Wednesday, 28 May 2014

Liverpool Care Pathway - In The Beginning Was The Pathway...

"I am the way and the path and the death... In my Father's house are many side-rooms; and I go to prepare a place for you.

John Bingham reports in The Telegraph that cuts in care for the elderly and disabled are putting services under ‘unsustainable pressure’ -

The National Audit Office found that despite a Government pledge to protect social care from the impact of austerity, spending on help for older people in England plunged by 12 per cent in just two years in real terms.
While councils have spoken of protecting services by focusing on other cost-saving measures, the NAO concluded that the vast majority of the reduction had been achieved by cutting the amount of care provided by tightening the eligibility rules.
Yet the cuts come at a time when need is greater than ever with the number of people over the age of 85 growing at a faster rate than the overall population.
Even the Government does not know how long the system can continue to cope with the pressure from rising demand but declining funding, it warned.
This is not new news. The EoLC Strategy permeated every section of society. Last year, the CCGs took the helm. We are only half way there. Do ideas already floated require refloating? Are they trying to tell us something? Is it a repeat fiasco of the independent auditor misinterpreting the figures as when Doc Foster reported a 'ten-fold increase' in hospital palliative deaths?

Guys and St. Thomas', home of the Amber Care Bundle and very proud of their record, were actually hauled over the coals in the Doc Foster report. See, for instance, -
Liverpool Care Pathway - Missing The Plot
See also -
Liverpool Care Pathway - Appointment With Death
So, the National Audit Office warns that spending has fallen by 12%.

Caroline Abrahams, Age UK national director, is concerned. Age UK, remember, backed the LCP. Age UK is currently working with a pro-euthanasia pressure group, Compassion in Dying.

These cuts were long planned and budgeted for as the Municipals acknowledged their role in EoLC and were required to accept cuts in central funding. This is Birmingham Council -
Birmingham City Council will be opening the consultation for the 2013/14 Budget next month against a backdrop of greater than previously notified grant reduction from national government.
Edinburgh Council, likewise, had to budget for required savings of almost £13 million in the last financial year. So, what's up Doc? It looks like the required spending cuts are being made. Care expectations are being downsized accordingly. The EoLC programme is biting all round. It is serving its purpose.

See -
Liverpool Care Pathway - The Micawber Principle
Studies demonstrate death to be a key focus of the day to day business of hospitals. And they are only half-way there.

This is a society geared to downsizing great expectations of life.

This is The Telegraph –

The Telegraph headlines: “Stop medicating the elderly and let them die naturally.”

Let someone “die naturally”. They make themselves sound so reasonable, compassionate.

Whatever age you are there's many an illness, if it isn't medicated, will most certainly cause you to die 'naturally'. Are the rules determined by your positioning on the Complete Lives priority curve?

Jane Ellison has responded to Mr Nicholas Brown at Question Time that permission is not required to slap a DNR on a patient’s file...

“Decisions about CPR are sensitive and complex and should be undertaken by experienced members of the healthcare team and documented carefully.”

Studies demonstrate death to be a key focus of the day to day business of hospitals. And they are only half-way there.

This is a society geared to death.

Caroline Abrahams, Age UK national director, is concerned...

The Lakhani Recommendations have downsized CPR. Are these the Byatt Recommendations to downsize treatment?
Writing in the journal Evidence Based Medicine, Dr Byatt said: “The data strongly suggests that we are over-treating many over-80s. 
“The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reduction in other cardiovascular end points.” 
Dr Byatt said studies have shown that: “these medications are greatly over-prescribed in the healthy elderly, and largely irrelevant in the frail elderly.” 
“In my experience, it is not uncommon in the oldest of these often frail but relatively disease-free patients, to see death as the next natural event in their life, especially welcome if they have outlived their peers,” he added.
“However this cohort is often deferential to the doctor, whom they frequently want to please or at least not upset. - The Telegraph
When someone visits the quack, it’s usually because they have a health issue they would like addressed. They may be happy or not happy with the treatment, but to extrapolate that dissatisfaction to demonstrate a preference to 'die naturally' is, frankly, bizarre.

Dr Madina Kara at the Stroke Association says that the success of statins and antihypertensive drugs has been proven and that they save 7000 lives each year.

