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My Take: Translating Science Into Survival

When paramedic and AHA staffer Russell Griffin looks at translating science into survival, he sees strides but know we’re only part way through the journey. Here, he tells it in his own words:

AHA staffer Russell Griffin keeps his skills current as a CareFlite paramedic.

AHA staffer Russell Griffin keeps his skills current as a CareFlite paramedic.

My interest in pre-hospital systems is directly influenced by my background. I started my work in EMS in high school and continue it to this day. Through the years, I’ve seen a lot of variation in quality of care and in the design of pre-hospital systems across the U.S. and the globe. This lack of consistency leads to variations in systems of 500 percent or more. Obviously, this increases – or decreases – your likelihood to live.

AHA and seven other member councils have been involved with ILCOR since 1993, working to “translate science into survival.” We’re using advocacy, outreach, and marketing to put evidence, research and science into practice in the regions of the seven member councils – United States, Canada, Europe, Australia, New Zealand, South Africa, Latin America and Asia.

I see our biggest challenge with translating science into survival as measuring success and knowing where to focus next. This past September for World Heart Day, the World Heart Federation called upon global health organizations to step up their efforts to track the impact of cardiovascular disease and stroke. There are so many countries that don’t capture or report on critical cardiac metrics.

In the United States we do a pretty good job at measuring where we’re improving and where we could use more resources. It’s not a perfect system, as the 2015 Institute of Medicine Report on Cardiac Arrest pointed out, but it’s still on the leading edge compared to others.

I view it as our moral imperative to work with our fellow global health advocates to establish systems to set goals and measure against them so that we can truly determine where there are needs and how we are doing in meeting them. It’s about creating health equity and standardization. As my colleague Michael Hulley said so well in a blog last month, “Where you live should not determine if you live.”

Given my background, I choose to focus on pre-hospital care. There is so much variation in the design and process of EMS systems across the world. In the United States alone there are more than 100 different EMS designs.

It’s incredibly hard to standardize designs and processes given budget, staffing and cultural differences. So the AHA is looking at it from a Systems of Care perspective, seeking practical solutions that can be implemented reasonably to make a significant difference. One example is dispatcher-assisted CPR, also known at telephone CPR (T-CPR).

EMS World recently tweeted, “Your dispatch center really has no excuse not to be doing telephone CPR.” AHA was an early proponent of T-CPR and is now developing program and performance recommendations that set standards for timely and high-quality delivery of T-CPR.

T-CPR also demonstrates the importance of metrics. Research shows that as much as 50 percent of bystander CPR in communities that provide T-CPR instructions to 911 callers is directly attributable to those instructions. That’s why we are leading the T-CPR charge and why a major component of AHA’s recommendations will be a set of metrics against which EMS performance can be assessed.

It’s time to open up this entire spectrum of best practices and share it globally. It may not be easy, but the benefits will be immeasurable.

 

 

 

 

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Making a difference in the lives of pediatric stroke survivors

photo-michelle-ballasiotesBy Michelle Ballasiotes. Michelle is a pediatric stroke survivor. She can be reached through her Facebook group, Youth Advocates for Pediatric Stroke, as well as the the KISS Pediatric Stroke Facebook group.

There seems to be a lot of resources and information for adults who suffer strokes, but what about children? Most people don’t realize that a stroke can also happen to children, teens, babies and even the unborn, leaving lifelong disabilities.

I know this first hand, having suffered a stroke before I was born. As a result, I am missing a portion of the left side of my brain that leaves me with hydrocephalus, right hemiplegia, and short term memory deficits. I’m considered a “lucky” survivor because I started weekly occupational and physical therapy at just six months and continued for 10 years in order to reach my full potential. And unlike many global survivors, I benefitted from access to high quality health care and good health insurance.

Stroke in babies, children and adolescents is often misdiagnosed or not diagnosed due to the lack of awareness that the condition can happen in this population. Yet every year, stroke occurs in five of 100,000 children. Of those who survive, more than 60 percent suffer permanent neurologic deficits.

Further, when a child suffers a stroke, the family may feel alone and vulnerable because supportive community resources and medical treatments are not universally available. This is a global challenge even in high-income countries like the United States.

