Factors affecting public access defibrillator placement
As part of her work to enable data-driven placement of Public Access Defibrillators Diane Lac has completed a survey of individuals, groups and organisations across the UK who are involved in PAD installation.
Results were published in Resuscitation Plus: Diane Lac et al., ‘Factors Affecting Public Access Defibrillator Placement Decisions in the United Kingdom: A Survey Study’, Resuscitation Plus 13 (1 March 2023): 100348, https://doi.org/10.1016/j.resplu.2022.100348.
This study aimed to understand current community PAD placement strategies and identify factors which influence PAD placement decision-making in the United Kingdom (UK).
Individuals, groups and organisations involved in PAD placement in the UK were invited to participate in an online survey collecting demographic information, facilitators and barriers to community PAD placement and information used to decide where a PAD is installed in their experiences. Survey responses were analysed through descriptive statistical analysis and thematic analysis.
There were 106 included responses. Distance from another PAD (66%) and availability of a power source (63%) were most frequently used when respondents are deciding where best to install a PAD and historical occurrence of cardiac arrest (29%) was used the least. Three main themes were identified influencing PAD placement: (i) the relationship between the community and PADs emphasising community engagement to create buy-in; (ii) practical barriers and facilitators to PAD placement including securing consent, powering the cabinet, accessibility, security, funding, and guardianship; and (iii) ‘risk assessment’ methods to estimate the need for PADs including areas of high footfall, population density and type, areas experiencing health inequalities, areas with delayed ambulance response and current PAD provision.
Decision-makers want to install PADs in locations that maximise impact and benefit to the community, but this can be constrained by numerous social and infrastructural factors. The best location to install a PAD depends on local context; work is required to determine how to overcome barriers to optimal community PAD placement.
The full article is available here.
The latest OHCA data has been published by RRG and the Scottish Ambulance Service, here is a summary of the main findings:
- From 1st April 2021 to 31st May 2022 there were 3,140 cardiac arrests where resuscitation was attempted. This represents an incidence rate of 573.0 OHCA per million population of Scotland.
- Overall, 30-day survival was 9.7% (Strategy aim 15%), representing 2 55.5 survivors per million population. This is less than in 2018-19
- (11.9%), but significantly recovered after a drop in survival to 7.5% during the COVID-19 pandemic.
- Return of Spontaneous Circulation (ROSC) rate in patients with a shockable initial rhythm (Utstein comparator) was 52.3%, with a 30-day survival rate of 26.1%, the highest recorded level since 2011-12.
- Bystander CPR rate was 66.1% (Strategy aim 85%), the highest recorded since 2011-12 and having continued to rise during the COVID-19 pandemic.
- The number of Public Access Defibrillators (PAD) in communities across Scotland that are registered on the national defibrillator network (The Circuit) has more than doubled since 2019 and is now at almost 5,000. The rate of PAD deployment by the public was 8% (Strategy aim 20%).
- Scottish Index of Multiple Deprivation (SIMD) associated inequalities remain, with those living in the most deprived areas in Scotland (SIMD1) more than twice as likely to have an OHCA and 40% less likely to be alive 30 days after the event when compared to people living in the least deprived areas in Scotland (SIMD5).
- The COVID-19 pandemic had a significant impact on OHCA outcomes but we have made a substantial recovery.
The full report can be accessed here
A range of organisations, businesses, clubs, groups and communities across Scotland have already installed an Automated External Defibrillator. Many make them available to the general public and visible to emergency services: such Public Access Defibrillators (PADs) are key to strengthening community readiness to respond to an OHCA.
While RRG is working with partners to gather evidence on how PADs might best be used in Scotland, we are eager to offer advice to those thinking of placing a PAD in their community.
This guide, prepared by the OHCA Strategy Delivery Group, aims to outline key things that individuals and communities should consider before purchasing and installing a PAD.
Special thanks to John Fotheringham for his work in drafting the guide.
In the third year after the launch of Scotland’s Strategy for Out- of-Hospital Cardiac Arrest we have reviewed the data from 2015-16 and 2016-17 in order to continue to track patient outcomes and measure the impact of efforts to implement the strategic aims. The key findings are detailed in a Scottish Government published report.
Summary of main findings
- The number of incidents of OHCA resuscitated by SAS has increased from 2692 in 2011/12 to 3455 in 2016/17. The proportion of SAS incidents which could be linked to outcome data also increased from 73.0% in 2011/12 to 86.6% in 2016/17.
