India’s silent emergency: Why CPR awareness must become a civic responsibility

During medical emergencies, the difference between life and death is measured in minutes, not hours. Despite this, one of the main critical life-saving interventions, cardiopulmonary resuscitation (CPR), continues to remain unfamiliar, misunderstood, and intimidating to the general public in India.

Cardiac arrest acts as one of the most time-sensitive medical emergencies. When the heart suddenly stops pumping blood effectively, oxygen supply to the brain and vital organs ceases almost immediately. Within a couple of minutes, the irreversible brain injury might start, which significantly reduces the chances of survival. In such moments, immediate intervention matters more than waiting for professional help to arrive.

According to the Cardiological Society of India (CSI), the rate of bystander CPR in India has been estimated to be between just 1.3 per cent and 9.8 per cent, a figure which is supported by pooled data analyses such as Patel et al. (2023).

This stands in sharp contrast to the approximate 30 per cent global average, and far below the 62 per cent target goal recommended for optimised community survival networks. These statistics highlight a troubling reality: in most cardiac emergencies, the people who witness a collapse might hesitate, panic, or avoid intervening entirely — even when immediate action could significantly improve survival chances.

For healthcare professionals, one fact that has remained clear is that survival often starts not in the hospital but in the hands of ordinary people willing to act before medical services arrive. The first couple of minutes after cardiac arrest are very decisive. Without intervention, survival rates decrease significantly with every passing minute, while the risk of permanent neurological damage rises sharply.

In several parts of India, hesitation during emergencies if quite common. People often fear causing harm, making mistakes, or facing legal issues after helping someone in distress. Emergency response is still perceived as the responsibility of doctors and hospitals alone, rather than a collective community responsibility.  But the reality is very straightforward: doing something is almost always better than doing nothing.

Modern emergency medicine strongly supports the idea that even basic chest compressions by an untrained bystander can improve outcomes substantially. CPR does not demand perfection. Presence, confidence, and timely action matter far more than expertise in the first few moments of an emergency.

Acknowledging the cultural and educational barriers that are associated with conventional CPR training, the Resuscitation Council of India, established through the Indian Society of Anaesthesiologists (ISA), developed an important alternative — Compression-Only Life Support (COLS) guidelines.

The COLS framework was made specifically for simplifying emergency intervention for ordinary citizens. Conventional CPR usually feels scary as it involves rescue breathing, technical instruction and fears related to physical contact. COLS acknowledge these concerns by introducing an uncomplicated, algorithmic pathway intended for untrained laypersons and reluctant bystanders.

As acknowledged by Garg et al. (2017), the core directive of COLS minimises the need for rescue breaths entirely and exclusively focuses on high-quality, continuous, uninterrupted chest compressions. The objective is clear: make CPR easier to learn, easier to remember, and more likely to be performed during emergencies.

This simplification is particularly relevant in India, where cultural hesitation, lack of confidence, and inadequate training often discourage intervention. A method that focuses solely on chest compressions lowers psychological barriers and improves the likelihood that someone nearby will step forward when every second matters.

Unfortunately, CPR education has still not been integrated into daily life in India the way road safety awareness and fire drills are. Schools should include CPR education in their curriculum. Most workplaces do not make emergency response training compulsory. The residential communities, sports clubs, gyms, schools and public gathering spaces often lack both awareness and access to emergency equipment such as Automated External Defibrillators (AEDs).

This fragmented and reactive approach to emergency preparedness needs urgent change.

Schools play a vital role in transformation by introducing age-appropriate CPR and emergency response education. Universities and workplaces can organise periodic hands-on training sessions. Residential housing societies and recreational clubs should establish response plans while making sure that the staff members have been trained to confidently react during a critical situation.

Public awareness campaigns can be crucial for overcoming the emotional barriers that prevent intervention. Emergenies are chaotic situations and are emotionally overwhelming, and fear acts as a natural response. However, confidence is built through familiarity. The more communities normalise conversations around emergency response, the more likely individuals will be to act decisively rather than freeze during moments of crisis.

Technology and infrastructure can further strengthen this cultural shift. The installation of AEDs in airports, shopping malls, schools, sports complexes, railway stations, offices, and residential societies can dramatically improve survival rates during sudden cardiac arrest. Importantly, AEDs are designed to be highly user-friendly, providing clear step-by-step voice instructions during emergencies, making them accessible even to people without medical training.

The broader medical consensus across organisations such as the Indian Resuscitation Council Federation (IRCF), the Cardiological Society of India (CSI), and the Indian Society of Anaesthesiologists (ISA) remains clear: reversing India’s poor bystander CPR numbers requires a structured national response. This includes the development of a formal national sudden cardiac arrest registry alongside mandatory, simplified public-access CPR training programmes such as COLS to build a stronger, more responsive community of lifesavers.

At its core, CPR awareness is not merely a healthcare issue — it is a civic responsibility. A society prepared to respond to emergencies reflects a culture of empathy, confidence, and shared accountability. Emergencies rarely arrive with warning, and medical professionals are not always immediately available. In those moments, the actions of an ordinary neighbour, teacher, colleague, parent, or passerby may determine whether someone survives.

We often say that every second counts during cardiac arrest. But perhaps what matters even more is ensuring that someone is willing to use those seconds meaningfully.

If India hopes to improve emergency outcomes, we must move beyond awareness alone and foster a culture where helping becomes instinctive, preparedness is normalised, and life-saving action becomes everyone’s responsibility.

Public understanding of basic life support and cardiac emergencies is heavily shaped by fictional media representations. Hollywood and Bollywood films have misrepresented CPR, which has shaped public opinion. Epidemiological data confirm that the median age of a cardiac arrest victim is approximately 62 years, with more than 80 per cent of out-of-hospital cardiac arrests occurring in private residential settings. The dramatic portrayal of immediate, complete recovery—wherein a patient sits up, speaks, and regains full cognitive function seconds after resuscitation—hides the severe physical trauma of high-quality CPR, which frequently results in fractured ribs, pulmonary bruising, and cognitive deficits due to temporary cerebral hypoxia.

Hollywood cinema regularly violates these foundational biomechanical rules, presenting physically ineffective and clinically dangerous techniques. Some of the examples include films like Jumanji, Jurassic Park, Casino Royale, Mission Impossible 3, etc.

While Western media often attempts to project clinical authenticity while failing in execution, South Asian screenwriters and directors frequently bypass biophysics entirely, treating cardiac events as opportunities for emotional drama, divine intervention, or melodramatic metaphors. The famous scene from the 3 idiots movie, where a neonate is resuscitated using metaphors like “All is well” is a typical example of this.

Newer advances:

Mechanical CPR devices like LUCAS 3 and ZOLL autopulse are being used in specific situations. Mechanical CPR is recommended only under specific logistical circumstances—such as limited rescue personnel, prolonged resuscitation times, or patient transport in moving emergency vehicles and helicopters. Several AI-based training devices are also available nowadays.

(The author is a paediatric anaesthetist and founder & director of Children’s Anaesthesia Services)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK