Every year around 6000 people in Scotland suffer a cardiac arrest in the community outside a hospital environment. Unfortunately, most don’t survive to be discharged from hospital. But there are things we can do to ensure that more people survive an out-of-hospital cardiac arrest (OHCA).
Because no-one knows where or when an OHCA will occur, someone is unlikely to survive unaided until an ambulance arrives. Immediate action by those who happen to be present is crucial.
Unlike most other medical emergencies, with a cardiac arrest, what happens at the scene and at the time – and what we as individuals do – is what really counts. There is nothing the hospital can do if the heart can’t be restarted at the time of arrival.
The response rate and the professionalism of the Scottish Ambulance Service is impressive but for much of the time what happens before the paramedics arrive is what makes the difference.
A rapid response is essential to improve the chances of someone surviving a cardiac arrest. This is called the “chain of survival” and involves: early recognition and calling for an ambulance; performing cardiopulmonary resuscitation (CPR) in order to buy time; early defibrillation to restart the heart; and early advanced cardiac life support by paramedics.
The Scottish Government is currently drawing together plans to make sure that we are doing all we can at every stage of the chain of survival, but there are things we can all do as individuals to improve outcomes.
CPR and early defibrillation are the two critical interventions that are required for a person to survive an out-of-hospital cardiac arrest. CPR is the act of providing the rescue breaths and/or chest compressions that can keep the person alive until professional help arrives. Even without CPR training, someone can be coached and supported on the spot to perform CPR by the 999 emergency operator.
Automatic external defibrillators (AEDs) – which are sometimes also referred to as Public Access Defibrillators (PADs) – are machines designed to be operated by members of the public. They can deliver an electric shock to restart the heart if needed.
I know from my own experience of having attended a training course, how straightforward using one of these machines can be.
AEDs will automatically analyse a person’s heart rhythm through pads connected to the chest area, and deliver an electric shock if needed. They give spoken instructions and so are easy for people to use even without training. The reassuring part is that the machine works out if it’s a cardiac arrest. If it’s not, then it won’t go off. You can’t shock someone by mistake.
I have been greatly impressed by the determination of individuals, organisations and businesses to do their part in helping to create a community ready and able to respond to cardiac arrest. Volunteers who have trained as first responders, people who have found the time to learn how to do CPR and those who have supported the provision of public access defibrillators. Yes, there is more we can do but I believe we are making progress.
Michael Matheson is Scottish Government minister for public health