Defibrillators are not always in the public’s conscience, but there are ways that general practice can help to promote and educate this life saving tool to people other than health care professionals
Alongside good quality CPR (cardiopulmonary resuscitation), a defibrillator is a vital link in the chain of survival. While most healthcare facilities, like GP surgeries, are encouraged to be equipped with this potentially life-saving piece of equipment, the decision is ultimately in the hands of each practice if they fund a device that can be used by the public.
Every year in the UK there are more than 30,000 out of hospital cardiac arrests yet currently less than one-in-10 survive. We urgently need to improve these shocking survival rates in order to prevent such needless loss of life. As a gateway to local communities, GP surgeries have the potential to play a fundamental role in helping drive forward this ambition.
In October 2014 the British Heart Foundation (BHF) launched a campaign – Nation of Lifesavers – with the ultimate goal to increase survival when cardiac arrest takes place out of hospital. No one measure alone will allow us to achieve the world class standards of countries like Norway, where survival rates are up to three times as high. However, the BHF believes that by improving the availability of public access defibrillators (PADs) alongside training every person in CPR, could contribute to an additional 5,000 lives saved every year.
How can GP surgeries play a role?
Often located in a well known, central and easily accessible location, GP practices are usually a key focal point of local communities. This makes them an ideal place to have a PAD.
In some cases of cardiac arrest, every minute without CPR and defibrillation can reduce a person’s chances of survival by 10%. By placing defibrillators in more locations where they are accessible to the public, bystanders are better equipped to act in emergency situations and give any person the best chance of survival.
The Department of Health awarded the British Heart Foundation
£1 million to make PADs and CPR training more widely available in communities across England. This follows the Government’s commitment to invest £1 million to improve defibrillator availability in the March 2015 Budget.
The funding programme means that organisations, such as charities, social enterprises, community groups and commercial organisations can apply to the BHF for free community packages that include up to five PADs and a BHF Call Push Rescue CPR training kit. This will help equip local communities with the life-saving skills and equipment necessary to improve survival rates from out of hospital cardiac arrest.
The BHF is encouraging applications from GP surgeries based in England via this Department of Health funding, providing the surgery can prove that the defibrillator will be available to the public at all hours. This funding only applies to England, however GP surgeries in Wales, Scotland and Northern Ireland can choose to fund a defibrillator as a community resource.
Fundraising for defibrillators is a collaborative and effective way of raising the required funds to equip a local community with this lifesaving piece of equipment.
Practice managers can play an instrumental role in drumming up interest from various community organisations such as schools and community groups – vastly amplifying fundraising possibilities.
Both secondary schools and community groups are eligible to receive the BHFs Call Push Rescue CPR training kits for free and by spreading awareness of this among teachers, parents and individuals practice managers can help to galvanise support. The training programme operates by using a self-directed learning film, omitting the need for a trained professional to conduct the training.
GP surgeries are therefore able to adopt the role of a CPR training ‘hub’ – offering CPR training and defibrillator awareness sessions to the community on a regular basis. One session can take as little as 30 minutes and can train as many people as the room space will allow for.
In some cases, immediate CPR and defibrillation by a bystander can double a person’s chances of survival therefore equipping a community with a PAD alone has limited benefit – without the knowledge and skills of how to perform CPR, this equipment becomes somewhat redundant. You could have defibrillators on the corner of every street in a community but this does not translate to superior survival rates.
Currently, less than half of people in the UK (43%) carry out life saving CPR when someone suffers a cardiac arrest and 62% of UK adults would be worried about knowing what to do if they witnessed someone collapse.
CPR ensures that blood continues to flow around the body and most importantly to the brain. When bystander CPR is not carried out immediately, or when not done at all, it greatly increases the risk of brain injury leading to death or poorer outcomes if the person survives the arrest.
Good quality CPR can also help to keep the heart in a ‘shockable’ rhythm so a defibrillator can be used.
When someone suffers an out of hospital cardiac arrest all bystanders should have the ability and confidence to bridge the gap until the ambulance arrives, or a defibrillator is retrieved – a key pillar of the Nation of Lifesavers campaign and one that GP surgeries could help deliver.
There are a range of different suppliers of PADs and different models. They all have spoken instructions and won’t deliver a shock unless one is needed. Certain other functions, like whether to have child/adult pads or the visual presentation of the unit are down to personal preference.
You can get fully and semi-automatic versions too, the difference is whether the rescuer has to press the shock button or not.
Defibrillators are checked by the Medicines and Healthcare products Regulatory Agency (MHRA) that covers the whole of the UK. However, organisations are currently under no obligation to register devices.
This means that there is no central register or map of defibrillators across the UK, although local NHS ambulance services hold some records of defibrillators in their areas. Any provided by the ambulance service or a similar body are most likely to be registered and well maintained, but there are countless privately owned devices around the country.
In its strategy to improve survival rates, BHF is committed to creating and maintaining a database of the locations of defibrillators and work has already begun on this.
Individuals and organisations like GP surgeries are encouraged to formally register the equipment with their local NHS ambulance service – allowing 999 operators to quickly and easily inform callers of where their nearest defibrillator is when someone suffers a cardiac arrest.
A victim could collapse meters away from a defibrillator, however if this is locked inside a building or blocked by a gate, that person’s chance of survival starts to rapidly decline.
A significant barrier to access is often the location in which defibrillators are stored. Devices that are kept in a locked cabinet or inside a building that doesn’t have 24 hour public access could mean the difference between life and death. Emphasis on ensuring that every defibrillator is freely and readily available has been made by many bodies and organisations.
We recommend PADs are located on the outside of the surgery where they can be accessed out of hours. It should be this straightforward – no ringing the caretaker or doctor on call to open the surgery and access the defibrillator.
The Resuscitation Council UK website details guidelines regarding public access (see Resources).
There is a common misconception among the public that defibrillators are only to be used by healthcare professionals and that, similarly to CPR, they are worried about doing more harm than good. The aim of PADs is to allow any member of the public to quickly and easily deliver a shock during a cardiac arrest, where it is needed. All PADs administer verbal instructions to give the user confidence and negate the need for formal training, some models also give advice on CPR to encourage the bystander.
It may be that in order to develop assurance to use a defibrillator in a real life scenario many people will require some kind of familiarisation. This is provided by several bodies including the BHF’s Call Push Rescue training as well as St John’s Ambulance and local emergency services.
Engaging the public
Ingraining these life saving skills into the fabric of society is a huge challenge, but one that has been seized by the BHF as part of its Nation of Lifesavers initiative.
Norway demonstrates what can be achieved given that four-in-10 people survive out of hospital cardiac arrest there, as opposed to less than one-in-10 in the UK. This has been linked with the number of people who are trained in CPR, availability and accessibility of defibrillators and the fact that it is a skill taught within their education system. Both of these aims are integral to the Nation of Lifesavers campaign and with the support of key bodies, including GP surgeries, training the public in what to do when they witness a cardiac arrest can be achieved.
For more information about how to apply for a PAD, via the Department of Health funding, visit: bhf.org.uk/defibsdh or to join the BHF’s Nation of Lifesavers campaign, visit: bhf.org.uk/lifesavers.
Chris Allen, senior cardiac nurse at the BHF.
The Resuscitation Council UK