Community Defibrillation – Where is this going?

Since 2008 the numbers of community defibrillators has increased from around 2000 to over 70,000. This ‘rush’ to install defibrillators belies that the defibrillator is only part of the story, and up to 30% of defibrillators may in fact be non-functional. So where is this going, and can we do better?

There is a perception from media and some retailers that by having a defibrillator nearby will result in 100% of lives being saved. We know this is not true, with the current survival rates for RoSC to hospital averaging around 25%, and survival from hospital only 9% (NHS England figures). This is still better than in 2000 when the survival was only 2%.

Saving a life is time dependent, and the rescue must start fast, usually within a couple of minutes of their collapse. Their heart will degrade by up to 20% per minute in humans, so rapid action is key.

The process to save a life is known as the ‘Chain of Survival’ and this means each step needs to be followed in sequence, to save the life. The quicker each step can be completed, the better the chance for survival. The defibrillator is only step 4, so this is as much about creating time as it is about having a defibrillator, and education in understanding what to do, when, and how.

The changing face of the defibrillator

In the early 2000’s, the only defibrillators available were those that had been designed for trained users. They ‘talked’ to you, but did they speak your language? As a result of the change in training requirement, the numbers of defibrillators began to expend to today’s figure of around 70,000 cPADs in the public domain. In addition in shops, offices or schools where access is restricted at times of the day or due to safeguarding issues.

Since 2014 new technology has allowed defibrillators to meet better requirements for public use, and a good defibrillator now will be EQ2010 compliant and have visualised instructions in addition to the audio, and the audio messages given changed to use everyday language.  Visual displays are the single biggest development in the past 8 years for community defibrillators. Training is still essential, as clearly knowledge of how to recognise SCA, and how to do CPR is essential. Clinical evidence shows that there are twice as many successful rescues where the local community have attended training session than those that have not.

The pending new regulations of UK-MDR will result in non-compliant equipment to be removed from the market, and any community now looking at a project should insist upon only using MDR/FDA compliant equipment. It will also increase the need for governance systems, such as WebNos, and understanding by the public of their requirements to manage equipment. This is not just about reporting or replacement pads.

There is more technology coming in the next few years. These include automatically activated defibrillators, 5G enabled, disposable single use defibrillators and even waterproof defibrillators. At the moment, whilst ‘sexy’ these are several years away as they do not yet have UK-MDR approval, and some may never.

What is now available and will become increasingly important are monitored 247 cabinets, such as the Rotaid 247 and Smart Sentry. These not only monitor your defibrillator equipment, but also tell you when the defibrillator has been used and when returned. GPS tracking is now available as there are increasingly more defibrillators not returned after rescues. Theft, thankfully is still rare, but insurance companies will no longer cover theft of a defibrillator, something that needs addressing as this has the potential to slow down implementation of these important systems.

Signage

Use the correct internationally recognised ILCOR defibrillator signage. Currently there are 13 different types of defibrillator signage used in the UK, and this is causing confusion. The NHS guide on medical signage states,“Unfamiliar (and inaccurate) medical terms should also be avoided, but if they have to be used, a symbol may help people understand the sign” This is further exemplified by the ERC, and also the UK HSE “Under the current Health and Safety guidance for first aid signage, this has now been extended to include signage to direct people to the nearest defibrillator, as well as signage at the defibrillator site itself. Again, this signage should be universal and in accordance with the ILCOR recommendations” 

Future

Recent high exposure projects should be viewed as positive. However, they can also be criticised as being political gestures rather than of real benefit. The current DoE scheme to give all schools a defibrillator, for example, ignores that most schools in 2022 already have a defibrillator, and also that the numbers of SCA in children is remarkably low. A recent study suggest that out of 16,409 SCA in the community, only 8 occurred in schools in children under 18 years of age. No one denies having defibrillators from schools more accessible to the community is beneficial, and vice versa, but the DoE project is spending £20m on 25,000 (low cost) defibrillators without ever doing any study to find the need. This is just the defibrillator….no cabinet or training. Is this sensible use of funds? It would be better for the government to spend this funding on placement of defibrillators in area of high deprivation. The Scottish OHSCA policy plan identified that areas of high deprivation has 100% higher incident of SCA compared to better off areas, and survival was 47% lower. In the UK most community defibrillators are placed in areas of higher social status.

Conclusion

For the future we need to look at this on a holistic basis, and make sure the right equipment is used, placed in the right locations, identified using the right signage, as part of the right story, encompassing the Chain of Survival. We have gone through the initial excitement of defibrillators. Now let’s do this right, and save even more lives.

Article written by Martin Fagan, Community Heartbeat Trust charity, The UK defibrillator charity. Tel 0330 1243 067.