Interview with Dr. Walter Renier, president of the BRC

Interview Walter RenierWho is Walter Renier? Doctor Walter Renier became a general practitioner because he had been around a hospital since childhood, where his mother had advanced from an administrative position to the position of director.
“Ik koos specifiek voor huisarts alhoewel ik een functie ambieerde als chirurg. In mijn opleidingsperiode kon men zich als huisarts ook moeilijker specialiseren dan nu heden ten dagen.”

“In my position as president of the GP on-call service, I often encountered urgencies, which put me in contact with some eminent specialists in emergency medicine in Brussels including Prof. Dr. Luc Corne and Prof. Dr. Marc Sabbe of the UZ Leuven.”

“Through the then Vlaamse Huisartsenkring, now Domus Medica, I met Leo Bosschaert, Emeritus Professor of the University of Antwerp, and we founded the Belgian Resuscitation Council (BRC) in 1999. Thus, I am one of the founders of the BRC. Afterwards, it was a logical consequence to also be active within the European Resuscitation Council and I was promoted to course director. For some years now, I am proud to be the inspirer behind European Paediatric Resuscitation (EPBLS).”

Are there some notable experiences within the ERC or BRC ?

“The current president of the ERC, Koen Monsieurs, once asked me to teach a course in Moscow. I then taught the very first Basic Life Support (BLS) course there. Since then I am still a member of the Education & Sience committee.”

May we say that the origin or operation of the ERC has its basis in Belgium ?

“Actually, yes.
When new guidelines come out, they are often a result of proposals I once made.
In terms of information and photographs, I am very conservative and keep everything.
So I am happy to make my library available to support the operation of the ERC and the BRC.

Leo Bossaert started the ERC in the early 1990s.
Pretty soon, the idea of giving each country its own autonomy came up.
The BRC was one of the first to actively participate in starting the European story.
Spain and the Netherlands were ahead of us.
So I was the chosen one to join this project because they also wanted to involve general practitioners.”

We as Safety Expertise are going to introduce the ERC certificate BLS as standard in our trainings.
Is that a good addition to existing trainings in Belgium ?

“Yes indeed.
Recognizing a heart problem in time and alerting the emergency services is and will remain one of the most important links.
Safety Expertise in terms of education is certainly an important part of that and benefits a victim’s chances of survival.

The bystanders are the people who save the victim , the emergency services arrive on the scene to help save the victims.
Suppose we were to rely solely on the intervention of the emergency services we never get above the 10% survival rate after cardiac arrest.

It is the intention of the ERC and the BRC to implement the science in the existing training programs.
Hence, there are now new guidelines on CPR to improve the quality of CPR not only in Belgium but also throughout Europe.
What is also important is to create a homogeneous whole of training around CPR.
In this way a straight line can be drawn in the training and this can also be better scientifically monitored and researched.
This in turn can be used in the future to keep improving the guidelines.

The fact that we now have new guidelines is because of the continuous scientific research in many European countries. To improve data quality, it is really necessary that we all follow the same guidelines. “

How is that information gathering around resuscitations ?

“In Belgium, all resuscitations are registered (anonymously).
Very recently, it has been shown that ventilating a victim gives a better outcome than victims who did not receive ventilation.
But currently the data pool is not particularly large because we are not getting enough data.
Only a few countries are cooperating to bring this data together.

The new type of AEDs offer a lot of support in this.
They allow us to see the quality of compressions and ventilations.
On that mannie we can then also see which victim has already been ventilated before the emergency services arrived at the scene.”

Why are there countries where the survival rate for an OHCA is significantly higher ?

(OHCA = Out of hospital cardiac arrest)

“A study in 2020 showed that in Belgium we are now at 11% survival rate, knowing that we are coming from 7% to 8%.
In Belgium we are obliged to make use of the voluntary bystanders who are nearby at the time of an incident and are aware and want to help.
Many watch and dare not do anything.
Only a 40% of victims are resuscitated by bystanders.

In the Netherlands, citizen responders are called to start CPR and use an AED which increases the chance of survival.
The sooner the first shock can be given the better.
Currently they are at 23%.
(hartstichting.nl)

The best results are seen in Copenhagen.
Prof.
Dr. Freddy Lippert once investigated whether using trained bystanders has a positive effect on the survival of victims.
And what turns out ?
They have the highest rate of survival in an OHCA compared to the other countries.

Switzerland has almost as good grades as the Netherlands.

In Belgium, we do not find enough volunteers and many people use privacy laws to not allow bystanders to enter their homes to start CPR.
75% of cardiac arrests do not happen in public places.
25% of cardiac arrests that do then happen in public places have a greater chance of survival.
If we do not change this issue we are never going to get an increase in survival.

We are trying to change this with an application.
Evapp , www.evapp.be, is an example of this.

If we could obtain from the government to make a central registration system where all AEDs are visible, that would already be a step in the right direction.
But because of the individuality of the manufacturers and sellers of AEDs, this information does not come together.

We are going to have to cooperate with all parties involved for this.
We cannot forget that the victim is the most important thing in this story .”  

Aren’t schools the ideal place to provide CPR training ?

“CPR training is already included in the educational attainment levels.

Hilde Crevits once,as minister of education, decided to give at least 2 x 2 hours of CPR training to +12 year olds.
In French-speaking Belgium it is slightly higher and is at 3 x 2 hours of training.

Much work remains to be done in this regard.
A progressive plan during students’ school careers would be a good step.
School boards and inspection is still not convinced of the importance of this training.

The ERC believes that learning the procedures step by step is very beneficial in the knowledge of CPR.
It is and always will be a stressful situation and that is where a knowledge of the right steps can be important.”

What will the future bring us in the field of CPR and AED ?

“The AED of the future will analyze after applying electrodes while giving compressions.
Current devices do not allow the victim to be touched during analysis.
So we hope and believe that will increase the quality of CPR if the AED does continuous monitoring of cardiac function during CPR.

During my doctoral studies,which I am currently working on, I am exploring implementing more technology in family medicine.
It involves a monitor slightly larger than a cell phone.

It is important to know when monitoring what is happening in the moment but also what has already happened, and there is currently a lack of devices that can do this.

Our cell phone will take an even more important place in the future in the field of rescue and medicine.
We need stronger batteries to deliver a shock with a cell phone because we need at least 150 joules.

With all acute and severe emergencies, it is important to know what happened “before” emergency services arrived on the scene. Currently we have too little data from that that we could absolutely use to improve victim care. GPs are also very important in this.”