You may dispute a study or its validity...
The recommendations are based on clinical evidence showing that stricter guidelines provided no additional benefit to patients, explained guidelines author Dr. Paul James, head of the department of family medicine at the University of Iowa Carver College of Medicine.
 "We really couldn't see additional health benefits by driving blood pressure lower than 150 in people over 60 [years of age]," James explained. "It was very clear that 150 was the best number."
 The American Heart Association (AHA) and the American College of Cardiology (ACC) did not review the new guidelines, but the AHA has expressed reservations about the panel's conclusions.
 "We are concerned that relaxing the recommendations may expose more persons to the problem of inadequately controlled blood pressure," said AHA president-elect Dr. Elliott Antman, a cardiologist at Brigham and Women's Hospital and a professor at Harvard Medical School in Boston.
 In November, the AHA and ACC released their own joint set of treatment guidelines for high blood pressure, as well as new guidelines for the treatment of high cholesterol that could greatly expand the number of people taking cholesterol-lowering statins. -
You don’t use rule-of-thumb pathways. You don’t treat the herd; you treat the patient, the individual in front of you.

Japanese report from 2002 recognises this and actually appears to pre-empt the findings of the recent US report...
Hypertension in adults is defined as systolic blood pressure of 140 mmHg or more or diastolic blood pressure of 90 mmHg or more (14). However, since blood pressure changes with age, the blood pressure level to be treated by antihypertensive drugs and the therapeutic goal pressure should be established separately for the elderly.
The treatment guidelines for hypertension published in the USA and Europe are essentially guidelines and, whilst a useful reference point for the control and treatment of hypertension, it is not appropriate to adopt them indiscriminately to Japanese hypertensive patients without consideration of the differences in genetic and social background.

So, what's all that about 'dying naturally'...?

It is all about promoting a landscape of downsized healthcare. The idea becomes integral to it. It is about denying and removing the possibility of hope. It is surrendering as vain and inappropriate Canutian endeavours all attempts to salvage and to preserve life.

No, Lady Jane, these doctors lack the capacity to understand or respect the courage of the human spirit, this day and every day, to live life and live it fully through another day, and they would give up on you, especially when you need them most.

God help us, this ilk would have sold us out to those 'thugs of Nazis' as my dear mum called them. These Quislings would have seen it all as futile and Canutian to attempt to hold back the Nazi horde. Heavens, we would today be ruled and overrun by a German led Europe...

And how would they have met the outrageous bravery of a Douglas Bader determined to reach for the sky and fly again? It is not a matter of refusing to face up to the gaping maw of death but all about confronting it. It is all about doing all you can until there is no more you can do.

Do you stand shoulder to shoulder with the suicide to urge them back from the brink or, side by side, do you tip them over the edge, with or even without their urgings to do so, to comply with some self-assessment of "best interest"?

This is the Economic and Social Research Council –

We are the UK's largest organisation for funding research on economic and social issues. We support independent, high quality research which has an impact on business, the public sector and the third sector. At any one time we support over 4,000 researchers and postgraduate students in academic institutions and independent research institutes.

The social architects are ever hard at work behind the scenes, manipulating and moulding. Society is but putty in their hands. When the ESRC makes funding available it is understood that it is toward matters of some considerable import.

The ESRC has been funding research into 'terminal sedation until death’ at Southampton University. Professor Sheila Payne is a member of the study group.

The Research Project discusses -
...the differences and similarities between 'continuous deep sedation until death' and euthanasia. Across Europe, the law surrounding end of life care has developed in significantly different ways.

For example, euthanasia (at someone's competent request) is now legally permissible in the Netherlands and in Belgium, but illegal, although subject to fierce debate and a review in the UK. There are some figures from research which suggest that the use of 'continuous deep sedation until death' may be used as a 'substitute' for euthanasia in some cases.
It is stated that continuous deep sedation until death may be used as a substitute for euthanasia. The UK data set is comprised of surveys completed by UK medical practitioners. This will be data from use of end of life pathways such as LCP, at home, in hospital and in hospice.

See -
Liverpool Care Pathway - The Side Effects
Jane Ellison has responded to Mr Nicholas Brown at Question Time that permission is not required to slap a DNR on a patient’s file...

“Decisions about CPR are sensitive and complex and should be undertaken by experienced members of the healthcare team and documented carefully.”

