side to side could make lungs breathe. Two years later, Silvester suggested that lifting hands up and down will do the trick. In 1892, Friedrich Maass used external chest compressions for a successful resuscitation. Despite these early efforts, these tricks were not popular. In 1932, a newer resuscitation method by Holger and Neilson became popular. The victims were made prone, and their hands moved up and down in an effort to make them breathe. This method was also endorsed by the Red Cross.

During 1946 polio epidemic, some physicians noticed that mouth-to-mouth breathing could buy moments, by the time a ventilator could be connected. This worked even when ventilators had a malfunction. James Elam had made this accidental discovery, and in 1956 he discussed it with Peter Safar, a fellow anaesthetist. The duo worked on this technique and by 1959 it was well established that this was the way to go to rescue breathing.

A postage stamp issued by Gilbert and Ellice islands in 1970 shows mouth to mouth breathing. By 1988, the Islands had renamed themselves as Kiribati. The 1970 stamp was pictured again inside a 1988 issue by Kiribati
Chest compressions were a later addition

In 1960, doctors in John Hopkins rediscovered the power of chest compressions. However, by 1962 Peter Safar and his colleagues came up with a sequence of Mouth-to-mouth breaths and chest compressions. This sequence got a name A for airway; B for breathing and C for circulation. Chest compressions could effectively restore circulation of blood from heart to the body. While in 1966, Safar expanded it further, the sequence was eventually standardised to ABC. Hence, Peter Safar is celebrated as father of CPR.

This is 1984 postage stamp from China. In the lower left corner of the stamp, two rescuers are performing the CPR sequence. The stamp commemorates 80 years of Chinese Red Cross.
The CPR sequence in BLS

In 1966 itself, Peter Safar lost his 11 year old daughter. She had Bronchial Asthma, and died on the way from home to hospital. Peter realised that no one knew how to give artificial breaths. If someone did, his daughter would have saved. Thus, began the training programs, on how to treat lay persons, the art and science of CPR.

This 1989 postage stamp from Isle of Man (internet image) shows Red Cross volunteers being taught the art of CPR by an instructor. They are learning the technique on a mannequin. In fact Peter Safar also had a role in designing first mannequins. He convinced a Norwegian doll maker Laerdal to make first such training mannekin.

The current BLS sequence starts with identifying an unresponsive victim and moving the person to a safe place. This is termed as scene safety. This is quickly followed by call for help. Till a second rescuer arrives, the one already on the scene should start chest compressions

A 1975 postage stamp from Bulgaria. A rescuer approaches an unresponsive victim.
This 1983 postage stamp from Yougoslavia, shows a rescuer moving the victim to a safe place
Till 2010 the CPR sequence was ABC (Airway, Breathing and Compression). The same year, we reversed the sequence to CAB (Compression, Airway and Breathing). This 2020 special cover issued by Indian resuscitation council, shows a single rescuer performing CPR. Current standard is to deliver 30 compressions (at a rate of 100 per minute) before any rescue breaths.
This 1988 set of four postage stamps from British Virgin islands (internet image) show a CPR sequence. The first stamp (top left) indicates scene safety, followed by head-tilt to open the airway. Third and fourth stamps indicate breathing and compressions. In 2010 this sequence got reversed.
Epilogue

In 1958 Peter Safar also suggested cooling of body to preserve brain function. This concept was accepted many years later. Peter was nominated thrice for a Nobel Prize. While he never received one, all health care workers and lay person owe him the credit for devising a CPR sequence, and making it universal.

While CPR philately is quite limited, and there are some more stamps out there, featured in this article.