My family saw this first-hand and took steps to support me and others like me. My mother started a local support group. Guest speakers and doctors came to the quarterly meetings, and we had annual community picnics. Despite physical limitations, kids would storm the playground and meet other children just like themselves. I would often give words of encouragement and answer questions from parents of younger stroke survivors. I cannot emphasize enough the importance of a caring community for both the parents and children.

After six years locally, there was enough interest that my mom created a global organization, the International Alliance for Pediatric Stroke (IAPS). It partners with AHA and the University of North Carolina to produce resources and publications for families, patients and healthcare providers. The website is very comprehensive and has a vast number of publications, resources, current news, research, a list of organizations worldwide and inspiration. Information and inspiration are so important for survivors and their families.

Recently, I learned about a program by a mom with a pediatric stroke survivor. Her organization, Pediatric Stroke Warriors, assembles “Brave Boxes” that are given to children before they go into surgery or have a major medical appointment. The box contains toys and other fun goodies based upon the child’s age and is designed with the dual purpose of distracting the child and easing parents’ nervousness to see a happy child. Parents aren’t left out, either. They receive “Warrior Bags,” with educational tools from IAPS and lists of local and national resources so they can see there is a caring community surrounding them.

I just started my freshman year of college and hope to give back by starting a program with hospitals near my university that would create communities of care for pediatric stroke survivors. Ideally, it will be a peer-led mentoring program for other children affected by stroke.

Pediatric stroke survivors like me will need a lifetime of ongoing care, treatment and support. The same is true for everyone suffering from a noncommunicable disease. If you’re wondering where to start, try the American Heart Association’s Patient Support Network, the American Stroke Association or some of the other resources mentioned in this post. Together we can make a difference.

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Power Your Life by Loving Your Heart

This blog was written by Michael Hulley of the American Heart Association.

It’s been two years since an artery spasm sent me to the emergency department at Baylor Scott & White Medical Center in Dallas. I’d been on the road for 16 days and was sitting in a meeting at the office, which just happens to be the American Heart Association. We’re closing up a discussion about ACLS when it started. Tunnel vision. Tightness in the chest. Pain. Clamminess. Thirty minutes later I’m  en route to the hospital, accompanied by my colleagues, ECC’s senior leadership.

The story ended well, but it’s illustrative of the need for AHA’s global mission. Baylor McKinney had excellent staff, new rooms and the most current equipment. A colleague knew to hand me an aspirin. I got admitted very quickly once at the hospital and was seen by highly trained healthcare providers.

But in my position within AHA’s International division affords me a look on the other side of the glass. What would have

AHA International VP Michael Hulley's Healthy Heart selfie in honor of World Heart Day (Sept. 29, 2016).

AHA International VP Michael Hulley’s Healthy Heart selfie in honor of World Heart Day (Sept. 29, 2016).

happened if this occurred in a taxi in China? Or while in rural Central Africa? I had no idea what was going on – and I’m probably more educated in heart conditions than most. Would I have made it to a hospital? Would the treatment follow the AHA’s Guidelines Update for CPR and ECC or Get With the Guidelines program?

In China, where there is a shortage of doctors and nurses, average citizens gather in a room where medical professionals can examine up to eight people at a time. Hallways are wide to accommodate those who are waiting for treatment. Survival rates from out-of-hospital cardiac arrests are low – approximately one percent.

That’s why what the training and education that AHA is conducting in cooperation with the Chinese government and in 80 other countries is so important. It will save millions of people in that nation over the next decade.

It’s also a significant reason for our support of the World Heart Federation, the global cardiovascular advocacy organization, in its goal to reduce premature deaths around the world from cardiovascular disease (CVD) by 25 percent by 2025.

World Heart Day, September 29, 2016, recognizes that every year, 17.3 million lives are lost to heart disease and stroke. In fact, cardiovascular disease is the leading killer around the world. It’s our mission to change that and give people a fighting chance at survival. One way to do this is to control the four main risk factors of CVD: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.

After my scare I made deliberate lifestyle changes to power my life. I work out, even on the road. I changed my diet. I lost 16 pounds when I started taking my health seriously.

It’s time we reverse the trends of premature deaths from CVD and inequalities in low- and middle-income countries, which now account for 80 percent of CVD deaths.

