Getting more AEDs in public places

Sudden cardiac arrest (SCA) is a leading cause of premature death. In the UK alone, approximately 30 000 people sustain cardiac arrest outside hospital and are treated by emergency medical services (EMS) each year (Pell et al, 2003). However, many SCA victims can be saved by bystanders who recognise what has happened, summon the ambulance service as soon as possible, perform basic CPR and use an AED to provide a high-energy electric shock to restore the heart’s normal rhythm (Resuscitation Council (UK) and British Heart Foundation, 2013).

It has been shown that a strong predictor of SCA survival is the interval from collapse of the patient to defibrillation (Valenzuela et al, 1997). While this generally applies to defibrillation as carried out by healthcare professionals—from emergency physicians, to paramedics, to first responders—it also extends to defibrillation carried out by the layperson (Rea and Page, 2010). The introduction of public access defibrillation (PAD) programmes has produced positive results. One US study, which looked at a prospective series of cases of SCA in casinos, attended to by security officers instructed in the use of AEDs, recorded survival rates as high as 74% (Valenzuela et al, 2000).

In April, the Department for Education announced a plan to allow schools to purchase defibrillators at a lower cost. As a result, the Government is currently working to identify a supplier who will offer defibrillators at a competitive price, affirming that the deal will be sealed in time for the autumn term. Around 270 cardiac arrests occur in schools in the UK each year, highlighting the evident need to have AEDs on hand.

Ambulance services have played their part in encouraging PAD as well as the number of defibrillators in the community. On 1 May 2014, London Ambulance Service NHS Trust launched a campaign to get 1 000 defibrillators in shops, businesses and gyms across the capital, while South Central Ambulance Service NHS Foundation Trust have launched an app that uses GPS functionality to show where the nearest AED is, as well as a list of other AEDs in the area, as part of its ‘Start a Heart’ campaign.

Undoubtedly, there are considerations to take into account with regards to PAD, such as the investment to purchase AEDs and maintain layperson responder proficiency (Rea and Page, 2010). However, given that AEDs are designed to be used by laypersons, with the machine guiding the operator through the defibrillation process by verbal instructions and visual prompts (Resuscitation Council (UK) and British Heart Foundation, 2013), there is plenty of argument in favour of PAD.

References:

Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM (2003) Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology. Heart 89(8): 839–42

Rea T, Page RL (2010) Community approaches to improve resuscitation after out-of-hospital sudden cardiac arrest. Circulation 121(9): 1134–40

Resuscitation Council (UK) And British Heart Foundation (2013) A Guide to Automated External Defibrillators (AEDS). Resuscitation Council (UK), London

Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP (1997) Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation 96(10): 3308–13

Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG (2000) Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 343(17): 1206–9

Taken from Journal of Paramedic Practice, published 6 June 2014.

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Schools to be able to purchase AEDs at lower costs

The Department for Education has announced a plan to allow schools to purchase defibrillators at a lower cost.

The Government is currently working to identify a supplier who will offer defibrillators at a competitive price, affirming that the deal will be sealed in time for the autumn term.

The Department of Health estimates that around 88 children per year die of sudden cardiac arrest; however, there is currently no data on how many of these occur in schools.

This announcement comes at the same time as new statutory guidance for schools on supporting pupils with medical conditions has been published.

Supporting pupils at school with medical conditions covers a range of issues including developing the roles and responsibilities of those involved in supporting pupils at school, information on staff training and advice on emergency procedures.

Schools Minister, Lord Nash, said:

‘There is nothing more important than keeping children safe at school. That is why this Government is today publishing updated guidance to schools on managing children with medical conditions.

‘By securing defibrillators at a reduced price, schools will find it much easier to install these potentially life-saving devices. We hope schools right across the country will take advantage of this.’

Anne Jolly, founder of the cardiac charity SADS UK, said:

‘It is crucial that schools have immediate access to defibrillators. Around 270 cardiac arrests occur in schools in the UK each year; the earlier CPR and defibrillation are administered the better the chance is of survival. Heart conditions, both diagnosed and undiagnosed can predispose a person of any age to sudden cardiac arrest. Sports and exercise at school can be a precursor to cardiac emergency and any trauma or accident can also trigger cardiac arrest. Having defibrillators and emergency action plans in place if a cardiac arrest occurs in school is very important.

‘Cost of the defibrillator is a consideration for some schools,’ she added. ‘However, it is important that its not just a defibrillator they have on the school premises, it is a complete defibrillator package that the school feels confident with and suits the needs of their school and age range of pupils. SADS UK has found that more schools are researching into the defibrillator and ancillaries and are more concerned that the defibrillator package they obtain is suitable, discussing with SADS UK how many defibrillators they need dependent on the size and layout of their school and how quickly they are able to access the equipment. Many schools have found as SADS UK organise the defibrillator for them together with initial defibrillator training this frees up valuable school administration time.

‘Using an AED prior to the arrival of the emergency services can make the difference between life and death. Research shows that for every minute that passes without defibrillation the chances of survival decrease by 10–14%, and to give the best chance of survival a therapeutic shock should be given within 5 minutes of collapse from a cardiac arrest. Ambulance services endorse defibrillators being available in schools as they know when they arrive on the scene they have a better chance of sustaining life as they administer more advanced therapy as required.’

Mark Whitbread, clinical practice manager of London Ambulance Service NHS Trust, commented:

‘Even if an ambulance is parked round the corner from a cardiac arrest it can too often be too late. Devastatingly, eight minutes after a cardiac arrest, the chance of a child surviving will have decreased by 80%. Using life-saving AEDs prior to the arrival of the emergency services increases the likelihood of the child surviving ten-fold.

The statutory guidance Supporting pupils at school with medical conditions, will come into effect in September, replacing current guidance issued in 2005.

Taken from Journal of Paramedic Practice, published 2 June 2014.