Defibrillators - how beneficial ?

www.bbc.co.uk/news/uk-england-leeds-58818589.amp

The more defibrillators there are around the better. You don't even have to know how to use it, it tells you what to do.

While not answering the question, our village with a population of around 4000, has 10 according the defib map. Some located within 100m of another.

just accept that although the chances of success may be small, a life saved is a life saved?

I did a first aid course for Scouts with a paramedic and he said that, if you've got to the point where you're doing CPR or using a defibrillator, the life is very unlikely to be saved anyway but it is, obviously, worth the go.

I'm sure qualified medical professionals will be along shortly, until then I'm medically trained, although nothing I could legally use in civvy street apart from basic CABCD, however I'm of the mind with defibs, better to have it and not need it than need it and not have it.

They're life saving bits of kit but have no idea on the rationale behind location.

As for CPR, you keep going until qualified medical aid arrives or you physically cannot continue.

The longest I've done is 45 mins in the back of a helicopter split between myself and a RAF EMT. We were ****ed and ultimately the guy passed.

We were **** and ultimately the guy passed.

Yeah, the other thing the guy said about CPR was that if you're not knackered after about three minutes, you're not doing it right

The sooner a defibrillator is used, the more likely there is to be a good outcome.

The idea that if you’re doing CPR and using a defibrillator that the person is screwed anyway, is more about getting people past bystander “analysis paralysis” preventing timely action, than a definitive analysis of the likely outcome.

 Can one of them do CPR while the other goes for the defib?

Yes, although CPR is more important. AED will only fire is your heart is in arrhythmia, and its not always.

How long is it realistic to do CPR?

Call 999 and keep going until they show up and tell you to stop, they may well ask you to carry on while they do other stuff, so don't stop until they tell you for sure and not when they just show up

At what point does there become a value in a defibrillator – proximity of kit, and availability of helpers?

Proximity really I guess, the kit will tell you what to do, so if you know where one is, send someone to go and get it, and use it, don't worry about how long its been, just make sure some-one is doing CPR all the time.

Yeah, the other thing the guy said about CPR was that if you’re not knackered after about three minutes, you’re not doing it right

Ruined my dude, absolutely ruined. The EMT was impressive to watch, I continued as we handed over to the hospital, he was ****ed and gave the most concise and clear handover.

There are some crazy compression machines about these days. Not seen one in the wild, just videos and they look brutal.

Has anyone here ever used one of these telephone box defibs, or had one used on them?

If you live by yourself they’re a bit pointless.

The ones that we have at work are completely autonomous with the exception of requiring someone to push the “shock” button. They won’t shock a heart that’s not in a shockable rhythm.

For me the most useful thing about them is that they will guide a user through effective CPR, giving feedback on compression rate and depth.

A population-based cohort study published in the Journal of the American College of Cardiology examined 13,769 out-of-hospital cardiac arrests documented between December 2005 and May 2007. The aim was to see how bystander CPR and AED shock therapy provided before EMS personnel arrived (if any) affected SCA survival rates to hospital discharge. This study did not document the length of time between collapse and the defibrillation shock.

Based on the available data, the researchers discovered that:

7% of cardiac arrest victims with no bystander CPR or defibrillation shock survived to hospital discharge.<br />9% of cardiac arrest victims with bystander CPR but no AED shock survived to hospital discharge.<br />38% of cardiac arrest victims with bystander CPR and an AED shock survived to hospital discharge.<br />Astoundingly, of 13,769 out-of-hospital cardiac arrests, only 32% of victims received bystander CPR and a mere 2.1% received an AED shock. By waiting for EMS personnel—who typically take between 4 and 10 minutes to arrive—the survival rates were much lower than they could have been.

https://www.aedleader.com/aed-survival-rates/

It's definitely better than nothing, but still needs to be used very quickly.  If not used within about 10 mins of arrest, the chances of survival drops to below 10% (from what I learned whilst renewing my first aid qualification a few weeks back).

Yes. Early defibrillation and CPR is what makes the difference.

I did a first aid course for Scouts with a paramedic and he said that, if you’ve got to the point where you’re doing CPR or using a defibrillator, the life is very unlikely to be saved anyway but it is, obviously, worth the go.

He’s talking shite

AIUI a defibrillator is a bit of kit that reboots your heart if it has got itself into an electrical tizz (refer to disclaimer above). It’s used after a person suffers a cardiac arrest. To keep them alive between the arrest and the reboot, it’s necessary to manually pump blood to their brain with CPR.

Its used when your heart is not beating properly but the sort of defib found on the streets is no use if your heart has completely stopped.  Technically I think its misleading to say CPR is to keep them alive.  Its to try and supply the brain with enough oxygen that there is some hope of being able to restore the heart rhythm itself.

