White Paper

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Every minute counts

THE CASE FOR AUTOMATIC EXTERNAL DEFIBRILLATORS TO BE INCLUDED IN A STANDARD BUSINESS FIRST AID KIT

Executive summary 5

A growing problem 7

CPR and AEDs 8

The Chain of Survival 9

Early Defibrillation via AED 10

Increasing the number of AEDs 11

The Fire Extinguisher/AED Analogy 12

Affordable AEDs from Driver First Assist 13

Conclusion 14

References 15

Table of contents

DFA: Every minute counts: The case for Automatic External Defibrillators to be included in a standard business first aid kit

For automatic external defibrillators to be effective in improving cardiac arrest survival rates they need to be as common as fire extinguishers. The only way we can achieve this isfor them to be included as a standarditem in a business first aid kit.

Executive summary

Every year 55,800 people die from out-of-hospital cardiac arrests (OHCA) in the UK.1 Only 7% survive because most don’t receive the help that they need in the crucial first five minutes.

13% of workplace fatalities are due to out-of-hospital cardiac arrest.

EARLY DEFIBRILLATION, WHICH SHOCKS THE HEART BACK INTO A NORMAL RHYTHM, COULD SAVE UP TO 70% OF THOSE WHO EXPERIENCE AN OHCA.2

Automated External defibrillators (AED) are safe and can be used by the public to save the life of someone experiencing a cardiac arrest. However only 3% of cardiac arrests happen close enough to an AED to be useful.

Increasing the number of accessible AEDs by making sure they are in every office first aid kit would dramatically increase the number of people surviving OHCAs. Until now, price has been a barrier, with AEDs costing over £1000.

AEDs should be found alongside fire extinguishers. Driver First Assist has made this affordable for every business by producing an AED that will cost £220, 80% cheaper than the current market average price

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Only 7% of people who have a cardiac arrest outside of hospital survive

Sudden cardiac arrest is a leading cause of premature death. In cardiac arrest the heart’s normal electrical impulses are interrupted, causing the heart to malfunction, interrupting the circulation of blood and oxygen.

Without help the person will die within minutes.

With 60,000 people in the UK having out-of-hospital cardiac events (OHCA) each year, only 4,200 survive.

Every minute counts in a cardiac arrest as survival rates drop by 10% each minute that treatment is not received. Our ambulance service target response time is 8 minutes, 11 minutes if in an urban area. If this lifesaving treatment is to be administered in time to make a difference, we must rely on the public.

A growing problemThe numbers of people experiencing sudden cardiac arrest is likely to increase

• Our population is ageing. 12 million people are aged 65 and above and this is due to increase by 21.8% by 2030 (Age UK)

• 28.7% of adults are obese and a further 35.6% overweight (Health Survey for England 2017)

• 7 million adults are living with heart disease (British Heart Foundation)

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Neil

Father-of-two Neil collapsed at home as he was getting ready for a bath. His wife, Kelly, found him collapsed on the floor, and sadly, he was unable to be saved.

Kelly said: ‘My husband was just 32 when he died, and he could have been saved by a defibrillator. ‘They offer reassurance for anyone with a heart condition, which often people don’t know about, and they save lives. ‘There are no laws in place to have them in public places and buildings, like there are with fire extinguishers. ‘But they really do save lives. A person often does not have any chance of survival unless a defibrillator is there.’4

55,800 people die each year in the UK from out-of-hospital cardiac arrests 270 of these are children3

The Chain of SurvivalIn order to provide the best chance of survival of a cardiac arrest there are critical actions which should take place.

The weakest links in the chain of survival for cardiac arrests in the UK are Early CPR and Early Defibrillation5. Our survival rate of 7% is significantly lower than for populations in North Holland (21%), Seattle (20%) and Norway (25%).6

Early CPR

Bystander CPR occurs in only 40-50% of cardiac arrest in the UK.7 Programmes are underway across the UK to increase the numbers trained in CPR, however there is often nobody trained in CPR nearby when an OHCA occurs.

CPR and AEDs

DFA: Every minute counts: The case for Automatic External Defibrillators to be included in a standard business first aid kit8 9

CPR stands for cardiopulmonary resuscitation. To carry out CPR a person presses up and down on the casualty’s chest (chest compressions) and gives them a series of rescue breaths.

