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Cardiac First Responder Schemes Need Funding

IRISH MEDICAL TIMES – October 6, 2010 – The HSE must follow through on its funding pledges for community first responder schemes or lives will be put at risk, the Oireachtas Joint Committee on Health has heard. Gary Culliton reports

There should be a dedicated HSE budget of €1.5 million for a programme of resuscitation training in targeted places, the Oireachtas Joint Committee on Health has been told by a group that responds to heart attacks in isolated areas.

Community first responder (CFR) schemes were recommended in the sudden cardiac death report, which was published in March 2006. The HSE budget plan in 2007 allocated €1.5 million to fund the roll out and development of targeted sites nationally, to enhance the first responder and resuscitation training programmes, provide education and promote awareness.

John Fitzgerald, a member of Wicklow Cardiac First Responders, said: “We need that money budgeted back within the ambulance service training school, so that it has a dedicated budget for the CFRs. While we accept there have been problems along the way with embargoes and so forth, the recommendation for €1.5 million was signed off by the Minister for Health in the 2007 HSE service plan.

“That needs to be returned to the ambulance service training school budget,” he said. “We need their skills to teach instructors.”

14 people die per day

According to figures provided by the Irish Heart Foundation, approximately 5,000 people per annum (14 people per day) die from cardiac arrest in this country. Only 2 per cent of out-of-hospital cardiac arrest victims may survive. CFRs who use oxygen and defibrillators can double or treble this survival rate. The Pre-Hospital Emergency Care Council (PHECC) carried out a survey in the north west in December 2009, which found it was achieving a success rate of about 7 per cent. A cardiac-arrest patient will not be revived by CPR alone: he or she must be defibrillated.

Since the Wicklow Cardiac First Responders scheme started in 2005, the survival rate has been 4 per cent, twice the national average. This was mainly due to training, equipment, location of defibrillators and community awareness, Fitzgerald told the Joint Committee.

The chances of recovery for those who have suffered a cardiac arrest are reduced by between 7 per cent and 10 per cent for every minute that passes. If an automated external defibrillator (AED) is used on a victim within three minutes of going into cardiac arrest, he or she has a 70 per cent chance of surviving.

The CFR scheme operates in conjunction with the HSE, and the HSE ambulance service has rolled out the model in Co Wicklow. The first meeting of cardiac responders in the county was held in Shillelagh in 2004 and the first groups were launched in January 2005. After 12 months, 27 groups were live and active in Co Wicklow. All were connected to the ambulance service and were being dispatched by the 999 service.

In the event of somebody suffering cardiac arrest or respiratory difficulty, a member of the first responders team immediately calls the emergency services. Central control then dispatches an ambulance and immediately calls the number of the dedicated telephone in the kit bag. The responder who is on-call answers the call and is asked to go straight to the scene of the emergency.

In rural Wicklow, it can take between 30 minutes and one hour for an ambulance to arrive. Every second counts in the case of cardiac arrest and the group said that a responder typically appears on the scene in five minutes or under.

Typical call-outs involve cardiac arrest, stroke and heart attack, as well as any respiratory difficulties or choking. “We’ve attended cases involving infants, right up to those involving elderly people,” said Fitzgerald. To date, approximately 500 CFRs have been trained in 31 villages in Co Wicklow. The group has attended more than 800 call-outs. This is in line with the International Liaison Committee on Resuscitation recommendations of attending a cardiac arrest in under eight minutes.

“When a group decides it wants to have a CFR scheme in its area, we set out to train between 14 and 20 people to manage a roster and provide coverage 24 hours per day, seven days per week,” said Fitzgerald. The training lasts approximately 2.5 days and is usually provided on a weekend, with the half day provided shortly thereafter over a couple of evenings. The training is done under PHECC Cardiac First Responder and Irish Heart Foundation protocols. It includes cardiopulmonary resuscitation, the use of a defibrillator and oxygen therapy, which is used in nearly every call-out. Responders are also trained to use suction and in the administration of aspirin in the event of someone experiencing chest pain. The group also provides training on dealing with choking and stroke recognition. All training is provided under ambulance service protocols.

“We’ve 24 trained people in our group, but we also train once a month for a two-hour period. The training can consist of checking the kit bag and acting out scenarios of a heart attack, chest pain or choking. The practice would also include the use of the defibrillator itself,” said John O’Reilly of the Wicklow group. “An AED can cost anywhere from €1,350 to €2,500 for one with ‘bells and whistles’. They all save lives in the end, however.”

Under procurement policies, the ambulance service or the Irish Heart Foundation cannot recommend a specific AED to a community. Each community buys its own AED. The kit bag and the oxygen and suction device, aspirin, breathing apparatus and other medical devices are all supplied and kept up to date by the HSE ambulance service. Each village in the scheme has one kit bag. Tinahely, for example, has one kit bag with 20 volunteers. People will take a night or a day slot, depending on what suits. They must live within a three-mile radius of the community so they can get to the response in or under five minutes. There are 31 kit bags in Co Wicklow.

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