Where you live shouldn’t determine if you live.

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Teen’s heart stops in New York City train station

In case you missed it in last week’s American Heart Association News: a great CPR story illustrating the chain of survival in one of New York City’s busiest commuter and tourist locations.

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Three years before musician and actress Ilisa Juried appeared on The CW’s reality show Pussycat Dolls Present: Girlicious, her heart stopped in New York City’s Grand Central Station.

The then-18-year-old was sightseeing with her mom when they saw a group of hip-hop dancers performing at the train station, and Juried asked to join in. The lead dancer pulled her in, and a few moments later, Juried collapsed.

Deb Scholten, a nurse vacationing from Michigan, ran to Juried’s side and started CPR. When paramedics arrived 30 minutes later, they used an automated external defibrillator, or AED, to shock Juried’s heart back into a normal rhythm.

The Florida native spent six weeks in a New York City hospital, where doctors ultimately diagnosed her with long QT syndrome, a problem with the heart’s electrical system that can cause a fast, chaotic heart rhythm. The Juried family believes the condition, which is often inherited, may explain her father’s death from cardiac arrest at age 45.

While in the hospital, doctors implanted a cardioverter defibrillator, known as an ICD, to shock her heart back to its normal beat should a life-threatening rhythm ever occur.

Ilisa Juried_scar

Ilisa wears the scar from her ICD (left shoulder below clenched fist) as a badge of honor.

“My [ICD] scar is my star,” said Juried, who is now 29 and lives in Los Angeles. “Every day I’m reminded of my strength, simply by what I’ve had to endure with my condition.”

The device has shocked her heart three times.

“I always faint right before it happens, so I don’t remember any of it,” she said.

Following her recovery, Juried scaled back on dance, focusing instead on her love for music and acting. During the past decade, she has appeared in dozens of commercials and recently released a jazz album titled Making History.

Ilsia conducts an interview with a Fox News affiliate on behalf of AHA's Go Red for Women program.

Ilsia conducts an interview with a Fox News affiliate on behalf of AHA’s Go Red for Women program.

 

She takes medication to help manage her irregular heartbeat and is careful when doing any exercise. She also volunteers for the American Heart Association, sharing her story at local events and raising awareness about CPR.

“CPR is the only thing that saved me from major brain damage and kept me alive,” said Juried, who keeps in touch with Scholten through Facebook.

About 40 people each hour have a cardiac arrest while not in a hospital, and nine of 10 do not survive, according to AHA statistics. Yet receiving bystander CPR can double or even triple the victim’s chances of survival.

Juried first learned CPR as a teenager when she was a babysitter. Last October, she underwent training again.

“Everyone should learn CPR,” she said. “You can truly save someone’s life by learning simple techniques.”

Photos courtesy of Ilisa Juried

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Three New Journal Articles Stress Preventative Strategies To Improve CVD Outcomes

Occasionally our research team will flag recently published works that it feels are important to advance. This post reviews three such articles that review emergency heart and stroke care and outcomes based on lifetime risk, sex-based disparities, and digital preventative strategies.

  1. The study, Men may face high lifetime risk of sudden cardiac death, offers the first lifetime risk estimate for sudden cardiac death. According to this study published in the Journal of the American Heart Association, about one in every nine men will experience sudden cardiac death, most before age 70, as well as about one in 30 women. The study also found men with two or more major risk factors at all ages had even higher lifetime risks of at least 12 percent.
    High blood pressure helped to identify lifetime risk more accurately in both men and women than any other single risk factor and could lead to better screening methods for sudden cardiac death.
    Click here to learn more about this study.Infographic - Sudden Cardiac Death
  2. Published in the Journal of the American Heart Association, Gender gap found in cardiac arrest care, outcomes, is the first to represent sex-based disparities amongst more than 1,000 cardiac arrest patients from hospitals nationwide. During the 10-year-study, the number of cardiac arrest patients treated at hospitals increased while in-hospital death rates fell for both sexes, but remained higher for women.
    Additionally, the study found that women treated at a hospital after cardiac arrest may be less likely than men to receive potentially life-saving procedures such as angiography to look for blocked coronary arteries or angioplasty to open arteries.
    Click here to learn more about this study.
  3. A new scientific statement published in the journal Circulation, Digital strategies show promise for emergency heart and stroke care, examines several potential focuses for future digital strategy studies. These possibilities include: mobile devices that are converted into defibrillators; video sharing platforms to help real-time bystander CPR and automated external defibrillator (AED) coaching; and the potential for emergency personnel to use cell phones to pinpoint the best hospital based on patient, traffic, hospital readiness and average treatment times.
    These digital strategies have the potential to improve emergency care for cardiac arrests, heart attacks and strokes, according to a new scientific statement from the American Heart Association.
    Click here to learn more about this study.