Defibrillation is the delivery of a shock to the heart intended to re-establish a normal heart rhythm. If defibrillation can take place in the first five minutes, then the survival rate is 50 to 70%.

If we could improve the rates of bystanders carrying out CPR or using an AED then the number of people who survive could be increased tenfold, to 42,000.

Many people who collapse with cardiac arrest can be saved if people nearby

• Recognise what has happened

• Call for an ambulance immediately

• Start CPR

• Use an AED to shock the heart back to its normal rhythm.

Early Access to emergency response system

Early CPR (to buy time)

Early Defibrillation (to start the heart)

Early advanced care by hospital personnel

Early Defibrillation via AEDEarly defibrillation can be administered via an AED (Automatic External Defibrillator).

AEDs are compact, portable, easy to use, safe and very effective. They can be used by anyone, whether or not they have had formal training. An AED gives the person using it voice instructions. An AED will not allow a shock to be given unless the collapsed person needs one. AEDs can be stored for long periods without use and need very little maintenance.

There are 10,000 AEDs in public places in the UK. They can be found in airports, libraries, shopping centres and train stations. With 66 million people in the UK only 3% of cardiac arrests happen within the recommended retrieval distance of a defibrillator.8

This is largely since the majority of the general public do not know what AEDs are, where they are and that they can use them without training.

Increasing the number of AEDs

Las Vegas 70% survival rate

In Las Vegas AEDs are readily available and the survival rate for cardiac arrest outside of hospital is 70%.

If the UK survival rate was 70%, then 37,800 more people would live through a cardiac arrest. 37,800 more families would avoid the grief of losing a family member each year.

Having AEDs in the right place at the right time is key to increasing survival rates in the UK.

The cost of AEDs

The Royal College of Surgeons of Edinburgh and the Resuscitation Council (UK) state that AED prices are a significant factor in the poor cardiac arrest survival rates. Currently AEDs cost over £1000, creating a price barrier to increasing the number available for use outside of hospitals.

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“The key to a patient surviving a cardiac arrest is for them to receive basic life support as quickly as possible, including chest compressions and the use of a defibrillator. People can use them even if they have not had training by following the instructions on how to attach the defibrillator pads and the device will then talk you each step.

“I also really want to emphasise that members of the public can never do a patient any harm by using a defibrillator – it simply assesses the patient’s heart rhythm and will only deliver a shock if it is needed. When you use a defibrillator, you are only ever improving that person’s chances of survival.”

Dr Fenella Wrigley, Chief Medical Officer at London Ambulance Service9

Mark

Mark was on a trip to the Lake District with his father when he experienced one of the most harrowing experiences of his life. They had just completed a run and a walk up the Old Man of Coniston and were relaxing at a local pub when his father experienced sudden cardiac arrest.

The owner of the pub had lost her son to a cardiac arrest and had installed an AED in the wall outside the pub, making it particularly visible. Mark remembered seeing it and while he was doing chest compressions called for someone to bring it to him. He was able to shock his father’s heart into a normal rhythm, and his father survived.

Mark says: “I’m a great believer that these things (AEDs) should be the same as fire extinguishers in public buildings. Every building should have one because they are so, so simple to use.”11

The Fire Extinguisher/ AED AnalogyFire extinguishers are available everywhere they might be needed in order to save lives.

AEDs should also be available everywhere that they too could save lives. Currently there is no regulatory requirement for the siting of AEDs, unlike fire extinguishers.

Affordable AEDs from Driver First AssistDriver First Assist (DFA) is a not-for-profit organisation which has been working closely with emergency services for 7 years, training drivers in lifesaving first aid. Training includes cardiopulmonary resuscitation (CPR) and the use of automatic external defibrillators (AEDs).

Driver First Assist questioned why AEDs are so expensive, at over £1,000 per unit, and began to explore the possibility and efficacy of producing AEDs at a much lower price.

DFA worked with an established AED manufacturer for three years to produce an AED that costs only £220, 20% of the current average cost.

This means that even small businesses could afford to place AEDs alongside fire extinguishers and in business first aid kits, saving many lives that would otherwise be lost.

