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The more rural you are the more important community AEDs and first responder schemes are
This was the thought that motivated my initial post - community help may be all you have, as the ambulance is miles away waiting to offload a patient into a packed A&E. What I still don't really understand is how many times, in practice, community action is successful, in a circumstance where help is not immediately on hand, and an AED has to be fetched from somewhere. I'm not suggesting that installing them is pointless, or that we should give up - just trying to get a realistic idea of the situation. Maybe there isn't an answer beyond "it depends".
Survival rates are low anyway. A defib greatly increases the chances of a successful outcome but its still low. the most important thing however is knowledge
Doing CPR is not easy - its both tiring and mentally hard
In witnessed VF arrests survival rates have been as high as 50% in Scotland and higher in Scandinavian countries where CPR is widely taught. That's survival to discharge with good neurological outcome. The key thing here is the arrests were witnessed and therefore more likely to get bystander CPR. When looking at the numbers it's worth differentiating between the 50 year old sudden collapse on the golf course from MI which is a reversible cause and the the elderly person with multiple comorbidities who dies as a result of those where there's no reversible cause.
which is a small subset
overall survival rates post arrest outside of healthcare settings is much smaller Much smaller. the key thing with witnessed events is that CPR is started straight away
VF is one of the few things that are shockable where defibs make a real differnce
One thing people don’t tell you is how physically difficult CPR is, they also never mention if you’re first to perform the CPR you’ll feel breaking ribs as you’ve got to compress 1/3rd of the body depth.
This very fact is one of the many reasons i'm grateful for the quality and realism of the training I received over the course of my career from a variety of trained and experienced clinical professionals, who were also unrelenting in their assessment standards.
From my recent exposure to civilian FA courses, experiences absolutely do vary and thus so does the quality of aid.
From the various 1st Aid Courses I've had to do it seems like they are best placed where they have the best chance of beinig needed.
Also, on their effectiveness, treat them like a fire extinguisher. The sooner you can use one the better, the outcome for the patient is massively improved. They won't fix the problem, but it means your CPR will have a better chance of keeping them alive.
All the ones I've had use of (training scenarios only thankfully), have been very intuitive, and simple to use. They analyse the patient and decide what type of shock is needed, if at all.
I think they are a very good idea in principal.
But I'm concerened it may be a waste of money as they will require a high quality battery...
...for example if one was afixed next to a Canal or something like that... how often would they be serviced?
I'm not an expert in these matters, but common sence would suggest they would need regular battery maintenence/replacement.
And of course they might/will be vandalised or misappropriated, so there is a long term 'sunk' service cost there.
In the OP's village setting I imagine it is very unlikely they will get damaged. In our village there are five and they never get touched. Our previous (bigger / rougher) village had one accessible (never touched) but many others stupidly locked in buildings / cupboards for "fear" of damage without any supporting evidence.
Batteries have a clear replacement date. I'd hope whichever group went to the effort of placing the AED then keeps a note of it (it is usually parish council, village hall, church, school, football club committee etc and there will always be someone on it that loves a bit of admin).
Also don't forget or underestimate the power of a shout for help. If I found someone in the village, I'd probably start CPR whilst yelling for help. I'd bet within a minute there would be people to call paramedics, get the AED and assist with CPR. It is more out MTBing or walking that we are really on our own and tough decisions need to be made.
And for some facts behind the anecdotes, here is Darren from my work who would be dead without an AED in a Chorley park. He thinks he is the only dead guy to have completed an Ironman (there are others but they died / revived on the operating table).
The lack of awareness a frightening, this is why organisations like the BHF fight so hard to change knowledge and opinion.
I work for an airline - mulitiple members of the public have been kept alive through CPR and AED use at 36000ft
Indeed a fellow member of staff who looked 'a bit peaky' and went for a 20 min nap in the van was kept alive by his recently first aid trained colleagues who realised that a bit peaky was actually 'massive heart attack' and wouldn't let him leave on his own. Would have been found dead in his van later that day for sure.
And of course they might/will be vandalised or misappropriated, so there is a long term ‘sunk’ service cost there.
there’s some stats online somewhere if you hunt them down - the vandalism/theft rate even in unlocked cabinets is very low.
Yeah, the venn diagram overlap between "people who have any reason to steal a defib" and "people who'd actually do it" is very small. We had several stolen at the uni and it caused a wave of "bloody students" but it turned out to be just one kid with mental health issues who was hoarding them for "emergencies". Of course it does happen but the reality is way better than people seem to kneejerkily assume.
I’m not an expert in these matters, but common sence would suggest they would need regular battery maintenence/replacement.
They get swapped out on a schedule and the old ones get sent off for new batteries and a service.
And of course they might/will be vandalised or misappropriated, so there is a long term ‘sunk’ service cost there.
Cycle past loads (just about every village around here has at least one) and never seen a single one vandalised.
overall survival rates post arrest outside of healthcare settings is much smaller Much smaller. the key thing with witnessed events is that CPR is started straight away
Yes it’s very small but the biggest success rates from CPR and an early shock, not CPR alone.
As I said - having a defib to hand increases your odds - maybe doubles them?
See about 30-40 patients a year following out of hospital cardiac arrests. Outcomes vary widely, and not always predictably. Have seen people with CPR for over an hour survive intact, and people with very short periods of CPR sadly not wake up.
