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When cardiac arrest strikes, will those nearby be ready to intervene? In India, the answer is overwhelmingly no. With nearly 90 percent of out-of-hospital cardiac arrests (OHCA) going without life-saving cardiopulmonary resuscitation (CPR), the country finds itself in urgent need of a transformation in public health preparedness. As we celebrate World Stroke Day on 29 November, it is not enough to highlight stroke’s toll on lives, families, and the healthcare system; it is a poignant reminder of a larger, more troubling gap—our collective lack of readiness to respond to critical, life-threatening emergencies.
India’s stroke statistics alone stress the urgency: stroke ranks as the fourth leading cause of death and the fifth leading cause of disability nationwide, claiming over 105-152 people per 100,000 population (amounting to roughly 1.4-2.1 million new cases annually), with the impact most severe among those aged 65 and above. The socio-economic cost of this illness is also high, resulting in high mortality rates, with one-month case fatality rates around 18 to 42 percent, and long periods of disability for survivors. Adding to the concern, this incidence is projected to increase in the coming years due to India’s ageing population, shifting lifestyles, and the emergence of new cardiovascular disease risks.
As we celebrate World Stroke Day on 29 November, it is not enough to highlight stroke’s toll on lives, families, and the healthcare system; it is a poignant reminder of a larger, more troubling gap—our collective lack of readiness to respond to critical, life-threatening emergencies.
While India has seen significant strides made in the healthcare sector, very few are equipped to recognise or respond to sudden cardiovascular events (CVEs) or stroke symptoms. This gap in immediate response reflects a crucial structural issue: The lack of CPR and Basic Life Support, or BLS, training in our education, workplace policies, and public discourse. Figure 1 below explains key terms used in this context, including CPR, BLS, and OHCA, for clarity. Introducing CPR to more than just healthcare professionals and entrenching it within the public consciousness could rouse millions with the skills to save lives.
Figure 1: Key terms related to emergency preparedness
Rising cardiovascular events in India
Data from India's National Crime Records Bureau (NCRB) shows that deaths from heart-related incidents and other accidental injuries are on a steady and significant rise. Figure 2, which visualises a bar chart race, starkly shows the consistent uptrend in fatalities over several decades from a spectrum of causes—reinforcing the urgent need for India to be CPR-ready.
Figure 2: Yearly deaths due to causes that could be CVE, Compiled from NCRB Data
Source: https://public.flourish.studio/visualisation/19919571/
These figures are compelling enough to prompt immediate action. India’s bystander CPR rate sits between 1.3 percent and 9.8 percent, a rate that appears even more disconcerting when compared internationally. Countries with higher intervention rates owe much of their success to mandatory public Basic Life Support (BLS) training, where CPR is emphasised as a core public health skill. This becomes important as urban lifestyle factors—such as stressful environments, a lack of physical activity, and dietary changes—exacerbate the incidence of CVE. With less than 2 percent of India’s population formally trained in CPR, expanding public knowledge about CPR can save thousands of lives each year by increasing the likelihood of a bystander stepping in before medical help arrives.
Countries with higher intervention rates owe much of their success to mandatory public Basic Life Support (BLS) training, where CPR is emphasised as a core public health skill.
India’s low bystander intervention rates reveal not only a societal but also an educational gap. Although healthcare organisations, government bodies, and some private-sector entities have made moves to promote CPR training, these efforts are limited in reach and impact. Often, current programmes are offered as supplementary value-adds or optional training at universities or in select workplaces rather than as integral, mandatory life-skills training for all. This has to change; what India needs is an educational policy that combines BLS training at several levels—from schools and workplaces to public institutions.
Globally, countries like Norway and Japan, where survival rates from OHCA are notably high, have integrated CPR training into their school curricula. Currently, India's survival rates from OHCA remain low (<10 percent), a stark contrast to the 20-30 percent survival rates seen in nations that have established CPR curriculums. In schools, CPR would evolve from a supplementary skill into a civic responsibility, shaping children’s attitudes early so they grow up recognising CPR as a fundamental part of their civic duty.
