Nepal’s Role in the “Global Resuscitation Alliance” -is there one?

This past week brought the announcement of two new organizations to promote better resuscitation from cardiac arrest, worldwide. “The Global Resuscitation Alliance” and the “Resuscitation Academy.”

wow.  I love an audacious goal, but – I’m a bit of a skeptic.

The two organizations were announced at #EMS2016, an international gathering of EMS personnel.

The history:

A Call to Action

On June 6-7, 2015 at the Utstein Abbey near Stavanger, Norway, 36 Emergency Medical Services (EMS) leaders, researchers, and experts from throughout the world convened to address the challenge of how to increase community cardiac arrest survival and how to achieve implementation of best practices and worthwhile programs. We call for the establishment of a Global Resuscitation Alliance in order to expand internationally the reach and utility of the Resuscitation Academy concept developed in King County, Seattle since 2008. Such a global effort will promote best practices and offer help with implementation to countless communities. A Call to Establish a Global Resuscitation Alliance1

In my Nepal sessions I always discuss the syndrome of Sudden Cardiac Death, just before I introduce MONA. I draw upon the research from Seattle, while we discuss warning signs. Turns out the people from Seattle are  a driving force for this new initiative.

The Call?

from the Executive Summary of the “Call to Action” document

In 2015, twenty five years after the first Utstein meeting, 36 resuscitation leaders gathered at Utstein to solve another problem – how best to implement successful strategies in managing cardiac arrest and how to spread the lessons of best practices. This 25th Anniversary meeting is timely for several reasons:

There is an understanding of how best practices can achieve dramatic increases in cardiac arrest survival.

There is better science on the importance of high-performance cardiopulmonary resuscitation (HP-CPR) and Telephone-CPR (T-CPR; also known as Dispatcher-Assisted CPR (DA-CPR) and Telecommunicator CPR).

There is the emergence of large cardiac arrest registries that provides the platform for measurement and highlights the variability in community survival rates.

There is better understanding of EMS systems and the characteristics of high performing systems.

There are now successful strategies to achieve programmatic implementation such as the Resuscitation Academy, which bridges the gap between science and community best practice.

There is renewed emphasis in the proposed United Nations’ (UN) Sustainable Development Goals for 2030 to reduce deaths from non-communicable diseases including the growing problem of prehospital cardiac arrests in low and medium resourced countries.

Improving Survival from Out-of-Hospital Cardiac Arrest

Nations with emerging economies will experience dramatic increases in ischemic heart disease and an anticipated need for pragmatic implementation of costeffective resuscitation practices.

There is a pdf download that explores the idea of best practices, and the link is:

My feedback

At first I read this with enthusiasm because after all, this goes directly to the issue CCNEPal works on in Nepal. On further study, it’s not so clear. There are issues which are not addressed.

  1. The participants were all from developed countries in the “western world” with small representation from Asia ( there were people from Singapore, hardly a low- or even middle-income country).
  2. The participants all came from countries where there is an highly developed EMS system.
  3. The concepts they describe apply to out-of-hospital cardiac arrest, but in the low-income countries of the world, the educational system and the service system are struggling to reach a goal of acceptable survival even with in-hospital cardiac arrests.
  4. Finally, the sponsoring organizations have a vested interest in promoting only those initiatives that already fit in the proprietary box. For example, in order for a training course to receive approval by the American Heart Association, it must meet   the same criteria when taught in Timbuktu (or Kathmandu!) that it would if taught in the USA. If the goal is widespread dissemination of resuscitation skills, this is simply not practical and it smacks of “cultural imperialism.”

From my own experience?

Here is my feedback to this initiative.  The scope of need is vastly greater than can be met by using the approach now in favor with the developed countries. Considerable “ramping up” is needed.

For the “official” AHA ACLS course, equipment costing about $25,000 is needed. Few in Nepal can afford this investment.

Only the approved DVD may be used for the didactic component, and all discussions, including the debriefing must be done in English (or Spanish is also allowed).

This is simply ridiculous, and has been generally rejected. Obviously a doctor or nurse can be an excellent ACLS team member or leader even if they speak no English whatsoever – the physiology is the same regardless of the language spoken by the person who is delivering the resuscitation.

Next, such skills as airway management using a bag-valve-mask, reading an ecg, or using a defibrillator, are not presently taught in medical colleges or nursing schools in low income countries.

Finally, no one country or language group should “own” the knowledge. The scientific studies on which the protocols are based, belongs to all of us, no matter where we reside on the planet.


I hate to sound like I’m only ranting, so here are some ideas:

Why not a companion set of goals for “Improving In-Hospital Response To Cardiac Arrest?” especially in low income countries.

What about convening experts in this area from Africa, and/or South Asia, and/or other regions, to discuss ways to address this based on a non-Eurocentric approach?

And finally, for Nepal – facing an epidemic of smoking-related cardiovascular disease. How can Nepal tap into this expertise to develop a sustainable system combatting this problem?


people in Nepal are working on these issues, piecemeal. Somehow Nepal gets left out of the discussion when trying to develop a “Global Alliance” – hey, Nepal is on the same globe as USA is……

That’s it for today…..


About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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