Although these studies examine various aspects of emergency cardiovascular care and treatment, they all rely on preventative measures that are often completed outside of a hospital setting. Heart disease remains the leading cause of death in the United States and public access to cardiac arrest education, knowledge of how to perform CPR, and how to use defibrillators are imperative to improving survival rates. As we work to achieve our 2020 Impact Goals, remember that our collective effort each day matters¬¬—you’re helping us save lives!

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Actor, director of CPR training video share personal connections to heart health

Recently, ECC produced a new Hands-Only CPR training video. In it, two siblings grapple with the suggestions of their lovingly overbearing mother. But when practicing Hands-Only CPR, it’s the kids who end up teaching the mom. The story behind the actors is a fascinating one.

When taking on roles, actors often ask themselves, “What’s my motivation?” For those who made “Mama Knows Best,” the answer was simple: to save lives.

AHA trainer Deb Haile works with actor Roberto Morean on the proper hand positioning for CPR.

 

Roberto Morean plays the son, Tomas. In his own family, two grandparents have high blood pressure and several family members have high cholesterol. Morean became dedicated to promoting health when he was diagnosed with Hodgkin lymphoma in 2014. Some chemotherapy drugs, he learned, can damage the heart. “During chemo, they put a lot of emphasis on my heart to make sure it stayed strong,” said the 21-year-old. “It puts a lot into perspective.”

Morean’s cancer is now in remission. It helped him realize at a younger age than most that few things are as important as health. “I’ve been a big advocate for healthy lifestyles and raising money for organizations,” he said. “Doing something for the American Heart Association is just another way to be an advocate.”

During rehearsals, Morean for the first time learned how to perform CPR. “We spent lots of time filming me giving the dummy CPR,” he said. “And I thought, ‘This is crazy,’ because this is what a lot of people will watch to learn how to do CPR and save lives themselves.”

The opportunity to teach people about CPR meant a lot to Morean, and he hopes people who see it can make a difference. “Using art forms for purposes like this is important,” he said. “It helps people remember for when they need it most.”

The father of the video’s director, Fernando Vallejo, died suddenly from a heart attack when Vallejo was 32. “I guess we all take our heartbeats for granted,” he said. “We breathe, we walk, we live — until something goes tragically wrong.” For Vallejo, raising awareness about heart disease and CPR isn’t something he takes lightly. “It’s a matter of life and death,” he said.

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Calm in chaos: Emergency responders at work

An 18-year-old Danielle DeVito, a paramedic and AHA volunteer, was inspired to join this profession when she was on a city bus going to visit a friend and witnessed an accident. Two female responders got out of an ambulance to help the person, who almost died. It was the first time she had observed a professional responder in action – and also the first time seeing a person’s life saved right before her eyes.

CHICAGO, IL - FEBRUARY 24: Danielle DeVito (L), National American Heart Association Volunteer, shows Ginger S. Evans, Chicago Department of Aviation Commissioner, the Hands-Only CPR Training Kiosk provided by the AHA and Anthem Foundation after its launch at O'Hare International Airport's Terminal 2 on February 24, 2016 in Chicago, Illinois. (Photo by Brian Kersey/Getty Images for The American Heart Association) *** Local Caption *** Danielle DeVito; Ginger S. Evans

Danielle DeVito shows Ginger S. Evans, Chicago Department of Aviation Commissioner, the Hands-Only CPR Training Kiosk after its launch at O’Hare International Airport on February 24, 2016.

Danielle realized right then and there that EMS was what she wanted to do for the rest of her life. She was intrigued by the thought of helping people in emergency situations and being that link between someone being unsure of what to do, calling for assistance and looking for someone with training to show up. She says, “You may not have all of the answers, but you definitely have the tools from training to assist the community.”