Ideas jostle for our attention, a flotsam and jetsam which has been floated over many years and has become a flotilla. Its course already charted, it hastens rapidly to join an Armada that threatens to overwhelm what last vestiges of common decency there are left to sustain us. This Armada that has gathered has put up a barrage and now threatens us with its blockade.

What is Beacon? Beacon is...

Beacon is a GSF accreditation conferred by the GSF itself, as are its other standards of accreditation. These are: Beacon, Commend and Pass.

What is Beacon? Beacon is...

- Beacon
Beacon is a Training Partnership of the SCC and the Learning Enterprise. It is aimed at care assistants and support workers to identify and support patients for EoLC, familiarise themselves with LCP documentation and with ACPs.

They’re teaching support assistants and support workers using Ellershaw’s evidence base...

Ellershaw’s own team can't get it right.

Mr. Ellershaw... I won't call you 'Doctor' or 'Professor' or whatever else you profess to be; you should be struck off - wiped off! - every medical register for this great wrong that has proceeded.

Mr. Ellershaw, I will say just two words. These two words are a name. That name is Jack Jones.

Further reading -
Liverpool Care Pathway - These Disgusting People
Liverpool Care Pathway - Onward And Upward
The experienced lack the experience.

"Features of opiate toxicity may be interpreted as un-controlled pain, leading to the administration of more opiate medication. The consequences are increased sedation, dehydration and further toxicity." (O’Neill and Fallon, 1997).

From the 
BMJ archives -
"... It matters not whether we discuss continuous deep sedation or a lesser degree of sedation. Any level of sedation, even a small dose of morphine in the frail elderly, can result in dehydration that may prove fatal if left untreated for days. Unfortunately palliative carers tend to overlook this basic fact. They prefer to discuss sedation and hydration as separate issues without linking the two in their minds. In doing so they are in danger of missing or evading the point, which is that sedation without hydration kills."
What is Beacon? Beacon is...

The BEACON Project is bringing UK EoLC practices to VA Medical Centres and CLCs (Community Living Centres). CLCs are Nursing Homes designed to resemble ‘home’ as much as that is possible in a community setting. The Philadelphia VA Medical Centre, for instance, operates a 135-bed CLC. Beacon is said to be having a “positive” effect. In EoLC terms, that’s quite frightening.

BEACON stands for Best practices for End of life care And Comfort care Order sets for our Nation's veterans.

Further reading -
Is this the NCPC’s 'Dying Matters' programme...?
"We only die once, and therefore there is only one opportunity to provide excellent care to a patient in the last days of life." 
It could be, might as well be, but it isn't.

This is Science Newsline writing about BEACON –

There is much value in training hospital and nursing home staff in the basics of palliative care to make the last days of a dying patient's life as comfortable and dignified as possible. So says F. Amos Bailey of the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham in the US. Bailey is the leader of a study¹ that saw the benefits of introducing palliative care strategies, typical of hospices, within the setting of Veterans Affairs Medical Centers. Although conducted with US veterans in mind, their findings can have a wider impact, as most Americans will eventually die within the inpatient setting of a hospital or nursing home.
The results of the BEACON trial indicate the strategy's potential for greater dissemination to improve end-of-life care for the thousands of patients who die each year in inpatient settings.

"We only die once, and therefore there is only one opportunity to provide excellent care to a patient in the last days of life," writes Bailey and colleagues. "The keys to excellent end-of-life care are recognizing the imminently dying patient, communicating the prognosis, identifying goals of care, and anticipating and palliating symptoms. Since it is not possible to predict with certainty which symptoms will arise, it is prudent to have a flexible plan ready."
The Comfort Care Order Set (CCOS) has been developed for veterans diagnosed for EoLC in acute care wards and CLCs.

The multi-component intervention included training hospital staff on how to identify dying patients. Over 1,620 staff members received training.

The trial found ‘modest but statistically significant’ changes in several processes of care. These included more orders for Opioid medications, Antipsychotics and Benzodiazepines such as Midazolam...

The EoLC programme is all about downsizing care. The trans-Atlantic links are documented in these pages.

A national scandal is reported in Pine Island Eagle –

In the US, approximately 3 out of 4 people die in institutional settings; half of all deaths occur in acute care hospitals, a quarter in nursing homes.

More is being said by what is not being said.

