Health Service Focus

25.09.13

Every minute counts

Source: National Health Executive Sept/Oct 2013

The Welsh Ambulance Service has installed defibrillators on its fleet of non-emergency vehicles. NHE heard more from the organisation’s head of clinical services, Richard Lee.

After a cardiac arrest, time is of the essence, as every minute that passes for someone in a shockable rhythm without defibrillation decreases their survival chances by 10-11%.

As part of a drive to ensure Automated External Defibrillators (AEDs) are available in as many locations as possible, the Welsh Ambulance Service has installed the devices on all of its non-emergency Patient Care Service (PCS) vehicles.

The ambulance service trust’s head of clinical services, Richard Lee, explained more about PCS, telling NHE: “PCS operates single-crewed and double-crewed vehicles, and their role is to undertake non-emergency journeys for patients. These range from journeys as simple as taking people to their outpatient appointments, through to discharging people from hospital back to nursing homes or their home address, transferring people from one hospital to another, and so on.

“The non-emergency staff are trained in advanced driving, they’re trained in the manual handling and safe conveyance of patients, they’re also trained in dealing with specific patient groups like the elderly and people with Alzheimer’s. They’re trained in first aid and they’re also now trained to use an AED.”

The British Heart Foundation says that only about 10% of people survive an out-of-hospital cardiac arrest. Lee quoted the survival statistics and added: “Time is of the essence.”

He said having AEDs on-board all the non-emergency transport vehicles makes them available in two main circumstances: firstly if the patient being transported goes into cardiac arrest, which he said is “rare, but it has happened. They take people to Cardiac Outpatients, they take people to dialysis, so occasionally somebody becomes unwell on a non-emergency ambulance.”

But also, he said, the vehicles – which are marked up with the Welsh Ambulance Service logo and have ‘ambulance’ written on them – are flagged down by members of the public  dealing with an emergency on the roadside, especially if they’re waiting for an emergency ambulance to arrive.

He gave an example from January, when Newport-based PCS staff Antony Peters and Kevin Price came across a nine-year-old girl who had collapsed on her way to school. Peters performed CPR until paramedic Simon Mullins arrived in a rapid response car and delivered an electric shock with a defibrillator to restart the girl’s heart. Mullins then continued treatment in an emergency ambulance en route to the Royal Gwent Hospital, where she required further defibrillation but has since made a full recovery. 

Project benefits

The project, which cost more than £250,000, was funded via the Welsh Government’s All Wales Capital Programme. 

Lee also suggested that the installation of the AEDs could allow the future development of a capability to deploy a non-emergency ambulance as a first responder to a cardiac arrest in the community. But he made clear that is not a policy being developed as of yet, just a potential one for the future.

The installation in July means an extra 250 defibrillators are available in Wales every day. They’ve already been used on three occasions since then, Lee told us.

He praised the devices – AED Plus, manufactured by Zoll – because they are incredibly simple to use and require no servicing, beyond changing the batteries every five years, and changing the pads if the machine is used.

“There is no servicing or revenue commitment,” he said. “They are simple to use – you turn it on and it tells you what to do and talks to you.”

The trust is also partnered with the British Heart Foundation for its ‘No Time To Wait’ campaign to increase the number of defibrillators in the community, which is also one of the strands of clinical strategy.

Lee said: “We want AEDs in places like golf clubs, schools, scout groups, shopping centres – any areas where there are large numbers of people congregating.”

Above image: PCS driver Helen Bie with the new AED Plus device that has been placed on all non-emergency ambulances in Wales.

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