While Danielle was working, she observed young and older people suffering strokes and cardiac arrest. She started to realize that few people seemed to recognize the signs of a stroke and even less started CPR before a first responder showed up. Danielle wondered if there was something that she could do to encourage more people to take action.

She searched for ways to help people before they call 9-1-1, which is what brought her to volunteer with AHA on the program Power to End Stroke, an education and awareness campaign that seeks to impact the high

CHICAGO, IL - FEBRUARY 24: Danielle DeVito (C), National American Heart Association Volunteer, demonstrates the Hands-Only CPR Training Kiosk provided by the AHA and Anthem Foundation at O'Hare International Airport's Terminal 2 on February 24, 2016 in Chicago, Illinois. (Photo by Brian Kersey/Getty Images for The American Heart Association) *** Local Caption *** Danielle DeVito

Danielle DeVito (C), demonstrates the Hands-Only CPR Training Kiosk at O’Hare Airport.

incidence of stroke within communities. She then expanded her volunteer work to encourage greater use of Hands-Only CPR, most recently launching a Hands-Only CPR kiosk at O’Hare Airport in Chicago.

Danielle thinks learning CPR is important for the simple fact that a person never know when someone standing or sitting next to them will go into cardiac arrest. Danielle appreciates the pass-along effect of her education efforts, saying, “If I am able to teach one person what to do, that person will go home and help their families.”

As part of their jobs, EMS professionals are required to keep up their skills and stay current with best practices and guidelines. Danielle likens the body to a computer in that it is always changing. “Every few weeks,” she says, “it is time to reboot and update.” Those in her field are typically the first professionals on the scene with knowledge on how to treat a victim. “We are held to a very high standard,” she states, “Our reports are filed with hospitals and even with the Centers for Disease Control & Prevention. So we need to be at the top of our game.”

HOCPR - Devito Mom and Daughter

Danielle conducts a CPR demonstration.

Danielle is inspired by her daughter, who used to sit quietly in a chair while Danielle taught CPR courses. She remembers when her daughter was four years old, she suddenly got up and started doing CPR on an infant manikin. Her daughter, now 13 years old, was recently told to do 15 compressions as part of CPR education in her health class. Her daughter corrected the teacher and said, “You need to do 30 compressions to the song ‘Stayin’ Alive.”


June 15 – 21 is designated as EMS Week in recognition of those who put their lives on the line in order to save lives. During this week – and every week during the year – we salute our EMS providers for all of the work that they do to make our communities a great place to live, work and play.

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Nursing: A Profession of Healers … And So Much More

“Nurses Week [May 6 –  May 12, 2016] is important because it puts the spotlight on the people who really take care of you at the hospital,” said Jo Haag, MSN, RN, Resuscitation Learning Director for the American Heart Association. “It raises awareness of the wide variety that nurses do, and they do it all. This is another chance to educate the public and future nurses of all the things you can do when you are a nurse.”

Jo Haag (standing) observes a participant training on CPR.

Jo Haag (standing) observes a participant training on CPR.

Although this wasn’t a childhood career aspirations, one of Jo’s very first toys – the Nurse Barbie Careers Doll – proved prescient. What drew Jo to the profession is a little bit of a blur, but she really loved helping people and the variety of doing different things. As she grew in her career, she felt a sense of accomplishment that drove her to continue. Jo has worked in many different departments, from Labor and Delivery to ER to ICU, and even as a flight nurse. “I’ve been a nurse for so long it is part of who I am.”

Jo grew up and worked in Illinois both a hospital nurse and American Heart Association volunteer. She was also an adjunct faculty member at three different colleges. She loved the feeling of explaining academic concepts to students and seeing the “light bulb of knowledge” go off.

Jo had hospital colleagues who said she would be a great CPR instructor. She gave it a whirl, enjoyed it and got involved at wider level. She still teaches CPR classes at her church and in the community.

Photo - Jo Haag at Training Center

Jo Haag (center) attends the opening of a Training Center in Hong Kong.

