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Cardiopulmonary Resuscitation in Resource-limited Health Systems–Considerations for Training and Delivery

Published online by Cambridge University Press:  19 November 2014

Jason Friesen*
Columbia University, Mailman School of Public Health, Department of Health Policy and Management, New York, New York USA
Dean Patterson
Columbia University, Mailman School of Public Health, Department of Health Policy and Management, New York, New York USA
Kevin Munjal
Mt. Sinai Medical Center, Department of Emergency Medicine, New York, New York USA
Correspondence: Jason Friesen, MPH, EMT-P Columbia University Mailman School of Public Health Department of Health Policy and Management 375 South End Ave. #35R New York, New York 10280 USA E-mail


In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a life-saving skill that can be taught successfully to the general public. Cardiopulmonary resuscitation can be considered a cost-effective intervention that requires minimal classroom training and low-cost equipment and supplies; it is commonly taught throughout much of the developed world. But, the simplicity of CPR training and its access for the general public may be misleading, as outcomes for patients in cardiopulmonary arrest are poor and survival is dependent upon a comprehensive “chain-of-survival,” which is something not achieved easily in resource-limited health care settings. In addition to the significant financial and physical resources needed to both train and develop basic CPR capabilities within a community, there is a range of ethical questions that should also be considered. This report describes some of the financial and ethical challenges that might result from CPR training in low- and middle-income countries (LMICs). It is determined that for many health care systems, CPR training may have financial and ethically-deleterious, unintended consequences. Evidence shows Basic Life Support (BLS) skills training in a community is an effective intervention to improve public health. But, health care systems with limited resources should include CPR training only after considering the full implications of that intervention.

Friesen J , Patterson D , Munjal K . Cardiopulmonary Resuscitation in Resource-limited Health Systems–Considerations for Training and Delivery. Prehosp Disaster Med. 2015;30(1):1-5 .

Special Report
Copyright © World Association for Disaster and Emergency Medicine 2014 

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Conflicts of interest: none


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