It is heartening that the Singapore Heart Foundation (SHF) and the Singapore Civil Defence Force (SCDF) launched an initiative to provide face masks and hand sanitiser sachets at 10,000 publicly accessible automated external defibrillator (AED) cabinets.

The Resuscitation Council UK and the US Centres for Disease Control and Prevention state that compression-only cardiopulmonary resuscitation (CPR) is an aerosol generating procedure (AGP). The World Health Organisation's (WHO) scientific brief on Covid-19 also included CPR in the list of AGPs.

According to WHO, droplet transmission of the Covid-19 virus occurs when a person is in close contact (within 1m) with someone who has respiratory symptoms (for example, coughing or sneezing) and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets.

During chest compressions, aerosol generation is possible as research has shown. Furthermore, the person performing chest compressions is in physical contact with the patient and in close proximity (less than 1m) to the airway.

For all the above reasons, I strongly encourage that eye goggles be included as personal protection equipment in all publicly accessible AED cabinets.

The current face shields used by healthcare workers and volunteers who are caring for and/or swabbing Covid-19 positive or potentially positive persons do not provide adequate protection as there are huge gaps, especially around the jawline. During CPR, the direction of aerosol travel is upwards and not horizontal as expected during normal operations.

Dana Elliott Srither (Dr)