A rich heritage

Åsmund S. Lærdal initiated and sponsored the first international symposium on emergency resuscitation in Stavanger a year later. The conclusion was simple and clear: first-aid workers of all categories, school children and the general public should be taught mouth-to-mouth resuscitation, and the training should be compulsory for all school children. Åsmund expressed the way forward: “Implement what has been shown to work, and drive therapy through education.”

At this stage, compressions were considered too risky for lay people to administer, being reserved for professional health carers and certified life savers. But Peter Safar had already suggested a flexible chest ring inside Resusci Anne for compression simulation. In his quiet, almost self-effacing but determinedly efficient way, Åsmund was a persistent key mover. He supported the production and printing in 12 languages of Safar’s CPR manual and enabled Norwegian anaesthesiologists to organise a new international symposium in 1967, which recommended that all health personnel should be trained in the full CPR method. Seven years later the American Heart Association (AHA) decided to recommend that lay people should also train in chest compression; any chest injuries would be outweighed by the chance of preventing lasting brain damage or death.

That same year Åsmund established Laerdal Medical Corporation in Armonk, NY – the first step in creating an international company. In line with this, the Norwegian vowel ‘æ’ in the company name was replaced by the more easily internationally grasped ‘ae’. The family, however, retained the Norwegian spelling of the name.

At the 50th anniversary of modern life saving in 2010, the AHA estimated that about 350 million people around the world had been trained in CPR, most of them on Resusci Anne. CPR was recognized as one of the most important public health initiatives in the last two generations and is now estimated to have contributed to saving at least 2 million lives.

Åsmund was always seeking to improve things. He kept listening and discussing needs for innovation with his increasing network of users and specialists. Resusci Anne gained a family: Resusci Andy and Resusci Baby, and, two decades later, Resusci Junior. Resusci Anne herself acquired innovative, performance-recording features to address the AHA’s desire for trainees to “Practice to Perfection”. As other urgent needs became clear to Åsmund, he responded with the Resusci Folding Bag – the predecessor to the world-leading Silicone Resuscitator launched in the 1980s.

Even before starting his own company, Åsmund S. Lærdal had told his wife-to-be, Margit, of his dream to make so much money that he could afford to give away half. All along, he had provided direct financial support to the mission of helping saving lives, mostly behind the scenes. In 1980, he finalised his plans for the Laerdal Foundation for Acute Medicine and provided it with a starting capital of NOK 10 million ($1.1m). Over the years, this foundation has supported close to 2,000 research projects, in recent years with annual grants totalling up to NOK 40 million.

Also, Åsmund thought about handing over the company – his son Tore had joined Laerdal in 1975 after graduating – and devoting his own energies to help low-income countries, in the sense of helping people to help themselves. As he expressed it: “Equipping the people not with tractors but with better spades.”

However, Åsmund S. Lærdal became seriously ill and died in November 1981 before the Foundation’s first award ceremony. Tore was not yet 30, but with the mission in his blood he shouldered the full responsibility for running the company. 30 years later, he realised his father’s vision by establishing Laerdal Global Health.

By the mid-80s Laerdal’s internationalisation had progressed rapidly. Whereas the number of employees in Stavanger remained at about 350, sales companies in eight countries had increased the total employed to about 600. US experiences drew Laerdal’s attention to the value of early defibrillation as well as CPR to improve survival from cardiac arrest.

This spurred a move into hi-tech. For the first time Laerdal decided on a joint venture with another commercial company, First Medic in Seattle, resulting in Heartstart 2000 – the first generation “intelligent” machine for the crucial shocking needed to restart an arrested heart. Such machines are called automated external defibrillators (AEDs). Till then, defibrillation had only been practical in hospital settings and in a small number of emergency services with highly trained personnel; now the goal became for all EMS personnel to start CPR within four minutes of the out-of-hospital cardiac arrest and defibrillate within eight minutes. The use of AEDs facilitated this because they required less training to use. Also, importantly, Heartstart 2000 logged vital data allowing for medical quality assurance, overcoming reservations from some quarters about EMS personnel defibrillating patients. Upgrades to Heartstart 2000 followed and a few years later led to an alliance with Hewlett Packard (subsequently Philips Medical) and further innovations in early defibrillation. This alliance lasted over 20 years – extraordinary for corporate alliances.

Another long-standing alliance, the one with the AHA, led to Laerdal’s purchase of Actronics, a company leasing an AHA-owned patent. Actronics was pioneering the use of computers for training and needed venture capital; this led to the development of the HeartSim cardiac rhythm simulator, a precursor to the e-learning suite of products in use today.