In for a shockby Karyn Scherer
An automated defibrillator could save your life. So, is there one near you?
Owen Munro doesn’t remember much of the day he nearly died. It was just over a year ago, and his brother was visiting from overseas. They were debating what to do with their day. “I believe I said to my brother, ‘Well, you make up your mind, I’m heading to the gym.’”
Munro had been a regular at the Akoranga YMCA, on Auckland’s North Shore, for many years, after suffering a heart attack nearly two decades previously. For a 69-year-old, he thought he was in pretty good shape. But halfway through his workout, he popped into the toilets, and went into sudden cardiac arrest.
“I had no notion at all that I was unwell – I just dropped. Fortunately, someone saw my head sticking out from under the door and called for help, and they brought the defibrillator and kicked it and gave me CPR.” An ambulance took Munro to hospital, where he underwent a triple bypass. Once he recovered, he made a point of thanking everyone who had cared for him, but he remains particularly grateful to the gym staff; and to the Lion Foundation, which paid for the equipment he believes is mostly responsible for saving his life.
“If the defibrillator hadn’t been there, I probably wouldn’t be here. It’s as simple as that,” he says. But Munro also realises he was lucky he was at the gym. “The sudden cardiac arrest – if I’d had that driving a car, I would probably have hit somebody, or driven off the road or something, which is a horrible thought. The survival rate is not good. You just don’t know. “An old mate from secondary school, he was in his early to mid-forties and he used to travel the country, and one day he was out jogging after work and he dropped dead. It was probably the same thing I experienced, but I was in a gym.”
It’s not just gyms that have automated external defibrillators (or AEDs) these days. Largely thanks to campaigning by medical professionals, and fundraising efforts by charities, many businesses and public facilities around the world now have such devices available. Over the past decade, AEDs have become smarter and cheaper to operate. They range in price from $2500 to $5000, and the consumer models are virtually idiot-proof, taking the user through each step. They work by delivering a controlled electric shock to the heart.
Hardly a week goes by without the international media reporting a case of someone whose life has been saved by an AED, in combination with CPR. The most celebrated case in recent times is that of Fabrice Muamba – the British footballer whose heart supposedly stopped for an extraordinary 78 minutes in the middle of a professional match earlier this year. In the past few months alone, AEDs have been used to save a Tauranga man at his gym, a Waikato man out biking, a Tauranga school principal, and an Auckland man in a hardware store.
In New Zealand, many Countdown supermarkets have an AED, and schools are also buying them. Most large international airports have AEDs, and some have dozens of them. Edmonton Airport in Canada, for example, which is used by about 10 million people a year, has 20 publicly available AEDs. Yet Auckland Airport, which is used by nearly twice that number of people, has just two AEDs, and neither is readily available to the public. One is listed as being with the airport doctors, and the other is in a separate building for cargo.
West Auckland deputy school principal Phil Hill, who is also a volunteer fire chief, was shocked to discover in August that even airport staff did not seem to know where the AEDs were. Hill and a colleague arrived in Auckland from Brisbane just before midnight, when they noticed a man lying on the floor near the baggage carousel, surrounded by several people. A young woman was doing CPR, and Hill recalls there were airport staff hovering. He called for a defibrillator, but got blank looks. The woman had never done CPR and commented that she was simply copying what she had seen on TV. Hill called again for a defibrillator, but the best staff could come up with was a basic first aid kit. So he took over the CPR, instead, until a doctor arrived.
Two days later, Hill rang the airport and spoke to someone in management who told him they were still putting together a business case for an AED. Hill was incredulous. “I said, ‘A business case? Haven’t you read all the information from ACC? If it’s one of your employees, [look at] how much money you save by actually having a defib rather than getting the recovery in?’ … And I said: ‘Haven’t you heard about American airports, where even the cleaners are trained to use AEDs?’”
It later occurred to him that he should have mentioned how seriously Auckland Airport’s image would be damaged if a person of renown, especially one from overseas, died there because no defibrillator was readily available.
Leading cardiologist Professor Harvey White is seriously concerned about the lack of publicly available AEDs at Auckland Airport. Not having them at hand for laypeople to use is next to useless, he insists, if it takes more than four minutes for staff to respond. “It’s absolutely outrageous,” he exclaims. “If you go to Gate 30, it’s about a bloody mile … it’s extraordinary. Just to walk there is 10-15 minutes and you get way out there and there’s no AED.”
The golden rule with sudden cardiac arrest is that for every minute that passes before an electric shock is given, the chance of survival drops by about 10 percentage points. This means that after 10 minutes, few attempts at resuscitation are successful. Phil Hill recalls the airport manager arguing that medical staff were on the scene that Hill witnessed within six minutes. “So I thought, ‘Well, if you’re looking for a business case, you need to do something a bit better than six minutes.’”
According to White: “The airport says things like, ‘There were 13 cardiac arrests last year and only one died.’ And I say, ‘Why did the one die? Give me the details.’ And they won’t answer.” He notes there are plenty of other public places where people congregate that don’t yet have AEDs, such as the Auckland Ferry Terminal, and other venues near Auckland’s waterfront.