We don't see many, if at all, that get shocked by community AEDs... simply because if they've been in a "shockable" rhythm and get a shock that quick, they are mostly awake enough to not need my services when they reach hospital. They don't just save lives, but they give a much better chance of minimising hypoxic brain damage as a consequence of the arrest. The overall numbers aren't massive, but to those they can benefit the gain is potentially huge.
Cost of defibs = ~ £1500/ unit
ICU bed = ~ £1600 per night (as a bare minimum)
ICU stay for OOHCA - typically minimum 3 days, up to many weeks and occasionally months. So costs probably into the 10,000s on average.
Cost of long-term health and social care for ONE young person with a hypoxic brain injury from oohca - hundreds of thousdands per year
25% of oohca are shockable. The difference between all of the above being potentially needed and almost definitely not needed is a shock within a couple of minutes of arrest. Community defibs are the only thing that makes that possible frequently.
This article from the BHF was interesting. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2023/june/defibrillators-used-in-just-10-per-cent-of-out-of-hospital-cardiac-arrests-study-shows
Two stats of many caught my eye
There are more than 30,000 deaths from out of hospital cardiac arrests in the UK each year, and fewer than one in ten people currently survive. Prompt CPR and defibrillation can more than double someone’s chances of survival.
and
The results found that 1649 cardiac arrests occurred in the East of England in the six-month period. Public access defibrillators were available (within 500m of the cardiac arrest) in 1302 (79 per cent) cases, but only used in 132 (10 per cent) of cases.
Which rather shows the need for education, arguably more than more AEDs.
My experience is first hand in that I collapsed while on a running race and firstly had CPR (from a cardiac nurse) and then defib brought me back. So I would say, yes, very beneficial. I would unlikely be here without one.
Which rather shows the need for education, arguably more than more AEDs.
I'm really surprised by that - my understanding* is that the 999 staff would tell you where the nearest defib is and if you have help, someone goes to get it while while the other dies CPR
*from my first aid training
Unfortunate typo there
But yes , from my first aid course it was recommended not to go and grab the AED if alone. But to carry out CPR constantly. Then hopefully a passerby will help and you send them.
Surprised there's not a button on Google maps tbh , be more helpful than most of the junk it's loaded up with.
The one we have at work never seems to need charging , the open access ones might as the yooof try to shock each other ,and it wakes up more frequently
The guy at the Helicopter station who had the heart attack at his desk:
Which rather shows the need for education, arguably more than more AEDs.<br /><br />
although the full discussion points out that defibs are not socio economically evenly distributed - so it may well be both, rather than either or.
they don’t seem to provide any analysis of why they weren’t used - 500m seems close, but it’s not that close. Let’s assume it is running distance not as the crow flies (although is suspect it is not - which add both navigation delay to find it and the distance somewhat misleading). Unless the person is fairly athletic a 1000m round trip, in ordinary footwear, on ordinary streets, probably being told where to go by the call centre staff on the phone, carrying a bad back, is easily a 6 minute round trip. Add another minute whilst they tell you the plan, tell you how to open and unlock the cabinet etc. and now it’s a 7 minute from “999 - defib needed” to the defib arriving on scene. That assumes it’s obvious to the call handler that CPR is underway or that there are multiple people who call, otherwise the call handler probably spends the first 2 minutes getting CPR started, basic address details, patient history etc. In areas where an ambulance might be relatively close then a paramedic may arrive first. Was there only one “bystander” at the scene etc. There will be many reasons why a public access defib was not used - distilling it down to simple numbers is probably misleading.
Then there’s the question if Amb Service know where the defibs are that will be accessible. I know eg that they know where the second closest one to me - accessible 24/7 with their code is, but it’s not clear if they know that there’s one in Tescos accessible when shop is open, or the dentists which for other people might be closer etc.
when I organise small public events part of our risk assessment identifies the nearest public access defib - but the online information is patchy at best.
Couple of potentially useful apps mentioned here..... https://www.lucky2bhere.org/live-aed-map/mobile-app.htm
Why not add/update the details closest to you on the Crowdsav app. It might be you that benefits if someone else is working on you.
Nearest defib to me, that I know of is 640m away, so 1200m round trip..
The Scottish Ambulance Service are trying to make sure all community defibs are registered so callers can be directed to the nearest one if appropriate.
The guy at the Helicopter station who had the heart attack at his desk:
>
That is one bit of footage we (also based there at LBA...) used to use as it is very relevant.
More recently I like to show this one to our trainees, as recommended by who trained me.
I would reccomnend everyone here takes 3 minutes to watch. Everything shown here can be done by every single person reading this - and it does save lives. You dont have to be technically perfect, or skilled or highly trained. You do have to be quick, decisive, and, no doubt, bloody brave. This video I like to think makes people realise, me included, that if it ever did come to this, they can help and make a real difference.
In November 2017, karate instructor Mark Kingsland suffered a cardiac arrest whilst taking part in a karate training session. Incredibly, the moment was captured on camera.
Thanks to the help of his friends and the quick response of paramedics, who used a defibrillator to shock Mark’s heart, Mark was successfully resuscitated. He was rushed to hospital and underwent an emergency procedure to insert a stent, and has since made a full recovery.
Again referring back to the OP, in a village location I'd imagine that people won't need much directing to the AED locations, especially if there was a bit of publicity when they were installed.
In our case, they are pretty prominent in big yellow boxes. If you use the village hall, you will definitely have seen one. If you go to the footy pitches or playground you will have seen another. If you visit or walk by either school, you will have seen two more. And if you drive or walk out the main end of the village, another is staring in your face.