Around 25% elderly Medicare patients are veterans. There is a black hole of demand the resources simply cannot fill. Unmeetable expectations are being placed on diminishing resources. Rolling out an EoLC programme and downsizing care expectations is imperative, therefore, and for provision of care of the dying in inpatient settings to take priority over curative care options for patients 'diagnosed' to be at Life's End.

Here's some Communitarian reasoning from US liberal commentator and blogger, Matthew Yglesias -
"Read Frakt for a bit of an account of how this arises operationally, but what I think is more important is that it arises on a meta-level because we have such a fragmented health care system. When your health care spending is all in one bucket, then at any given level of spending you face a question about how to allocate it. And when allocating spending between young and old, you're cross-pressured. On the one hand, older people have more need for health care services which militates in favor of allocating spending to them. On the other hand, providing health care services to younger people generally offers better value in terms of years of life and quality of life saved. A 25 year-old who's in a bad car accident can, if found in time and treated, still live a very happy and healthy life. If you're 95 and get into the same car accident, then treatment is going to be much more difficult, recovery will be much less complete, and in the grand scheme of things you're not going to live very long anyway."
When you’re on the upper end of that priority curve, you just don’t count for much, then. You don’t get shifted to the front of the queue for treatment anytime soon.

Additional reading -
Liverpool Care Pathway - The State Rules. Okay?
Liverpool Care Pathway - Reja Vu

Sunday, 18 May 2014

Liverpool Care Pathway - In The "Best Interests" Of The Interested?

In the best interest of those who determine "best interests"!

Falconer gives easy assurances that all the bases are covered in his euthanasia charter. The euthanasiacs should be worried; very worried. This 'Magna Carta' may come to permit more than they know or realise.

They thought they had all the bases covered in their Great Charter to protect those deemed not able to protect themselves...

This is This Is Local London –

Tens of thousands of the most vulnerable patients are effectively being kept prisoner in care homes and hospitals through misuse of mental health laws, a damning House of Lords investigation has found.
In the worst cases safeguards aimed at protecting patients with a wide-range of conditions are being used to " oppress " people and force decisions on them, peers said.
They found measures that are supposed to be used to look after at-risk patients, such as people with dementia who might get lost if they leave their care home, are being used on a significant scale to wrongly deprive them of their liberty.
The Mental Capacity Act does not "empower” patients who lack capacity; it empowers those granted the authority to decide what is in their “best interest”.
"The evidence suggests that tens of thousands of people are being deprived of their liberty without the protection of the law, and without the protection that Parliament intended."
We live in a post-Orwellian world and we are groomed to think in newthink. We are long-accustomed now to newspeak and, fittingly, these laws that purportedly provide 'protection' do nothing of the sort.

Forthright as always...

Mail Online says –
Astonishingly, this report by a House of Lords committee on the workings of the Blair government’s 2005 Mental Capacity Act found that ‘thousands, if not tens of thousands’ of old people have been  forcibly incarcerated in care homes or hospitals against their wishes and are being ‘de facto detained unlawfully’.

At the heart of the scandal is the ultra-secretive Court of Protection, set up under the Act, which rules every year that thousands of people are deemed to ‘lack mental capacity’ — so that control of their lives and property can be handed over to social workers and other state officials.
Last year, Mail Online reported the harrowing story of devoted daughter, Wanda Maddocks, who was cast in prison, where she suffered torment and abuse, for rescuing her elderly dad from the clutches of a care home in Stoke-on-Trent where he was being abused and being held against his will. Her dear dad was returned to the care home, where he subsequently died.

Wanda's brother, Ivan, was also hauled before this secret court and forced to endure its humiliation. His two month sentence was suspended.

Read further here -
Liverpool Care Pathway - Shall We Permit The Tide To Turn?
Liverpool Care Pathway - The Dispassionate, The Merciless And The Cowardly
The stations of uncensored expression are closing down; the lights are going out; but there is still time for those to whom freedom and parliamentary government mean something to consult together. Let me, then, speak in truth and earnestness while time remains.  Winston S. Churchill 
There are secret courts in this land that sit in judgement behind closed doors, not to decide and adjudicate heinous crimes, for they are overlooked and go unpunished - as at Gosport and Mid-Staffs; no, these are a cowardly breed who persecute the innocent.

We may yet speak out but, already, the censors' guillotine threatens to slice off our tongues should we dare to break the edict handed down by them not to speak.

