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EMERGENCY
N° 0 • JULY 2009
EMERGENCY ROME
Via dell’ Arco del Monte 99/a, 00186 RomeT +39 06 688151 - F +39 02 68815230roma@emergency.it
www.emergency.it
EMERGENCY MILAN
Via Gerolamo Vida 11, 20127 MilanT +39 02 881881 - F +39 02 86316336info@emergency.it
www.emergency.it
EMERGENCY USA
4910 Massachusetts Avenue NW, Suite 300Washington, DC 20016 – T +1 888 501 EUSAinfo@emergencyusa.org
www.emergencyusa.org
EMERGENCY UK
PO Box 62437, London, E14 1GAT +44 (0) 333 340 6411info@emergencyuk.org
www.emergencyuk.org
 
AFGHANISTAN
Trainingfor Critical Care Units
«F
alcon 4 Falcon 4… cardiac arrest in Intensive CareUnit”. It was ten minutes before midnight, andsomeone was calling me on the radio. “Start thecardiac massage,” I replied as I ran towards thehospital. Latif, Fahim and Samiullah, just graduated from the GovernmentSchool for Nurses at the University of Kabul, and were working the nightshift. The school curriculum offers CPR training. Unfortunately, the qualityof teaching is still very far from acceptable or satisfactory standards. This isunderstandable in a country devastated by thirty years of war.In all of its projects, EMERGENCY strives to provide intensive training for local staff through daily hands-on experiences with highly qualified doctorsand nurses coming from other countries.This and other targeted activities provide local staff with current medicalknowledge, and eventually lead to their autonomy. In the first months of 2008,Daria, Elena, Debbie and I, all international nurses at the EMERGENCYHospital in Kabul, have established a Basic Life Support (BLS) course in aneffort to accomplish these goals.
The ABC’s of resuscitation —Airway, Breathing and Circulation
BLS encompasses all cardiopulmonary resuscitation procedures performedto rescue a patient who is unconscious, or suffering from cardiac arrest.Independently from the cause of cardiac arrest, the heart fails to contract andpump blood to the tissues.The lack of oxygen supply to the brain cells, known as cerebral anoxia,causes irreversible damage within 10 minutes of the onset of circulatoryarrest. This implies that the time available to rescue a victim of cardiac arrestis extremely short before irreversible brain damage occurs.The goal of BLS is to maintain an “emergency oxygenation” throughartificial breathing and cardiac massage, until more efficient means can beused to correct the factors that determined the arrest. The BLS proceduresare standardized and recognized as effective by several key internationalorganizations that provide constant revisions and updates.To help with memorization, the BLS phases are schematized in threesteps, indicated by the first three letters of the alphabet.  A: Airway – Opening and control of the airway, removal of potentialocclusions (foreign-body, food, blood), and insertion of a plastic tube to keepairway pervious. B: Breathing – Sustain breathing by ventilation with Ambu bag (if unavailable, proceed with mouth-to-mouth breathing). C: Circulation – Sustain cardio circulatory function by control of carotidpulse, and potential cardiac massage.  At each step, a vital sign (airway, breathing, cardiac pulse) is checked andrestored, if compromised.
Learning to save Minianne really meanshelping Gul Arifa
BLS is of utmost importance in the training of health care staff. For thisreason, it is periodically taught to newly hired staff at all of EMERGENCY’shospitals.This latest course was designed specifically for nurses newly graduatedfrom the University of Kabul, and working in the critical care areas (ER,intensive care, surgery room).It is divided in two sessions. The first session illustrates the guidelines of the Italian Resuscitation Council (IRC), while the second, besides reviewingprevious material, allows students to practice the reanimation resuscitationof Minianne.Minianne is an inflatable manikin provided by the IRC. It is particularly
Basic Life Support Course in Kabul – Emergency Cardiopulmonary Resuscitation (CPR)
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useful in the teaching of lifesaving maneuvers, since it allows effectivesimulation of cardiac massage and manual ventilation.During this session the nurses, divided into small groups, ask questionsand practice until they feel confident with all the maneuvers. The hands-onnature of the class has guaranteed the expected results.In fact, the staff has acquired both physical and psychological confidencewith instruments and maneuvers, and it is now ready to effectively cope withany emergency situation.It is midnight. Out of breath, I reach the intensive care unit. I don whitecoat and shoe covers and I step inside. Latif is by Gul Arifa’s bed performingventilation. Samiullah is standing on a step stool, ready to administer acardiac massage.Fahim, the youngest, looks at me nervously as I come closer. Together wegaze at the monitor. Gul Arifa’s heart has resumed beating. We smile at eachother. “Great! Well done!”.
NADIA DEPETRIS Translated by Ada Buvoli 
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