1 Exclusive of Puerto Rico, Virgin Islands, and of Alaska, 1955-58, and Hawaii, 1955-59.

3 Data not available.

2 By place of occurrence, except Alaska, 1959-64; and Hawaii, 1960–64.

Source of data: Public Health Service, National Center for Health Statistics.

Infant mortality, selected countries, 1966 (rate is number of deaths under 1 year

Sources of data: Statistical Papers, Series A, vol. XX, No. 2, population and vital statistic report, data available as of Apr. 1, 1968. United Nations Demographic Yearbook, 1966, 18th Issue, United Nations, New York, N.Y., 1967. National Center for Health Statistics, Public Health Service.

Mr. FLOOD. Go ahead.

Dr. LEONARD. Mr. Chairman, I would also like to express my thanks to be heard by your committee and I would like to talk today about an appropriation through the Children's Bureau for the intensive care facilities under Public Law 89-248, Social Security Act of 1967, that apparently was not appropriated in the Johnson administration that we feel has a very high priority in this work.

Mr. FLOOD. You say it was not in the so-called Johnson budget? Dr. LEONARD. That is right. It was in the budget but not appropriated.

Mr. FLOOD. Was it in the budget for this year?

Dr. LEONARD. Yes, it was.

Mr. FLOOD. No action has been taken so far?

Dr. LEONARD. That is right.

Mr. FLOOD. That budget has been amended by the so-called Nixon budget. Is it in the Nixon budget?

Dr. LEONARD. Yes, it is. This is an appropriation for intensive care facilities for infants, and what I would like to do is to point out several problems. In the first place, in the United States today there is an infant mortality of approximately 23.5 per 1,000 live births. This places the United States approximately 14th in the world. I know this received quite a bit of publicity in the last few years, especially during the Johnson regime, because of this high infant mortality and what could be done about it.

In the last year and a half at the University of Minnesota Hospital we have developed a transportation system and a computerized intensive care facility for infants. We have made this entire system available

to the practitioners in a five-State area. In this facility we have developed a system whereby we can measure the output of the heart arterial and venous pressure as well as monitor externally the regular monitoring systems available to date (respirations, temperature, ÈKG pulse rate).

This system was researched from our laboratories by developing a special pump system for the infant so it wouldn't lose blood during the measurement of cardiac output. It is very necessary because in the system practically, if you draw off more than a few cc.'s of blood this is a large percentage of the infant blood volume compared with an adult.

I bring up this development because in the country today we need regional facilities such as this to decrease infant mortality. This facility is working out as a regional effort in the five-State area which includes North and South Dakota, Minnesota, a portion of Wisconsin, and Montana.

In the last year we have taken care of 30 babies through this transportation system. We feel that we have added several hundred years of living to infants who otherwise would have expired in their local regions. The problem is that the local physician in an outlaying area has a blue baby or a baby with multiple congenital or premature infant born, and he does not have the facility to take care of these infants because they require round-the-clock care. They require very specialized trained individuals. It is somewhat like handling an 80-percent burn out in a small region. The general practitioner does not have the time or the facility to handle that particular problem and does not have it for the infant either. The problem in development of facilities such as this has been the lack of funding, especially on a regional basis.

Our program has now become a demonstration program. I believe it is the first one in the United States with this combined system that reaches out to the physician to help him deliver these infants when born with multiple problems. We send out a resident or intern right to the hospital. For instance, in the northern part of the State of North Dakota, we will send a physician out to the area. The interns or resiident, a specially trained individual will prepare the baby for transportation. We have designed a special incubator to bring that baby into our facility. From there the baby is placed under intensive care for around-the-clock care in this computerized facility.

This requires again, to repeat, specialized personnel. It requires paramedical technicians who are trained in computer technology as well as specially trained baby physicians who deal with this newborn infant situation.

We are actually also carrying out another important process; that is, that we are preventing anoxia (or lack of oxygen) that normally would occur because of a time lapse, to a number of brains in these infants during the period of shock. It follows that this system also carries over into the mental health programs. We feel that, at least in part, it is possible that many of the mental health problems are

due to early anoxia because of the inability to get these babies into a facility such as this, where appropriate care by individuals who are highly skilled in this field can carry out these deeds.

So the funds are necessary in this appropriation for both the training of physicians, training of paramedical personnel, transportation system, and the development of the physical intensive care facility on a regional basis that would take care of maybe three or four States or several States in a package. The Children's Bureau is asking for six of these type facilities throughout the country in this particular appropriation. We have funded ours at present on private funds and funds through the university support, because there has not been funding of this type available before.