Last year, a parliamentary select committee considered a petition that asked MPs to ensure there was “ready access” to AEDs and training “in all communities and workplaces”. St John argued there was “very clear evidence” supporting the case for AEDs in high-volume areas such as airports, casinos and shopping malls. The committee recommended the Government “work towards installing” AEDs in community areas that fitted the Ministry of Health’s criteria. But ministers responded by saying they did not believe either the Government or the Ministry of Health was “directly responsible”. Instead, charities already involved were best placed to “further promote” AEDs.
Among other things, the Cabinet noted that about 80% of sudden cardiac arrests occurred in private homes. It also noted that “AEDs are already present in most large New Zealand airports”. White admits to occasionally feeling as if he is banging his head against an extremely solid surface. “I think it’s silliness rather than cost, myself.” But he isn’t entirely despondent, and believes the message is slowly getting through.
In Portugal this year, the Government made AEDs compulsory in large shopping centres, airports, transport centres, sports arenas and other places with the capacity to hold more than 5000 people. “There’s been huge public awareness and frequent articles in the media noting the number of lives saved, so that’s been fantastic,” says White. “Over the past two years, the number of AEDs in New Zealand has gone from 800 to 2400, so it’s gone up 200%. I did want to get up to 10,000, but we’re heading in that direction.”
There is now a website, aedlocations.co.nz, that plots the sites of many AEDs throughout the country, although so far it is only a voluntary system. There is also an app available for both Apple and Android devices. “We have strong support from St John and we have their icon on the app. But we’ve failed to ensure that emergency services receive the details of where the AEDs are.”
Ideally, an ambulance service should be able to identify whether there is an AED on site and prompt the caller to get it, says White. As for people being more likely to suffer a sudden cardiac arrest while in their own home than in a public place, he agrees that those who can afford to do so should buy their own AED. “My father is not alive, but if my dad died in my drive for want of $4000 – that’s 2% of my income, but I’ve got a dead dad. So that’s why I have one in my car. It’s just like owning a fridge. It may not be as cost-effective for how often you use it, but what price a life?”
PEACE OF MIND
Back on the North Shore, Owen Munro doesn’t need to buy his own AED – he now has a miniature version implanted in his chest. He’s been told he shouldn’t need a new battery for several more years, which gives him huge peace of mind. “It hasn’t fired yet, but it’s nice to know it’s there, I must admit.”
It concerns him, however, that many people probably don’t realise what a lottery a heart attack can be. According to St John, at least one person suffers a cardiac arrest in Auckland every day. Nationally, the average length of time for an ambulance to arrive and apply defibrillation is 12 minutes. There’s no national data on survival from cardiac arrest, but pilot data suggests it’s about 7%. The best rate in the world is about 20%, but it is acknowledged that quick access to an AED boosts this rate significantly.
It bothers Munro that not all gyms have staff trained in medical emergencies who are available at all times. And it also bothers him that many people probably wouldn’t recognise an AED even if they saw one in a public place. “It wouldn’t hurt if it was described so the public could understand what it was,” he suggests. “There should be a sign: ‘There is a defibrillator in this building, situated at wherever.’”
Anyone who works for a medium-size or large company should certainly raise the subject with his or her employer, he believes. And should also make a point of thanking colleagues who take the time to train in first aid. “Some of these people, they do these courses and they don’t get any thanks for it. It’s certainly saved lots of lives, and mine was one of them.”
Meanwhile, he still regularly visits the Akoranga YMCA. “After all that, I wouldn’t go to any other gym, would I?” he says, chuckling.
Sudden cardiac arrests
- There are about 1500 sudden cardiac arrests each year in New Zealand, or one per 3000 people.
- The average age of these people is 65, and 70% are male. About 80% occur in a private home.
- Sudden cardiac arrests are more likely to occur in the morning, at the weekend and in winter.
- Research shows strangers are more likely to provide CPR than family members.
- Using an AED before an ambulance arrives appears to boost survival from about 10% to 30%.
- The highest survival rate in the world is at Chicago Airport: 52%, but based on a small sample.
- There are 88,000 public AEDs in Japan, but in one study an AED was used in only 4% of 12,600 cardiac arrests.
- AEDs cost an average of $3600 and should last 15 years. However, they need a new battery and pads every five years, adding about $320 a year.
Source: St John, Sudden Cardiac Arrest Foundation
Further to your article on Automated External Defibrillators (AEDs) (In for a shock, Dec 8), Auckland Airport can confirm that unlike most public buildings and venues, we have an Airport Emergency Service (AES) operating on a 24/7 basis. There are two medical crews operating 365 days, 24 hours a day, that respond to all medical emergencies in the terminal buildings. These crews are committed, highly trained paramedics and carry sufficient medical equipment (including AEDs) to deal with most emergency medical incidents. So far, our response rate for medical emergencies remains high.
However, we are always considering ways of improving the service provided, so to complement (but not replace) the emergency medical service already provided by the Airport Emergency Service, we have recently installed 12 AEDs in strategic locations throughout the international and domestic terminal buildings. There are three in the domestic terminal and nine in the international terminal located so that anyone using the terminals is no more than two minutes away from any unit. The AEDs are stored in highly visible cabinets which are set up to transmit a signal to the Incident Control Room whenever the cabinet door is opened. This will confirm the incident’s location and automatically alert AES of any emergency involving these devices.
Training courses are held regularly, although very little training is required as the AEDs we have installed were selected for their simplicity of use and deliver clear voice prompts to lead the user through the rescue process. We have also offered training airport-wide to anyone who wishes to attend.
Corporate relations manager, Auckland Airport
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