The Healthy China Initiative (2019−2030), including two government-driven campaigns related to CA — health literacy and cardiovascular/ cerebrovascular disease prevention and treatment — will guide our work over the next 10 years (Table 1). CA-related first aid is the first topic of the Campaign of Cardiovascular and Cerebrovascular Disease Prevention and Treatment, but there is only one quantitative assessment indicator monitored by the government, which is the rate of emergency rescue training among residents, with training of teachers being the primary strategy chosen to achieve improvement of this indicator. In 2020, the Red Cross Society and the Ministry of Education of China issued a joint notice to strengthen CPR training and train teachers specialized in emergency education. The plans involve installing automatic external defibrillations (AED) in crowded places, including schools, workplaces and institutions, airports, transport stations, shopping malls, and cinemas. Organizations involved in implementation of this effort include the National Health Commission, the Ministry of Education, the Ministry of Finance, and the Red Cross Society of China.
Campaign Government-monitored indicators Main practices Health literacy campaign Mastering basic knowledge and skills on of first aid including CPR Encouraging professional institutions and media to educate the public; encouraging residents to master essential skills, such as making an emergency call and CPR; encouraging families to have the first aid kits Cardiovascular and cerebrovascular disease prevention and treatment campaign Percent of residents with certification in emergency rescue training: ≥ 1% in 2022 and ≥ 3% in 2030 Supporting professional institutions to carry out mass emergency rescue training; training teachers in primary and secondary schools, 1 teacher trained for each 50 students in the first aid Outside the monitored indicator system Providing the first aid drugs and AEDs in crowded places; providing an ambulance for every 50 thousand people; achieving 100% of 10-second answering rate for pre-hospital medical emergency institutions; increasing the 5-minute departure rate of ambulances Abbreviations: CPR=cardiopulmonary resuscitation; AED=automatic external defibrillation.
Table 1. Campaigns related to cardiac arrest in the Healthy China Initiative (2019−2030).
Timely and effective bystander CPR may be the best hope for survival once CA occurs. Initiating CPR within 1 minute of CA and use of AEDs within 3–5 minutes can increase CA survival rate to 50%–70% (7). Currently, there are four national laws closely related to increase in CA survival (Table 2). Among these, the Civil Code implemented in 2021 is particularly important for legally protecting bystanders who are not medical staff when witnessing a CA and providing onsite first aid. The Primary Healthcare, Medicine, and Health Promotion Law implemented in 2020 guarantees comprehensive measures to improve onsite first aid in terms of training potential bystanders, public participation, availability of equipment, and mechanisms for legal protection. The ongoing Law for Medical Practitioners is anticipated to play a key role in encouraging and protecting medical practitioners to implement a rescue for OHCA by exempting medical practices from restrictions on place, category, and specialty. Lastly, the Law of the Red Cross Society revised in 2017 authorizes the Red Cross Society of China — a non-governmental organization (NGO) — to establish an emergency rescue system in an attempt to improve likelihood of successful rescue from CA.
Name Basic description Function in cardiac arrest Law for Medical Practitioners A draft of this law, issued on January 27, 2021, is based on a revision of a similar 1999 law We suggest that medical practitioners should be encouraged and protected to implement OHCA by exemption from restrictions on their medical practice such as place, category, and specialty by this law, although this draft includes rescue for patients in case of emergency. Civil Code China's first law named after the code occupies a fundamental position in the legal system; implemented on January 1, 2021 Articles 183 and 184 provide a basic guarantee of civil rights for any bystander who conducts out-of-hospital CPR; Article 1,005 requires organizations or individuals with legal obligations to fulfill their own rescue duties. Primary Health Care, Medicine and Health Promotion Law China’s first basic and comprehensive law in the field of health; implemented on June 1, 2020 Article 27 establishes and improves a pre-hospital first aid system, defining what the jobs of the government as following: 1) carrying out first aid training and public education; 2) encouraging onsite first aid; 3) providing first aid facilities in public places; 4) forbidding refusal and delay from first aid centers due to fees. Law of the Red Cross Society 2017 revised version with functions of the Red Cross Society in non-war or non-armed conflict scenes added. Article 11 defines the functions of the Red Cross Society, including establishing an emergency rescue system, carrying out emergency rescue training, popularizing emergency rescue and health knowledge, and organizing volunteers to participate in onsite rescue. Abbreviations: OHCA=out-of-hospital cardiac arrest; CPR=cardiopulmonary resuscitation.
Table 2. Current national laws closely related to cardiac arrest in China.
To supplement national laws, some local governments have enacted detailed regulations to support CA rescue. For example, considering people who are likely to become witnesses of a CA, public transportation drivers and attendants, teachers, tourist guides, firemen, policemen, security staff, and pension service personnel are designated as specific recipients of CPR training in Hunan Province, Shanghai Municipality, Hainan Province, and Nanjing City. The Regulations of Hunan Province on Spot Rescue stipulates that CPR training should be included in all types of school curriculum. As the availability of AED devices is essential for onsite first aid for CA, the above regulations require or encourage provision of AEDs in crowded or high-CA-risk places such as transportation hubs, tourist attractions, stadiums, conference and exhibition centers, nursing homes, and schools.