Kickstarting Welsh Hearts

Petitioners have asked the Welsh Government to consider widening
access to, and awareness of, public defibrillators.
(Pic : zoll.com)

(Owen : Some work is being undertaken on the house over the coming week which may/will result in my internet connection being disrupted - possibly for several days, maybe longer. So if I don't post on my usual schedule that'll be the reason why.)

Following hot on the heels from their previous report, last week the National Assembly's Petitions Committee published a report (pdf) into a petition submitted by nurse Phil Hill which secured 78 signatures. He submitted the petition whilst working on master's degree research into attitudes towards public defibrillators.

The petition called for the Welsh Government to ensure defibrillators are made available in all public places in the same manner as firefighting equipment.

Everyone knows heart attacks are usually caused either by a serious defect or an interruption to blood supplies to the heart muscle itself (myocardial infarction). When someone suffers a heart attack, it causes ventricular fibrillation where parts of the heart which pump blood out to the rest of the body beat erratically, or even stop completely (cardiac arrest).

Again, as you probably know, defibrillators pass an electric current (normally between 200-1000 volts) across the heart to restore a normal heart beat (normal sinus rhythm), and when accompanied by CPR can greatly aid the chances of a person surviving.

The Committee made 5 recommendations, summarised as :

• The Welsh Government should raise awareness of the availability of public defibrillators, and make it clear they can be used safely by untrained people. They should "take steps" to ensure defibrillators are made available in public places whilst simultaneous factoring in what would be "a reasonable and practical" number of them.
• The Welsh Government should ensure all firefighting vehicles carry defibrillators, and also ensure the location of public defibrillators is registered with the Wales Ambulance Trust.
• The Welsh Government should keep under review whether legislation is required to underpin a  public defibrillator registry.

Current Availability of Public Defibrillators

One of the main issues raised was the fact we just don't know
where many public defibrillators are currently located.
(Pic : South Wales Argus)

The report says there are currently around 8,000 sudden cardiac arrests in Wales each year, and defibrillation is described as one of the crucial parts in a "sequence of events" needed to resuscitate the victim. Every minute a victim of cardiac arrest doesn't receive either CPR or defibrillation reduces their chances of survival by 10%.

It's said most public defibrillators are Automated External Defibrillators (AEDs) which cost up to £1,200 and are designed to be used by untrained people. However, the British Heart Foundation (BHF) say that many successful usages of the AEDs has been by trained people who happened to be nearby at the time of an incident, so training people to use defibrillators remains important.

There's one big problem – it appears many people who need to know where they're located don't know where they are.

The BHF and Resuscitation Council recommend AEDs are registered with the ambulance service, so 999 call handlers know precisely where they are and how far a patient is away from one. The WLGA argue that they don't have the capacity to undertake a survey of AED locations, and even some health boards admitted they don't know where they're located.

The Health Minister, Mark Drakeford (Lab, Cardiff West), wrote to the Committee in May 2013 saying that the Welsh Government "recognise the value of defibrillators in certain circumstances" and, as part of a new plan on heart disease, he's asked local health boards and WAST to review the provision of public defibrillators.

Views of the Emergency Services

Although AEDs are routinely carried by the ambulance service, hardly any are carried
by the fire service - who might arrive on a scene faster than an ambulance.
(Pic : via youtube.com)

The Wales Ambulance Service Trust (WAST) is responsible for running public awareness programmes into the use of defibrillators (Public Access Defibrillator Scheme, or PADS). They aim to train volunteers who can administer defibrillators and basic life-saving first aid. Around 5,500 people have been trained, while there are 300 PADS sites around Wales with 450 defibrillators installed.

Every ambulance, rapid response car and non-emergency service vehicle (PCS) carries an AED, while 999 control rooms can dispatch community first responders who also carry AEDs.

Despite this, Fire & Rescue Services vehicles (which might be the first on the scene to an emergency) don't routinely carry AEDs. Mid & West Wales Fire Service said there was "significant scope" to equip front line vehicles with defibrillators, while the Daily Post reported last week that no North Wales Fire Service vehicles carry them

Views of the Petitioners

One of the petition's supporters is June Thomas, whose son Jack (pictured) died of a
sudden heart attack in 2012. She now campaigns for defibrillators to be installed in schools.
(Pic : Wales Online)

In giving oral evidence, Phil Hill was accompanied by paramedic Richard Lee, and June Thomas – who has campaigned for defibrillators to be installed in schools. June's son, Jack, died of a sudden heart attack aged just 15 years old.

The petitioners were keen to demonstrate how easy AEDs are to use, providing Committee members with a short demonstration :

When concerns were raised about whether AEDs might be used inappropriately, Richard explained that the AED will tell the user whether to administer a shock or not once pads had been placed in the correct position and once the heart rhythm had been measured. He added that the optimum time to use the defibrillator in a cardiac arrest situation is three to four minutes, as that's how long it takes before the brain starts to be deprived of oxygen.

Phil Hill was concerned about misconceptions amongst the public that only trained personnel can use AEDs. He suggested a change in the law to ensure the public are made aware that AEDs are available 24/7, anybody can use them to save a life and they would be protected from law suits (a sad reflection of the impact of the personal injury industry).

June's story underlined that it can happen to anyone. Her son "never had any underlying health problems whatsoever", saying she's started a heart screening programme at Oakdale Comprehensive School with charity Cardiac Risk in the Young (CRY), convincing the school to install a defibrillator.

On availability and the risk of theft, Richard explained that at train stations AEDs are kept in unlocked cabinets and he's only heard of one occasion of a machine being stolen. It made the front page of a local newspaper and was returned to police. In the same manner, fire equipment rarely goes missing.

On costs, the petitioners believe the average £1,000 price tage was "excellent value for money", with Richard explaining that at one (unnamed) leisure centre, defibrillators have been used successfully before he had arrived in an ambulance on three separate occasions.

Conclusions

I'll admit there's something darkly humourous about the prospect of defibrillators being installed routinely in a climate where the proportion of people who are obese remains relatively high – and I say that as someone whose paternal grandfather suffered several heart attacks and was ultimately killed by one. It's a serious matter though and, as been demonstrated time and time to devastating affect, can happen to anyone, even otherwise healthy people.

Once we have a better idea of where these machines are located, we'll know how many we would need and how much it would cost to provide them. We've all seen them at staffed train stations – Bridgend's is located quite prominently – and I'm sure we can think of key places to install them such as schools, colleges, supermarkets and public buildings. Maybe it should be a legal requirement for large employers to have one installed in the same way as fire equipment (I'm not sure if it's required at present), and perhaps AMs can take this report into consideration when submitting amendments to the Public Health Bill (Tattoos, Bans & Bogs)

I've mentioned on my other blog that one of my (more unusual) favourite film genres is the public information film. This would be the sort of thing that the old Central Office of Information (UK Government puts Charley to sleep) would've produced a film for, but that's gone now – though that needn't stop the Welsh Government doing something similar. If it's done right it would probably be cheaper, quicker and easier than a new law.

If the last report highlighted one of the great weaknesses of the petitions system, this one highlighted one of its great strengths. It addresses a "gap" in current public services, is clear in its intentions, is non-ideological and has resulted in a well-considered report which could, in the longer-run, actually see something happen if everyone's on board.

Just a reminder that the Petitions Committee are undertaking a consultation on the future of the petitions system. It closes at the end of the week (July 17^th). All the information's here if you want to make your views known.