Jo has been a in her role as a Resuscitation Learning Director at the American Heart Association for a little over a year. She still maintains her skills as a nurse: “Keeping my license as a nurse gives me credibility in my position at AHA since primarily the audience I work with is the medical profession.” A big chunk of Jo’s role is also interacting with international training network, working with health professionals in many countries to establish AHA training.

Jo emphasizes how important it is for everyone to learn CPR because CPR can and does save lives. “We are getting more and more data on that. Even if all you get out of a class is call 9-1-1, it’s better than nothing. CPR empowers people to take action.”

 

During Nurses Week, we salute Jo and all of her colleagues in the nursing profession.

You are everyday superheroes!

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Meeting Demand of our EMS Professionals

At the American Heart Association, it’s critical that we acknowledge and meet the needs of healthcare providers. That’s why we launched our new Basic Life Support for Prehospital Providers Course – a course that uses real-life, team environments customized for the Emergency Medical Service (EMS) audience.

Each year in the United States, more than 400,000 children and adults experience a cardiac arrest outside the hospital, and only 10 percent survive. Oftentimes, the EMS professionals arriving at the scene are the first ones to provide quality patient care to these victims. These heroes are on the front lines of healthcare and need training tools and materials tailored to serve them in the unique environments where they encounter patients.

EMS professionals have asked the AHA for a course to help them provide better patient care, and with this new course (LINK), we believe we’re better meeting their needs. It is the first training program from AHA specifically designed according to the new National EMS Education Standards and training needs of prehospital providers.

90-1085-BLS-for-PHP-Instructor-Packet_med-2

“The American Heart Association’s new course includes high-performance team CPR training designed to help increase survival from cardiac arrest. It features a variety of interactive, real-world scenarios EMS professionals encounter in the field every day,” said Mark Terry, MPA, NREMT-P, Deputy Chief of Johnson County Med-Act. “Advanced training for EMS professionals is a primary key to starting the chain of survival and achieving good patient outcomes through the delivery of high-quality CPR and strong basic life skills.”

While tailored for prehospital providers, this course covers the same objectives as BLS for Healthcare Providers, and successful completion results in a BLS for Healthcare Providers course completion card. BLS for Prehospital Providers is for prehospital emergency care professionals, including emergency medical technicians (EMTs), police officers, fire fighters, paramedics and advanced EMTs (AEMTs).

Our frontline EMS heroes are a critical element in the chain of survival. It is imperative that they have the tools they need to effectively perform their job. We’re proud to release new training materials designed not only to meet their needs, but help them save more lives.

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AHA Earns Award at Global Healthcare Summit

**UPDATE: Monday, April 7th, 2014**

Our colleagues in India just wrapped up this wonderful video that highlighted the AAPI Summit. You can watch it here:

 

**ORIGINAL POST: Tuesday, January 28th, 2014**

Earlier this month, I had the privilege of representing the AHA at the highly successful and productive American Association of Physicians of Indian Origin (AAPI) Global Healthcare Summit in Ahmedabad, India. The AAPI’s overarching mission is to assist and enable Indian American Physicians to excel in patient care, teaching and research in professional and community affairs.

While there, I participated in key leadership meetings and shared the global role and vision of AHA during the AAPI-AHA Liaison Committee at the summit. I was quite humbled to be recognized by the Health Minister of India, Mr. Ghulam Nabi Azad, and the Cabinet Minister of Overseas Indian Affairs, Mr. Vayalar Ravi, for our organization’s strategic collaboration toward the common goal of reducing mortality from heart disease and stroke.

This trip exemplifies the progress of our global efforts. We currently have International Training Centers in more than 60 countries, and we look to expand our global footprint to improve worldwide survival rates and quality of life with our lifesaving CPR programs. We stand committed to the AAPI goals and plan to roll out programs focused on India in the near future. In fact, we are considering opening an office abroad in New Delhi, and Baroda Medical College in Gujarat, India is in the process of applying to become an AHA International Training Center.

Exciting things to come in India…stay tuned!

Fun Fact: Ahmedabad, India was home to Mohandas Gandhi – considered the father of the Indian independence movement. While in India, Gandhi’s obvious virtue, simplistic lifestyle, and minimal dress endeared him to the people. Many civil rights leaders, including Martin Luther King Jr., used Gandhi’s concept of non-violent protest as a model for their own struggles.