Our co-founder, Donovan Casey wrote recently about how, when it comes to saving lives from out-of-hospital cardiac arrest, education comes first.
The issue we and so many like us around the world are working to address, is the avoidable mortality associated with out-of-hospital cardiac arrest.
We suggested recently that the single biggest barrier to our success, is lack of preparedness to respond effectively when someone unexpectedly experiences a cardiac arrest.
Before preparedness, comes awareness of the problem. Education comes first.
The problem
Globally, the out-of-hospital cardiac arrest survival rate is less than one per cent.
Approximately six million people die every year due to an out-of-hospital cardiac arrest caused by ventricular tachyarrhythmias – or in other words, irregularity that prevents their heart from pumping blood.
The simple description for ventricular tachyarrhythmias – which includes ventricular tachycardia (VT) and ventricular fibrillation (VF) – is shockable rhythms. This means hearts in VT or VF can be shocked back to a normal rhythm by use of an AED (automated external defibrillator).
In other words, had an AED been used in time – ideally, within minutes of the cardiac arrest – these six million deaths could potentially have been avoided.
By these numbers, a single percentage improvement in survival rates represents approximately 60,000 lives saved.
Examples of the solution
The Chain of Survival describes what needs to happen to save a life in the moments following a cardiac arrest.
A bystander needs to recognise what is happening and call emergency services; commence CPR to buy time; and apply an AED to shock the heart back into its regular rhythm.
As the ratio of people in our communities who are ready to apply the Chain of Survival rises, so too does the rate of survival from out-of-hospital cardiac arrest.
How do we know this? Here are four examples that prove the point.
- Las Vegas casino security guards
An AED and CPR training program for security personnel in the late 1990s had a direct impact on out-of-hospital cardiac arrests among casino patrons.
This program improved the speed and quality of response to cardiac arrests, by educating guards on the problem, and coaching them in delivering the first three steps of the Chain of Survival.
The result was a 74 per cent survival rate for patients defibrillated in the first three minutes, and 49 per cent survival for those defibrillated after three minutes.
Note the difference time makes. For every minute assistance is delayed, chances of survival drop by 7-10 per cent.
- American Airlines flight attendants
Also in the 1990s, American Airlines trained its 24,000 flight attendants on the Chain of Survival. It also installed AEDs on all aircraft.
Over the next two years, approximately 40 per cent of patients who suffered a cardiac arrest mid-flight or in the terminal, survived to hospital discharge.
For many of these patients, rapid defibrillation bought them not only minutes, but hours before they could to be delivered to clinical care.
- Little Life Savers
The two previous examples demonstrated how the quality of bystander intervention could be improved in closed environments. This next example shows how education improves community-wide response to out-of-hospital cardiac arrest.
The Denmark government introduced Little Life Savers, its CPR in schools program in 2005. This included mandatory training for elementary school students, and for anyone applying for a driver’s licence.
Within five years, the rate of survival to hospital discharge for out-of-hospital cardiac arrest patients tripled.
- Seattle
US city, Seattle is the international poster child of what can be achieved when it comes to effective community response to out-of-hospital cardiac arrest.
What began as a community-based campaign to improve CPR literacy 25 years ago, evolved over time into a grass roots-led program of CPR training, AED access and organised community response.
While this did not begin as a government-led program, it today benefits from the direct participation of all levels of emergency response and public policy development and implementation.
The result? An otherwise unheard-of out-of-hospital cardiac arrest survival rate of 62 per cent.
Learning from best practice
The first vital learning from these examples is that improving the survival rate is possible – even at city-wide and national levels.
The second vital learning is that the first step to success for each of these programs was education.
Education of individuals and communities on the problem, and on the personal role each can play to be part of the solution.
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