This court may sit in absence and sit in secret. The publicising of its actions and its edicts may result in incarceration amongst Britain's vilest offenders, as has happened to Wanda Maddocks.

Mail Online does not flinch to report a case that bares remarkable similarity to that of Francesco Errante.

Korean War veteran, Mr. C, served with the ‘Glorious Glosters’. He served his country and served the cause of freedom in the Korean peninsula when the Red Fascists sought to overrun it.

When his wife developed Alzheimer’s, Exeter social workers considered Mr. C not an able carer and, with the authority of the Court of Protection, kidnapped her from her home. His dear wife of 50 years was placed in a ‘care’ home.

Upon his visits to see his dear wife, Mr C became concerned that they were not able carers and protested to the social workers. The Court responded with a further order forbidding him any further contact with his dear wife. That order forbade even contact by post.

How is this ‘care’; how is this ‘protection’?

With any dementia, in sailing that cerebral sea, it is important to anchor those memories that remain to familiar ports of reality and, in rough seas, to keep the home port lighthouse burning bright. What can they be thinking of?

Francesco Errante, likewise, is forbidden any and all contact with his mother, Margherita. He did not know if his mother was dead or alive. Last year, it was confirmed that she is still being held by the Older People's Team at Parkview Lodge Care Home in Bedford.

Further pertinent reading -
Liverpool Care Pathway - And Where Is Margherita...?
Liverpool Care Pathway - The Secret Wards
Liverpool Care Pathway - The Prequel
In this post-Orwellian world, of newthink and newspeak, a Ministry of Truth is now under construction, by order of the Mitteleuropean Court Of Justice. If you can't find it on Google, it didn't happen...

- The Metro  
The Metro reports that Google has been ordered - and other search engines could be ordered likewise - to rewrite history.

- Daily mail

What has great potential for being a force for freedom may, in Orwellian fashion, be turned on its head and become the instrument of control he foresaw.

Europe is falling into its familiar and habitual pattern, repeated through history. The maze of bureaucratic tangle that so dominated Kafka's writings has materialised before our unwitting eyes.

And is Britain falling into Europe? Then, who is there left; who will stand apart, next time, to defend life and liberty?

The Mental Capacity Act does not "empower” patients who lack capacity; it empowers those granted the authority to decide what is in their “best interest” to determine that they lack capacity!

Mail Online bravely reports further the case of the son who was arrested for taking his father sailing. Family property and assets have been seized. Some might say they have been stolen.

Mail Online here reports the case of Miss G -

A frail 94-year-old spinster fighting council social workers for the right to live in her own home without their interference has been banned from talking publicly about her plight.
In what is thought to be an unprecedented move by the secretive Court of Protection, the former NHS midwife – who can be identified only as Miss G – has been told she does not have the mental capacity to communicate with journalists and that it is in her ‘best interests’ not to do so.

The gagging ruling – which could last for the rest of her life – was made yesterday by a High Court judge who sent a message via a clerk to the Daily Mail, which has highlighted Miss G’s case, warning: ‘This means the press cannot speak to Miss G any more.’
This story is also reported by Christopher Booker in The Telegraph -
I have lately been following the bizarre story of a frail but otherwise capable 94-year-old woman who has become the object of attention by social services. Their aim, it seems, is to take control of her £350,000 home and her substantial savings, to transfer her against her will to a care home and then to evict from the house a niece and her husband who look after her. Having obtained a questionable psychiatrist’s report to show that the old lady is not “mentally competent”, the social workers used an order from the Court of Protection to deny her access to her bank accounts. She only learnt this when a teller refused to give her money and would not tell her why.
Having found her capable of carrying on a sensible conversation, and having heard from her niece how the fear of God is being put into the family by highly intrusive visits from a social worker, accompanied by four police, my friend Ian Josephs arranged for the woman to be assessed by an eminent psychologist, Dr Ludwig Lowenstein, president of the International Council of Psychologists. Not only did she pass all his tests, he was so critical of the report produced by the council psychiatrist that he volunteered to come to court this week to testify as an expert witness.
Britain is falling into Europe... Control is being wrested from our hands. The freedoms for which we have suffered and fought are being snatched back from us.

Christopher Booker further reported in The Telegraph the story of "Wendy" which he compares with that of Alessandra Pacchieri...