In an environment where there is a defibrillator relatively nearby, and a number of people present to do the CPR, this may work, and it may be justification for installing a defibrillator in places like shopping centres, sports stadiums, whatever.

the argument for that - more people = more risk of an incident, and enough folk around to help.

But what about less favourable environments? If I live on my own on top of a hill, is there any value in there being a defibrillator. on the top of the next hill? I would say clearly not.

How far away is the next hill? who called the ambulance? etc.  In contrast, your shopping centre a paramedic might be able to get on scene as quickly as someone runs, finds defib, works out how to open the case, runs back, unpacks, follows instructions to set up etc...  in a rural setting you might have a much longer wait for professional help.

I can’t do CPR to myself and also run over and get the defib. Suppose I live with my wife? Wife and son? Can one of them do CPR while the other goes for the defib?

Yes (obviously depending on the age of son; but they may be able to run next door to get help too).  Not sure if you have local first responders - and if they carry a defib or collect from public source, but in some cases a 999 call will get you a local first aid trained person with a defib whilst they wait for "proper help" to get to you.

How long is it realistic to do CPR?

Its physically exhausting.  One fit person would struggle to do CPR for much over 30 minutes, especially if they are not used to it or have emotions running high.  Even then its probably becoming less effectively the more tired they get.  Professionals swap.  Specialise experts carry what are essentially CPR robots for prolonged CPR.  This is part of the reason why getting you defibrillated as quick as possible is important - the earlier the shock is delivered the better the chances.  Bystander CPR (rather than professional CPR isn't always very good either).

At what point does there become a value in a defibrillator – proximity of kit, and availability of helpers? Or is that the wrong way to look at it, and just accept that although the chances of success may be small, a life saved is a life saved?

There will be a formula for the cost benefit.  I'm sure some are installed in hindsight by loved ones saying "if only", but generally they can save lives, but also ensure that if a life is lost those who tried to help aren't left thinking "I could have done more" which I think is just as valuable.

I did a first aid course for Scouts with a paramedic and he said that, if you’ve got to the point where you’re doing CPR or using a defibrillator, the life is very unlikely to be saved anyway but it is, obviously, worth the go.

A colleague is only alive today because he happened to have a heart attack in front of a building with a defib...

He was super lucky, just come in from wind surfing in a lake and had a heart attack on the jetty...

As for CPR, you keep going until qualified medical aid arrives or you physically cannot continue

Yeah this. My mate had a cardiac arrest in his office. His work mate did CPR for 15mins which gave the paramedics time to get there. They revived him with a defibrillator, twice, then carted him off to hospital. Full recovery. Handily for the benefit of  everyone who was not there, the paramedics turned up with a channel 5 camera team in tow - can't remember the name of the show now... but anyway, the workmate was wrecked after 15minutes of CPR and the paramedics were saying he was owed a beer or 2 from my mate.  Amazing effort.

Warning: the linked video is of real-life CPR/defib use 

I was shown this on our first aid course, run by BASP, a few weeks ago.

Some of the main points it raised:

1. Having a good team of people who know CPR is awesome

2. Without a defib handy, the ambulance crew would probably not have managed to save the guy

3. The people involved here do this stuff all the time, so were incredibly calm.  If this was the first time you had ever had to deal with something like this, you would almost certainly make mistakes, such as possibly not calling for an ambulance immediately.

Our canteen guy had a cardiac arrest after doing couch to 5k. With prompt and vigorous CPR from a couple of people that knew what they were doing (for quite a long time) and a nearby AED he survived. It actually took ages for the paramedics to arrive so without one he would probably be dead.

You are screwed without an AED (CPR is keeping you functioning not bringing you back). And the graph of survival % Vs time to AED application is pretty grim beyond 10 mins. Very glad our slightly remote village has numerous AEDs.

I think your Scout medical instructor needs to update his teaching.

I know of 2 people that have been saved with an AED .

Also on one First Aid course I attended a woman gave her Dad CPR successfully until the Paramedics arrived.

I did a first aid course for Scouts with a paramedic and he said that, if you’ve got to the point where you’re doing CPR or using a defibrillator, the life is very unlikely to be saved anyway but it is, obviously, worth the go.

Horseshit.

https://www.theguardian.com/football/2012/mar/25/muamba-collapse-minute-by-minute

Can the one thing we take away from this thread is tbat if you aren’t already qualified, go and do a decent 2-3 day First Aid course.

Volunteer to be a First Aider at work, or through a sports team or youth organisation or get a group of mates organised the next time you are down the pub and one of you says "we ought to do that".

