A survey of Orange County cardiopulmonary resuscitation volunteers that found two-thirds would refuse to perform mouth-to-mouth resuscitation on an AIDS patient has forced into the open an issue troubling public health officials nationwide.
The results of the survey raises this question: Is it safe for a lay rescuer to do CPR--which involves mouth-to-mouth contact--on someone known or suspected to have AIDS or to be infected by Human Immunodeficiency Virus (HIV)?
The consensus among AIDS and emergency medical services experts across the country is that the rescuer "probably" is safe--for reasons that may have as much to do with the low cardiac risk profile of AIDS patients as anything else. AIDS patients are generally young enough that they probably do not suffer heart and respiratory failure in great numbers outside of hospitals.
But it is indicative of the continuing volatility of the crisis that an official of the UC San Francisco AIDS task force declined to say if he himself would administer CPR to an AIDS patient if he did not have access to such safety equipment as the breathing bags commonly found in hospitals and in ambulances and emergency vehicles.
"I would recommend that (a rescuer) use a protective device," said Dr. W. Keith Hadley of San Francisco General Hospital.
But if such equipment--which makes it unnecessary for the rescuer to maintain actual mouth contact with the victim--is unavailable, as would be common in citizen CPR, Hadley said, "that's something that is a decision by the individual." Would he do it himself with no safety equipment at hand? "I don't care to answer that," Hadley said.
Officially, the federal Centers for Disease Control in Atlanta recommended through a spokesman that anyone needing CPR should be given it by qualified rescuers. CDC studies, the spokesman said, indicate "it is highly unlikely" that a CPR rescuer could get the AIDS virus from the saliva, blood or vomit of a patient.
The issue was raised in an article in the journal Annals of Emergency Medicine reporting results of a survey of more than 700 Orange County CPR trainees who were questioned by UC Irvine Medical Center researchers. A total of 67.7% said they would not perform CPR on someone they knew had AIDS; 55.4% said they would not do it on anyone "suspected" of having AIDS. On the other hand, 92.2% said they would do CPR on a stranger not thought to have AIDS, and 77.5% thought CPR should be performed on the terminally ill.
Dr. Gregg Pane, who headed the project, said the volunteers' fears were understandable, but added, "I think the balance of evidence is the chance of (contracting AIDS in CPR) are minimal or nonexistent." However, Pane said, "you can never give a 100% answer. I guess that it's kind of a moral (decision) for every individual to make at the scene. I would say that in my judgment, yes, it is safe, but it's your own personal judgment if you encounter such a situation."
Dr. Bruce Haynes, director of the California Emergency Medical Services Authority, said that while AIDS experts initially concluded the virus could not be spread through the contact that occurs in CPR, the certainty has given way to at least an element of doubt. The far greater danger, Haynes contended, is that irrational fear of AIDS could make trained citizen volunteers unduly afraid to use skills that could save lives.
"I don't know what I'd do," if faced with the decision personally, Haynes conceded. "I haven't really been confronted with that."
The medical literature on AIDS contains several studies concluding there is little or no risk in CPR performed by professional rescuers or in hospitals--provided safety equipment is used--and that CPR training dummies are not capable of transmitting the disease. But the question of whether CPR can safely be performed by lay people in typical emergency settings--sidewalks, office buildings and bedrooms--has, surprisingly, not been specifically addressed. Studies of CPR have shown it most often occurs in the homes of comparatively elderly heart attack victims. Family members are the most frequent successful rescuers.
Beer and Lactation
The folkloric belief that drinking beer can stimulate lactation in mothers of newborn babies--sometimes passed on by doctors as medical fact--has been challenged by experts in three cities writing in a question-and-answer advice column for physicians.
The question was raised by an unidentified California doctor who asked the "Questions and Answers" column of the Journal of the American Medical Assn. the advisability of prescribing a beer a day for new mothers to "increase lactation."
In separate replies, a variety of experts questioned the beer-breast feeding link. Dr. Sheila Blume of Amityville, N.Y., even suggested the advice could be misconstrued as a "prescription" that could provide a potential alcoholic with an excuse to prolong a drinking problem.
All of the experts dismissed the alleged relationship between beer drinking and lactation. In fact, two Chicago experts said there is evidence that alcohol consumption may reduce milk production in breast-feeding women. But Dr. Frank Falkner of UC Berkeley took a more tolerant view. "The one beer a day will provide fluid and calories. It may be pleasant and soothing to the mother," he wrote. "So why not?"