CPR in the national curriculum
Currently, CPR training is largely absent from Indian school curricula, and where it exists, it is viewed as an optional skill that schools offer as a side activity rather than a required competency. This perspective must shift. Like mathematics and language skills, CPR and BLS should be thought of as foundational life skills. At present, CPR is present in the national curriculum as part of a grade 9 health book. The University Grants Commission recently mandated that higher educational institutions make BLS training compulsory, realising its ability to save thousands of lives every year by enhancing the ability of students, faculty, and staff to respond to life-threatening emergencies. This recommendation is also bolstered by a recently published study by the All India Institute of Medical Sciences (AIIMS) in collaboration with the Indian Council of Medical Research. The AIIMS study, which trained over 4,500 students from grades 6 to 12 across 15 schools, revealed that students, especially those in higher grades, could competently perform CPR techniques after training. Based on these findings, a panel of experts emphasised the need to integrate CPR training into the school curricula, establishing CPR skills as fundamental competencies.
The AIIMS study, which trained over 4,500 students from grades 6 to 12 across 15 schools, revealed that students, especially those in higher grades, could competently perform CPR techniques after training.
In 2022, Dr Shrikant Eknath Shinde, Member of Parliament, proposed a bill in the Lok Sabha requiring CPR training for schools in India to reduce the high fatalities due to cardiac arrest. The proposed national curriculum would be backed by the government and a body of experts. The status of this bill is currently unknown. Since education is on the concurrent list of subjects, this could also be an opportunity for states to enact their own CPR training laws tailored to regional needs while complementing national efforts. Taking inspiration from several states in the United States that have successfully passed legislation that mandates CPR training for children in schools, Indian states could spearhead such localised initiatives to build a CPR-ready nation from the bottom up.
BLS training shouldn't only be for universities and schools. BLS should be an occupational necessity for industrial workers who usually work in high-risk environments and should be mandated by workplace safety regulations. The integration of CPR and BLS training into operational policies should also be done similarly for offices, public transport systems, as well as government offices.
A holistic approach to basic life support
While the discourse often fixates on CPR alone, there is much more to talk about the broad umbrella, i.e., BLS. The fact is that BLS training involves training people for more than cardiac arrest-related procedures, such as choking, burns, and sudden traumas. It is such a matter of minutes in emergency cases that simple interventions could be the difference in giving someone a chance at life. The focus should therefore be on a comprehensive training model that includes hands-only CPR, relief for choking, strokes, and basic first aid. This step is important from a purely CPR-focused approach to a BLS approach since it equips the individual with the manoeuvring skills to handle a wide variety of emergencies and not just cardiac arrest alone.
Nearly half the road deaths in India could be prevented, but three out of four refuse to assist accident victims, frightened off by the possibility of police harassment and prolonged legal procedures. Over 200,000 lives are lost each year to road accidents, translating into an economic loss equivalent to about 3 percent of the gross domestic product every year. The Good Samaritan Law of 2016 was enacted to ensure legal immunity to those helping accident victims and safeguard them from unnecessary judicial and procedural burden. A rampant ignorance and misunderstanding of the Good Samaritan Law created to protect rescuers is proving to be a major deterrent in India. Public sensitisation programmes can assuage this fear and reassure citizens that they are protected if they rescue someone's life.
A rampant ignorance and misunderstanding of the Good Samaritan Law created to protect rescuers is proving to be a major deterrent in India.
A robust push for CPR and BLS training across demographics—parents, pregnant people, teachers, public transport drivers, and industrial workers—will require the collaboration of multiple sectors. Preparing new caregivers can prepare them for possible child emergencies, whereas the dual-positioning of school teachers—being educators and potential responders—can ensure safe schools. As part of a new initiative, the Union Health Minister launched a nationwide CPR awareness campaign conducted by the National Board of Examinations in Medical Sciences. The one-day online CPR awareness campaign was attended by over 20 lakh participants from different backgrounds, including students and professionals.
Securing India’s health
India stands at an important juncture where it has the potential to be more health-prepared by moving BLS and CPR from niche skills to societal norms. Currently, the landscape of public knowledge on CPR is undermined by misinformation, often spread through feel-good viral content that inaccurately depicts proper techniques. Such content can unintentionally cause harm and create distrust among the public regarding healthcare professionals criticising said content, and thus the need for an evidence-based, standardised approach to CPR and BLS training. Accredited programmes, going forward, should focus on reliable, medically sound methods that could be easily disseminated nationwide.
The landscape of public knowledge on CPR is undermined by misinformation, often spread through feel-good viral content that inaccurately depicts proper techniques.
While building the blocks for responding to medical emergencies and ensuring healthcare equity is crucial, a public that can act in those critical first moments is equally important. The goal for a CPR- and BLS-ready India should not only be meeting a healthcare target but also a social imperative that aligns with the nation's long-term health security.
KS Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
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