Just do a course.

Are Defibs and CPR beneficial? In short, yes.

The BHF are doing a big push on both getting defibs installed and on CPR training at the moment. Further info here on how you can get a defib installed in your community and on free CPR training

https://www.bhf.org.uk/how-you-can-help/how-to-save-a-life/defibrillators/apply-for-a-free-defibrillator-for-your-community

https://www.bhf.org.uk/how-you-can-help/how-to-save-a-life

I think your Scout medical instructor needs to update his teaching.

Indeed. The survival percentage leap from having one available to not and just using CPR is massive. If you can get hold of one without neglecting the cpr its an absolute gamechanger.

I look after a defib provided to our rural area by Lucky2bhere. It's bolted on to my next door neighbour's house. At our last training session, the guy from lucky2bhere said that the longest he would be prepared to leave someone needing cpr to get a defib is one minute. The trouble is our local rural area has about 30 houses and the distance ever house is much more than a minutes and most are lived in by couples. So if one was having a heart attack the other would struggle to go to a neighbour to get help let alone drive 5 mins to ours. On the back of this we have an emergency whatsapp group - put in a group call on the whatsapp group and hopefully someone on the group will answer and come help via the box. The box has a map I've knocked up of everyone's house just in case someone gets flustered when the time comes.

In my time looked after the box it's twice been retrieved by someone at the instruction of 999 on the phone but neither time actually deployed. Long may it stay that way.

I know know a few mountain leaders who specialise in leading older folk who now carry the small AED you can buy. Virtually pencil case sized. Not cheap but amazing that that can now be a thing.

When your doing CPR on someone I can absolutely guarantee that you wish someone rocked up with a charged AED pronto.l

Has the mapping of where AEDs are improved or are there still multiple websites and resources that don't include all locations?

I know know a few mountain leaders who specialise in leading older folk who now carry the small AED you can buy. Virtually pencil case sized. Not cheap but amazing that that can now be a thing.

I think this is the future - a population heavily dotted with people carrying these things who know how to use them.

However, the next government's focus should also be on getting paramedic response times back down again - report out yesterday found that the average response to suspected heart attack and stroke was 38 minutes, which is not optimal for good outcomes for either. I know there is a 'golden hour' for the delivery of post-stroke treatment in many cases which can make all the difference in terms of quality of recovery.

I've been getting annual first aid training with St Andrew's First Aid (like St John's, but in Scotland) for work for quite a few years now and every time they emphasise that prompt use of an AED dramatically improves a casualty's chances of survival compared to CPR only.

The more there are,  the better the chances.  I've been doing first aid at work training this week and today we were told,  cpr alone success rate 1 in 10. Defib applied inside 2 mins success rate rises to about 7 in 10, it drops about 1 I n 10 every further 2 mins delay.   Hence why they need to be abundant. 

Also we were told website called the circuit has there their locations

I'm still amazed (and frankly horrified) by the level of confusion surrounding the difference between a heart attack and a cardiac arrest. I've seen numerous headlines "He died after  suffering a massive cardiac arrest."
Of course the former can precede and precipitate the latter but their only connection is the organ they affect.
AEDs are fantastic and offer a chance of survival that just wouldnt be there without them. Of course, they are of no use if the patient is in asystole but for those in VF (ventricular fibrillation or wobbly, ineffective heart rhythm) they are very good at restoring normal sinus rhythm. 
I'd rather have a 50% chance of survival than 0%.

I've used one. No way was the guy coming back to life but we did all we could. I don't think they're actually that useful but if they save a handful of lives then that's worth it.

I’d rather have a 50% chance of survival than 0%.

Likewise. I’d rather have 1% chance than 0%. But the original question was about understanding what real world situation corresponds to a 1% chance, a 10% chance etc. From what people have said, and the links provided, it looks like the chance of survival is actually better than I’d thought.

There's 5 24/7 public ones in my little town, plus at least 4 more that aren't so easy to access, and they're well spread... Ambulance should be reasonably quick here but it'd need luck for one to arrive before you could run for a defib. I especially like the one right outside the old man pub, maybe they should get a 2-pack there. All got to be a good thing.

IHN
Full Member

I did a first aid course for Scouts with a paramedic and he said that, if you’ve got to the point where you’re doing CPR or using a defibrillator, the life is very unlikely to be saved anyway but it is, obviously, worth the go.

My understanding is that this used to be somewhat true, just because of the sheer lack of people who could do CPR usefully and the rarity of defibs (and the earlier public ones weren't as good), but also that it was sometimes used as useful disinformation since so many people are quite understandably scared to get involved, afraid of making it worse. Even with training I really don't want to have to do any of it! And probably the more people understand that the defib won't let you shock someone inappropriately, the better, even if you use sketchy methods.