Last week, I investigated a story as shocking in its own way as that which I broke last month about the Italian woman detained in a psychiatric hospital who, on the orders of a secret court, was then forced to undergo a caesarean section so that her baby could be sent by social workers for adoption.

“Wendy” has had her two children taken from her and has fought to have them returned to her.
But when, last year, to aid her fight, she repeatedly applied under the Freedom of Information Act to see her medical records and the notes of the social workers, she mysteriously ran into opposition. On December 2, while out shopping, she stopped her car for a cigarette. An ambulance drew up, she was bundled into it and taken to the psychiatric wing of Calderdale Royal Hospital, in Halifax, where psychiatrists and doctors assessed her as insane under Section 2 of the Mental Health Act.
A week later, the psychiatrist in charge of her case told her that her home had been burgled. She was allowed home, under escort, to discover that her house had been ransacked. Nothing was missing apart from papers relating to her case, photographs of her children, reading glasses and £300 in cash. But the same psychiatrist then accused her of having done this herself, even though she was all the time detained in hospital.
The case of Alessandra Pacchieri may be read here -
Liverpool Care Pathway - Child Theft Antepartum

This court has now authorised a further medical assault, this time upon an unidentified woman in her 30s. We must go on trust that this decision is reached in the "best interests" of mother and child because this decision is reached in secret.

This is Mail Online –

Are we to permit these assaults on our liberty to proceed unchallenged?

Say -

Acknowledgements to Spinoff Online

Further reading -
Liverpool Care Pathway - The Great Snatch 'N Grab Robbery
Liverpool Care Pathway - In Whose Best Interests?
Liverpool Care Pathway - No More Time For 'Learnings'
Liverpool Care Pathway - When The Learnings Had To Stop

Saturday, 10 May 2014

Liverpool Care Pathway - It's Living Matters Awareness Week!

Life is precious. Live every second, every moment as though it is your last. It won't come round again.

Let’s do some Life Café...

It's Living Matters Awareness Week!

CPR saves lives. It doesn't matter what the stats show, this life, this time, matters. This is Herald News -
When Jesse, 14, took a babysitting course 21/2 years ago and learned CPR, he never pictured what it would be like to do it for real. On his mother. 
He remembers watching her slide out of the chair and onto the floor, a moment he talks about quietly, looking down. He called 911 and, at the dispatcher’s instruction, began chest compressions. 
Five minutes later, paramedics took over, using a defibrillator three times to restart the Cole Harbour woman’s heart.
The sea-shore may be littered with stranded starfish; how can you save them all? To this one, this time it matters that you toss it back into the sea. You don't calculate the odds; you act. You just act!

This life, this time, matters. This is the Khalsa Save a Life Campaign -

The Leicestershire Sikh Alliance (LSA) is a community based body which provides the Leicestershire Sikh community with a shared and united platform from which to operate.
Leicestershire Sikh Alliance are providing free CPR training to their community. CPR saves lives!

Khalsa Save A Life CPR Promo

This man, this time, got his CPR training from You Tube...

This is ABC 10 News 

When an elderly lady collapsed unconscious on board his Delta flight from NY to San Diego, it was fortunate for her that he had not heard of the Lakhani Recommendations.
Thrower began performing CPR and chest compressions which he says he had just learned how to do from watching a video on YouTube.
Moments after they began resuscitative efforts, the woman regained consciousness.
"We were like, 'Nana, can you hear us? Can you hear us?' And then she nodded her head."
This Swansea doctor is taking CPR into schools. This is ITV Wales -

"All the young kids, wherever they are, at every school, should learn how to do it..."

There are 8000 cardiac arrests each year in Wales...

Dr. Gareth Roberts is taking CPR into schools.

In Jackson, Mississippi, they're taking CPR into every school...

This is -

Lawmakers have sent to Gov. Phil Bryant a bill to require high school students to take a CPR course as part of their physical education requirements. In addition to the cardiopulmonary resuscitation training, HB432 provides that students in grades 9-12 across the state also would be taught how to use automated external defibrillators. The instructional courses, which would carry one-half credit toward graduation, would be developed by the American Red Cross or the American Heart Association. "When you reach these students when they are in high school they will carry it with them all the rest of their lives.
What will you do for Living Matters Awareness Week?