I would like to thank you for hearing us.

I think that, as I said before, this is one area where we can really contribute with this type program to make useful citizens out of many individuals who otherwise would not be, either because of brain anoxia, congenital abnormalities prematurely causing multiple brain damage which, because of the problems in remote areas, could not be taken care of immediately.

Many infants with heart defects and respiratory problems we have demonstrated recently, that we have been able to salvage with this type of program.

Mr. FLOOD. Mrs. Reid?

Mrs. REID. No questions.

Mr. FLOOD. Thank you, Doctor.

MONDAY, MAY 26, 1969.

HEART DISEASE AND STROKE

WITNESSES

DR. ELIOT CORDAY, LOS ANGELES, CALIF.

DR. B. L. MARTZ, INDIANAPOLIS, IND.

WILLIAM D. NELLIGAN, BETHESDA, MD., REPRESENTING THE AMERICAN COLLEGE OF CARDIOLOGY

STATEMENT OF DR. ELIOT CORDAY

Mr. FLOOD. Now the American College of Cardiology. Dr. Eliot Corday, of Los Angeles.

Dr. CORDAY. Sir, it is a great honor to be present with your committee once again.

Mr. FLOOD. Glad to see you.

Dr. CORDAY. With me I have the president of the American College of Cardiology, Dr. Martz, and the executive director of the college, Mr. William Nelligan.

I propose today to review a few of the projects which the college feels will benefit the health of the Nation and therefore are worthy of special consideration.

Mr. FLOOD. We will do that. We will place your statement and biographical sketches in the record.

(Statement and biographical sketches follow :)

STATEMENT OF AMERICAN COLLEGE OF CARDIOLOGY PREPARED FOR TESTIMONY TO THE HOUSE OF REPRESENTATIVES SUBCOMMITTEE HEARINGS: DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES

HEART DISEASE AND STROKE CONTROL PROGRAM

The problem of sudden death due to coronary disease

Coronary artery disease is the leading cause of death in the United States. It is estimated that every year over 800,000 people suffer an attack of coronary thrombosis or occlusion, many in the prime of their life. Of these, over 400,000 attacks result in death, 60 percent before they can receive adequate medical help. Recent breakthroughs in the field of coronary care lead us to believe that if the 250,000 Americans who die each year before they reach the hospital could receive modern coronary care, many would be saved. Eighty-nine thousand of these victims each year are under age 65-in their years of greatest creativity and productivity. The loss and suffering resulting from these deaths is astounding and of great social and economic significance.

On January 25 and 26 of this year a national conference was conducted to determine how the new advances in coronary care could be applied at the earliest time in the course of a patient's illness. These new techhniques have reduced the number of deaths among patients hospitalized for acute myocardial infarction by one-third. The Conference was charged with the duty of finding ways to reduce the dreadful number of out-of-hospital coronary attack deaths. This workshop was convened under the co-sponsorship of the American College of Cardiology, the American Heart Association, and the heart disease and stroke control program, regional medical programs service, of the U.S. Public Health Service. Seventy-seven experts from the fields of medicine, the allied health sciences, psychology, sociology, law, and representatives from voluntary health organizations deliberated and prepared the attached report (Appendix A). The conference concluded that much of the mortality from heart attacks could be reduced if the patients sought and obtained medical attention as early as possible.

The conferees recommended new investigations to improve the delivery of medical services to the patient with early manifestations of acute coronary artery disease, including education of the public to seek aid immediately for symptoms suggestive of an acute heart attack, and deployment of personnel and lifesaving equipment in special ambulances and to crowded sites outside hospitals.

They pinpointed many potentially beneficial programs that need to be tested prior to possible implementation in communities across the Nation. Because establishment of these projects may be expensive and complicated to implement, pilot studies should be initiated to measure cost effectiveness, and to determine if a given program is truly worthwhile in terms of lives saved, manpower required and dollars expended.

In the attached report (Appendix B) there is a review of some of the more important recommendations, estimates of costs, and indication of the need for a cooperative effort of the Federal, State, and municipal governments, and the medical profession. A productive, yet austere program requires a new Federal appropriation of $6.8 million this year which program can best be conducted by the heart disease and stroke control program of the regional medical programs service.

NATIONAL HEART INSTITUTE

We believe it advisable for the National Heart Institute to investigate the causes of sudden death outlined in the attached Bethesda conference report. It will provide new methods for preventing sudden death which occurs once in every five coronary attacks. This requires an appropriation of $3 million per

year.