- The mean age of OHCA patients, ratio of men to women and the distribution across the Scottish Index of Multiple Deprivation (SIMD) quintiles remains broadly similar from 2011/12-2016/17.
- The proportion of patients receiving bystander CPR has risen from an average of 41.3% between 2011-2014/15 (prior to the introduction of the strategy) to an average of 49.3% in 2015/16- 2016/17.
- The proportion of all OHCA patients resuscitated by SAS who were still alive at 30 days was 6.2% in 2011-14/15 (prior to the introduction of the strategy) and 7.7% in 2015/16-2016/17.
Half of the Scottish adult population do not feel confident administering CPR – and more than a fifth do not know when it is required, according to a collaborative study involving the RRG and the University of Stirling.
The study, which has been welcomed by the Scottish Government, is the first to examine the readiness and willingness of Scots to carry out cardiopulmonary resuscitation (CPR). Experts believe the work could help to explain why our survival rates from cardiac arrest are poor when compared to other countries.
Fiona Dobbie, a Research Fellow at the Institute of Social Marketing, part of the Faculty of Health Sciences and Sport, led the work, which also involved the Resuscitation Research Group at the University of Edinburgh and the Scottish Government.
“The findings of our study will help develop policy and future interventions to improve the rate of bystander CPR,” Ms Dobbie said. “From a policy perspective, there is a need for more tailored and targeted interventions to encourage CPR training, which has been linked with improving confidence in CPR. As confidence increases, so does the likelihood of providing emergency aid in an out-of-hospital cardiac arrest.
“Our findings suggest that priority groups are people who are not working, in a lower social grade and the elderly.”
In 2015, Scotland’s Strategy for Out-of-Hospital Cardiac Arrest was launched with the aim of equipping 500,000 people with CPR skills in a bid to save an additional 300 lives per year following an out-of-hospital cardiac arrest.
The new study, which informs the Strategy, comprised an Ipsos MORI survey, which canvassed 1,027 adults in Scotland.
Fifty per cent said they would not feel confident administering bystander CPR, with a further 21 per cent admitting that they would not know if it was required.
Twenty-two per cent would not be comfortable giving CPR, for fear of causing an injury to the victim, while 19 per cent would be reluctant due to their lack of skills. The same proportion would be put off by visible vomit or blood and 16 per cent by indications that the ill person is a drug user, the poll found.
The team found that confidence was affected by age, social grade and employment status; the older the person was, the less likely they were trained in CPR, show willingness to be trained, or feel confident to administer CPR. Fifty-eight per cent of 35 to 44 year olds said that they would like to be trained in CPR, compared to just 37 per cent of 55 to 64 year olds and 23 per cent of those aged 65 and over.
Respondents with professional, managerial and non-manual occupations were more likely to have been trained in CPR than those in manual, unskilled occupations and the long-term unemployed.
Dr Gareth Clegg, a Senior Clinical Lecturer at the University of Edinburgh, an Honorary Consultant in Emergency Medicine at Edinburgh Royal Infirmary, and an Associate Medical Director, of the Scottish Ambulance Service, co-authored the paper.
He said: “Survival from cardiac arrest in Scotland is a poor relative to the best performing centres in the world. One of the most important determinants of survival is bystander CPR, which more than doubles chances of survival.
“We already know that people in the most deprived areas in Scotland are much more likely to have a cardiac arrest, at a younger age, and less likely to survive than those in affluent areas.
“This work is important because it suggests that those living in communities which are most likely to need CPR are least ready to carry it out.”
Dr Clegg added: “Using the findings from this research, we hope to develop ways to teach hundreds of thousands of people in Scotland how to perform CPR – and save hundreds more lives each year.”
Minister for Public Health Aileen Campbell said: “That half of adults in Scotland in this survey were already confident giving CPR gives us a firm foundation to build on, and to date more than 200,000 people across the country have learned CPR since 2015.
“This is great progress towards our 500,000 target by 2020 and a testimony to the work put in by our Save A Life For Scotland partnership, who have brought these lifesaving skills to more people across the country.
“Any CPR is better than no CPR and we know it’s the main way we can increase survival after Out of Hospital Cardiac Arrest.”
The study, Attitudes towards bystander cardiopulmonary resuscitation: results from a cross-sectional general population survey, was commissioned by the Resuscitation Research Group at the University of Edinburgh and is published in PLOS ONE.