Together with James Elam, he rediscovered the initial steps in CPR. These included the head tilt and chin lift maneuver to open the airway of an unconscious victim, as well as the mouth-to-mouth breathing. He influenced Norwegian doll maker Asmund Laerdal of Laerdal company to design and manufacture mannequins for CPR training called Resusci Anne. Safar, who began to work on CPR in 1956 at Baltimore City Hospital, demonstrated in a series of experiments on paralyzed human volunteers that rescuer exhaled-air mouth-to-mouth breathing could maintain satisfactory oxygen levels in the non-spontaneously breathing victim, and showed that even laypeople could effectively perform mouth-to-mouth breathing to save lives. He combined the A and B components of CPR with the C. He wrote the book ABC of Resuscitation in 1957, which established the basis for mass training of CPR. This A-B-C system for CPR training of the public was later adopted by the American Heart Association, which promulgated standards for CPR in 1973.
Other achievements
Safar's other achievements included the establishment of the United States' first intensive-care unit in 1958, at Baltimore City Hospital. In 1961, he went to the University of Pittsburgh, where he established its notable academic anesthesiology department and the world's first intensive-care medicine training program. In 1966, he was deeply moved by the death of his daughter, Elizabeth, at the age of 12 from an acute asthmatic crisis. He initiated the Freedom House Enterprise Ambulance Service, one of the first prehospital emergency medical services in the United States in 1967 and together with Dr. Nancy Caroline, developed standards for emergency medical technician education and training, as well as standards for mobile intensive-care ambulance design and equipment. Freedom House Ambulance service employed young African Americans who were deemed "unemployable". Several members of Freedom House went on to establish successful careers in EMS and public safety. In 1976, Safar co-founded the World Association for Disaster and Emergency Medicine, which is dedicated to saving lives in major disasters. He stepped down from the chairmanship of anesthesiology at the University of Pittsburgh and founded the International Resuscitation Research Center in 1979, dedicated to cardiopulmonary cerebral resuscitation. With Nicholas Bircher he published a textbook on CPCR that became the international standard. In March 1989, he assembled an interdisciplinary team of researchers – composed of the following individuals: Miroslav Klain, M.D., Edmund Ricci, Ph. D., Ernesto A. Pretto, Jr., M.D., Joel Abrams, Ph.D., and Louise Comfort, Ph. D. – which became known as the University of Pittsburgh Disaster Reanimatology Study Group. This research team in partnership with a team of Russian and Armenian physicians conducted the first international interdisciplinary disaster evaluation research field survey study of the earthquake in Armenia. The Armenia study led to a series of post-disaster field studies by the DRSG in Costa Rica, Turkey, and Japan. These studies helped to establish the "Golden 24 Hours" of emergency response in disasters and inspired Norwegian anesthesiologist and humanitarian Dr. Knut Ole Sundnes to establish in 1995 the Task Force of Quality Control of Disaster Management, under the auspices of the Nordic Society of Disaster Medicine and WADEM. Safar practiced and taught clinical anesthesiology at Presbyterian University Hospital in Pittsburgh until the age of 65, but he continued his research activities until his death. His lifelong goal was to "save the hearts and brains of those too young to die" and to improve the life-saving potential in disasters, a field he called "Disaster Reanimatology." In 1990, he appointed Ernesto Pretto, M.D., as leader of the Disaster program. In 1999, Safar was awarded the Cross of Honor, Austria’s highest civilian honor, for his services in the field of medicine. He was nominated three times for the Nobel Prize in Medicine. On 13 September 2014, the Alliance of Germanic Societies of Pittsburgh honored him, as well. Safar died on 3 August 2003 at his home in Mount Lebanon, Pennsylvania, from cancer.