(But also that it's become less and less true over time, with more defibs and more and more people having either training or basic understandings of cpr)

BAck to the OP, even in the arse of nowhere, it could help. I "helped" with a walker who collapsed on the west highland way, a long time back- there were more qualified people to do the CPR so I never did that, just helped with scene management and looking after the people who were doing the interventions and with access and ambulance- but tbf the guy had very little chance, there was no helicopter available and it was over an hour for the ambulance to arrive. But now there's a defib at the drovers, we could have had it to him in about 10 minutes, or we could probably have got the one from crianlarich well before the ambulance arrived. And that was a guy who'd just dropped while walking, by luck there were people nearby and then other people less nearby but, that's how it works. Thing is, sure they're less useful the further away from population centres and people you are, thta's inevitable, but equally that usually means slower ambulances too.

I've experienced several relevant examples but this one is probably the best to mention.   In contrast to @munrobiker and their unpleasant experience, I have delivered a patient clearly beginning to have a heart attack at a big event in a wheelchair the short distance to the on-site resus bay ... where the patient promptly crashed during handover and was revived within two minutes by the AED which a colleague had been unpacking as soon as they saw the patient's face.

This patient left the site alive and chatting to the ambulance crew.

If you go to Murrayfield for the 6Nations or Edinburgh's Hogmanay street party, there are staff walking about in the crowd with AEDs. Commercial providers often now also have these really compact units, literally pocket mask sized.  Less kicks than a bigger unit but still more than adequate for a responder role.

Outwith working for that provider, I take several AEDs in my car to every event that I personally cover, often distributing them out among the team.  I encourage race directors to buy and deploy their own among the marshals too, so even if I'm not there, we have the resource and plenty of folk trained to use them.  At home, everyone on the farm where I live knows that I have these (and a lot of supporting kit) and I look after other units around this end of the county.  I've no hesitation in saying that it's hard to have too many units and equally better still if you have trained folk to work them.  Good CPR isn't easy to achieve and takes practice as well as confidence.

Technically, a defibrillator doesn't restart the heart, it stops it so that it can restart itself in the proper rhythm, rather than the fibrillation rhythm it was in. Hence the name.

If somebody has a heart attack, CPR can keep them in condition to restart once defibrillated. As I understand it, it's very rare for CPR alone to bring somebody back from a heart attack, if there's no defib available. BUT if their heart has stopped due to drowning, CPR can work without a defib, although you would always try the defib if you have one, particularly since a heart attack may have been the root cause of the drowning.

I don’t think they’re actually that useful but if they save a handful of lives then that’s worth it.

Funny I’ve found them to be extremely useful.

One of my neighbours survived a heart attack with prompt CPR and a defib machine. Prompt ambulance response as well. His collapse was totally out the blue. Ran for miles every day. No previous symptoms. Had the good luck to collapse on a road with passers by outside a golf clubhouse with a defib machine.

Had he collpased 2 minutes earlier in a quieter location who knows?

https://www.bbc.co.uk/news/uk-scotland-67715220

Hmm I’d rather there was one close to hand in the event that I need one 🙂

YMMV.

Bloke dropped down in the middle of a jog luckily right in front of my office gates. A very quick thinking security guard saw it on cctv, grabbed a defib ran at least 500m to the scene with a colleague and performed cpr till the defib was ready and saved the runner.  Was in the local paper n everything. <br /><br />

so with that example and loads of others on this thread I simply don’t understand why posters are still persisting with the ‘ain’t much use’ theme. Clearly alone on a deserted island that is true but otherwise….

One of our running club collapsed and died on our hash just the other week, I don't know if a defib would have helped or not 😢 my niece owes her life to someone knowing to continue CPR despite lack of signs of life & the ambulance driver knowing which hospital to take a very young drowning victim. If you are thinking of doing a first aid course get on it.

GP friend of mine was out jogging with a pal, running through tiny village. Pal dropped to the ground, my friend grabbed the AED from the village hall about 5m away. Pads on within one minute and CPR given. Ambulance was 15 min to arrival and the guy was out running again 6 months later.  

Always used to have a giggle with the GP as I was a fit midlifer but tbh it means nothing as it’s a lottery,you could smoke 100 fags a day and eat a fry up every day and outlive a super fit jogger with a super healthy lifestyle, it’s all hedging your bets 🙂

Some people's knowledge is shocking.

I like the fact that there's a defib on every Coop funeral directors wall. One last chance.. .

I don’t think they’re actually that useful but if they save a handful of lives then that’s worth it.

In which case, you’re an idiot