More outdoor defibrillator stations needed if lives are to be saved: experts

There’s a new addition to a building called the Q in North Vancouver’s Shipyards neighbourhood. It’s an outdoor box holding a defibrillator, the first of its kind on the North Shore.

When it’s fully operational, it will also include naloxone and a Level 1 first aid kit.

It’s being set up by St. John Ambulance and the business group North Vancouver Chamber in one of the busier public spaces on the North Shore.

“It’s part of bringing support where it’s needed, when it’s needed,” said Patrick Stafford-Smith, CEO of the chamber. “I think it’s really exciting, a sign of things to come, taking care of each other when we don’t have the experts nearby.

“It’s great that we have these things in hockey rinks, but cardiac arrests happen all over the place.”

Experts have long urged more automatic external defibrillators, or AEDs, be placed outside of buildings and that more people be trained how to use them, along with how to perform CPR.

The high-profile cardiac arrest of Damar Hamlin, a professional football player who collapsed during an NFL game last month and was hospitalized for nine days, has led to an increased public awareness of the possibility that anyone could experience the same thing.

Any time, anywhere.

“If the people around you are prepared, you have a good chance and that’s what Mr. Hamlin has demonstrated,” said Dr. Jim Christenson, a professor in UBC’s emergency medicine department whose primary research is in cardiovascular emergencies, especially resuscitation.

Having his cardiac arrest in an NFL stadium meant personnel trained in CPR were nearby, as were defibrillators. Not everyone is so lucky. Not everyone’s partner knows CPR. Not every ambulance is close by.

“Why don’t we try to take luck out of the equation?” Christenson said. “That’s our big societal challenge.

“If we all put our heads together and we all commit to it … and defibrillators are in more places I firmly believe we can make a big difference (in the rate of survival).”

Cardiac arrest is better described as sudden unexpected cardiac death, Christenson said. Unlike, say, heart failure where the blood can’t pump enough blood, cardiac arrest is when the heart effectively stops pumping blood in relatively healthy people.

That’s separate from “expected deaths” where someone had been in palliative care, has end-stage cancer, ALS or some other death sentence.

“The person is basically going about their daily activities and all of a sudden something happens,” Christenson said. “And that’s a problem, the system has to respond quickly.

“You don’t know where it’s going to happen.”

Ambulances respond to about 8,000 cardiac arrests in B.C. each year.

It might be helpful at this point to mention how you would know if someone was experiencing cardiac arrest.

“You should shake them and shout,” Christenson said. “If they have absolutely no response, there’s no moaning or anything, then check their breathing. If they’re not breathing normally you will know they are in cardiac arrest.

“We don’t say ‘no breathing’ because then people wait too long to see if there’s going to be a breath … the brain is still sending signals for the body to breathe and they have a slow kind of snoring respirations maybe every 30 seconds.

“That’s not normal and people would know that that’s not normal. So, not responding, not breathing normally, do CPR, that’s the simple way to think about it.”

Paramedics respond to about 8,000 cardiac arrests a year in B.C. and in roughly half those cases the patient is dead when the ambulance arrives.

“People don’t appreciate how important that is, that’s over 8,000 people every year who their families expected them to live through that year and they didn’t,” Christenson said.

Of the 4,000 who are taken to a hospital, about 10 per cent are resuscitated. And of those 400 or so, only around seven per cent will leave hospital alive.

“So that number of deaths is more than the opioid crisis and COVID deaths, even before we had vaccines, that number far exceeds even the combination of those two health crises, right. And yet, we often don’t think much about it.”

Christenson is far from alone in wishing courses such as St. John first aid and CPR certification had been part of school curriculums for decades. But now would be second-best.

Some physicians and patient advocates are working with the Heart and Stroke Foundation to advocate mandatory CPR training in schools, such as the Scandinavian countries have, said Dr. Chris Fordyce, a clinical assistant professor with UBC’s cardiology division and director of cardiac intensive care at VGH.

“Denmark has increasing rates of bystander CPR and defibrillation from AEDs and improved survival is associated with that,” Fordyce said. “This normalizes CPR training in a population with improved public health outcomes.”

The provincial government introduced a bill in 2019 mandating public access to AEDs, which Fordyce said requires “somewhat voluntary” registration with B.C. Emergency Health Services. There are 1,176 registered, according to B.C. EHS.