Already familiarisation and training in the use of an AED is core component of the HSE-recognised first aid at work course, so employees who undertake the course will be trained and ready to use one when it is installed in their workplace.

Every business, small or large, has fire extinguishers.

In the absence of a regulatory requirement to make AEDs available the only feasible way to increase the numbers of AEDs across the UK is by reducing their retail price.

AEDs in office first aid kits

There are 1.4 million businesses in the UK that employ staff. There are 100 people a week who experience a sudden cardiac arrest in the workplace.10 13% of workplace fatalities are due to an out-of-hospital cardiac arrest.

If an AED was in every business that employed people then the majority of people who have a cardiac arrest out-of-hospital would be within the recommended retrieval distance of a defibrillator. This would benefit both the employees of the business and the public.

12 13DFA: Every minute counts: The case for Automatic External Defibrillators to be included in a standard business first aid kit

AEDAutomated

externaldefibrillator

42,000 people who would have died from an out-of-hospital cardiac arrest could potentially be saved if Automatic External Defibrillators were a standard item in business first aid kits.

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Conclusion.We can potentially save 42,000 people a year in the UK.

Automated External Defibrillators save lives, but they could save more.

If the placing of low-cost AEDs in the workplace was regulated, they would be available to save the lives of workers and anyone experiencing an OHCA in the local community.

Awareness of the existence and use of AEDs would also dramatically increase as workers see them appear in the workplace. This raised awareness would mean that more members of the public think of AEDs when they witness a sudden cardiac arrest and are willing to try to use them.

270 children die in the UK every year after suffering a Sudden Cardiac Arrest at school

Without immediate treatment, 90-95% of Sudden Cardiac Arrest victims will die

If a defibrillator is used and effective CPR is performed within 3-5 minutes of cardiac arrest, their chance of survival increases from 7% to 70%

Approximately 60,000 Out of Hospital Cardiac Arrests occur every year in the UK

The emergency services average response time to a cardiac event related incident is 8 minutes (11 minutes in an urban area)

For every minute that goes by where a victim of Sudden Cardiac Arrest does not receive treatment, their chance of survival decreases by 10%

References1 Out of Hospital Cardiac Arrest Outcomes (OHCAO) Registry, 2019,

University of Warwick2 Guidelines: Adult basic life support and automated external

defibrillation. Resuscitation Council UK, 20153 Cardiac Science, 20194 https://metro.co.uk/2019/08/23/widows-desperate-plea-for-more-

defibrillators-after-husband-died-at-32-5 The Cardiovascular Disease Outcomes Strategy, Department of

Health, 2013.6 Consensus Paper on Out-of-Hospital Cardiac Arrest in England, BHA

and Resuscitation Council UK, September 2014.7 Out of Hospital Cardiac Arrest Outcomes (OHCAO) Registry, 2019,

University of Warwick8 Resuscitation Council UK, 20199 London Ambulance Service NHS Trust 29th January 202010 iHasco 201811 Sudden Cardiac Arrest UK, Podcast – Saving my father with

Mark Holt, June 2020

About Driver First Assist (DFA)

DFA is a financially self-supporting, not-for-profit organisation, created and working in partnership with the emergency services. DFA trains drivers to deliver lifesaving first aid at the scene of road traffic collisions before the emergency services arrive, to relay accurate information for rapid response times and to get traffic moving again.

DFA provides training on behalf of a wide range of organisations. For example, DFA will teach 1,000 Highways England Traffic Officers on a rolling three-year basis; is the preferred supplier of Wincanton, the UK’s third largest logistics company; and has won the contract to train 1,000 drivers with Certas Energy, a leading oil and gas supplier. Our mission to certify up to 100,000 drivers over the next five years is firmly on track.

We work in partnership with the Association of Ambulance Chief Executives, the National Police Chief’s Council, the National Fire Chief’s Council, the United Kingdom Rescue Organisation and the THINK! road safety campaign.

Driver First Assist5 Erica RoadStacey BushesMilton KeynesMK12 6HS

www.driverfirstassist.orginfo@driverfirstassist.org030 30 40 10 20Company No. 6771027