There’s also an app called PulsePoint that alerts someone trained in CPR if there is a cardiac arrest nearby.

“However, we don’t really know the total number of AEDs in the province because of the voluntary nature of registration,” Fordyce said. “For example, many AEDs may be found at private businesses and homes that may not be registered or accessible.”

Dr. Brian Grunau, an assistant professor in the department of emergency medicine at UBC, agrees.

“It is difficult to know where the AEDs are and it is especially difficult to know where they are during an actual cardiac arrest when you need it quick,” said Grunau, who has an interest in out-of-hospital cardiac arrests and resuscitation.

“The second big issue with AEDs is they are often locked inside buildings and they are often difficult to find even when the building is open. Contrast that to AED programs of other countries such as Denmark, where AED’s are placed exterior to buildings so can be accessed 24-7.”

Although AEDs are sophisticated machines, they are easy to operate. There are several how-to videos on YouTube and the machines themselves will walk you through what to do with spoken instructions. They will even analyze the rhythm of the heart to determine if an electrical shock — a defibrillation — is required.

“They are very easy to use,” said Bryan Wong, who founded Red Cross-associated Pacific First Aid in 2009.

The machines tell you exactly what you need to do, he said.

“Once you make sure the machine is activated and the patient is not breathing, bare the chest. Cut the clothes because the machines all come with a rescue kit that will include razors, scissors, wipes.

“So you just cut the shirt off and follow the pictures that are on the pads themselves, put the pads onto the patient’s chest and the machine will guide you step by step.”

In a 2022 study Brunau, Fordyce and Christenson took part in, which was published in Resuscitation, a monthly international medical journal, researchers said optimal locations and cost-effectiveness of placing automated external defibrillators in residential neighbourhoods is unclear, but that the systematic placement of AEDs outside schools and community centres could increase their use in life-saving situations and be cost-effective.

“Prompt defibrillation … has been shown to significantly improve patient outcomes, largely because shockable rhythm, and by extension survival, declines as time elapse(s),” the report said.

The three doctors also took part in a study that looked into trends of pre-hospital resuscitation results from 2006 — when B.C. Emergency Health Services established a cardiac arrest registry — to 2016.

“Survival and the proportion of survivors with favourable neurological outcomes increased significantly,” the study found.

In a Jan. 8 article in The Conversation, which publishes in-depth analysis and research from leading academics and researchers, an emergency medicine physician and lecturer at the University of Toronto said football player Hamlin’s “catastrophic incident” reminded many that death could be close by if the right medical equipment and care is not immediately applied after a cardiac arrest.

“The average citizen — at home or at play, engaged in contact sports or casual interaction — may not be so lucky,” Dr. Adam Pyl wrote.

And that, Christenson said, is a problem.

“We’re talking about cardiac arrests, basically in public or business settings, not at home,” he said. “Eighty per cent of cardiac arrests happen at home, that’s where we spend most of our time.

“So we can increase the service by (placing AEDs) in public places, we can improve the survival when the arrest happens in a public place, but unless we can crack the nut of getting that same thing to happen in the home we won’t move the needle a whole lot.”

According to the American Heart Association, 3.8 million people a year worldwide have cardiac arrests outside of a hospital setting: Fewer than three per cent get a AED or CPR.

Bystander intervention with CPR saves lives. When that is combined with the use of an AED the chance of survival nearly triples, according to the Heart and Stroke Foundation.

And because every minute without AED or CPR significantly decreases the chance of survival, even living in one of the top floors of a highrise tower means your chances of surviving a cardiac arrest diminishes relative to people living on lower floors, according to a 2016 study published in the Canadian Medical Association Journal.

Simply stated, the closer one is to life-saving equipment, the better chance of recovery.

In Canada a lay passerby is attempting CPR in 45 to 50 per cent of the cases by the time an ambulance arrives, but in B.C. that figure is 60 per cent, the highest in the country, Christenson said.

“Let’s make sure nobody catches up to us,” said Stafford-Smith of the North Van Chamber.

“We all know where an ATM is. At some point maybe we’ll all know where our nearest AED is.”

gordmcintyre@postmedia.com

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