We thank Malhotra and Rakhit  for their observations of the challenges and potential beneficial outcomes in the management of out-of-hospital cardiac arrest. Clearly, prevention is the best course of action and therefore the promotion of greater awareness of the prodromal symptoms and signs that may precede a cardiac arrest and when to call for help is paramount. If and when a cardiac arrest does occur, survival rates will be greater if this occurs when the ambulance is already on scene after an early call for help. These actions need to be combined with improved levels of bystander cardiopulmonary resuscitation (CPR) and reduced times to defibrillation for all victims of cardiac arrest.
The Resuscitation Council (UK) and British Heart Foundation (BHF) are jointly funding a research database to identify best practice and improve patient outcomes for those suffering pre-hospital cardiac arrest . We are also working in partnership to promote the ready availability of public access automated external defibrillators (AEDs) and to call for the mandatory inclusion of emergency life support (ELS) education on the school curriculum. The evidence is compelling that this approach is not just aspirational but that it leads to improved outcomes. If we were to have the same bystander CPR rates as those in Seattle and Norway then thousands of lives could be saved every year in this country. We need the Department of Education to learn from these international exemplars and mandate ELS teaching for all school children.
Malhotra and Rakhit report the grim statistics from a British Red Cross survey of 2000 people in the UK that only 1 in 13 respondents are confident in first aid skills. This is clearly unacceptable, so how else can we further promote this concept?
Access to ELS training in schools has increased since our campaign started and therefore we need to continue promoting the concept. If at least one clinician in every local authority area can ask the question of what is being taught in all local schools then this would be a good start. If that clinician could then help to establish training in all these schools then we would instantly be in a better position. ELS training has the potential to boost self-worth and citizenship as well as provide lifelong essential skills. This is a public health issue and therefore we would also encourage all Directors of Public Health to include this in their priority list of local projects.
This year sees the first Europe-wide “Restart a Heart” awareness day on October 16th. The Resuscitation Council (UK) will be promoting this by sending a Lifesaver DVD (www.life-saver.org.uk) to all secondary schools. This not-for-profit product, that has already generated 81,000 hits, is free to download to smartphones and tablets. It aims to improve awareness of how to do CPR and also how to use an AED. We encourage everyone to promote “Restart a Heart” day.
Alongside this, the Resuscitation Council (UK) and BHF are working with the Department of Health to achieve their stated aim in the Cardiovascular Disease Outcomes strategy published in March 2013; namely “to promote AED site mapping/registration and first-responder programmes by ambulance services and consider ways of increasing the numbers trained in CPR and using AEDs”. AEDs should be signposted clearly and registered with the local ambulance service to ensure swift location and access following an emergency call. There is good evidence that prior training is not essential for their correct use , but we would still advocate increasing awareness of AEDs by inclusion of this topic in the ELS training packages in schools. We should also encourage the further development of first-responder schemes that carry AEDs.
Malhotra and Rakhit correctly reference the ‘chain of survival’. All of the links are vital but improved outcomes following transfer to a heart attack centre are dependent upon instigation of quality bystander CPR and the swift use where appropriate of a defibrillator. We call upon all clinicians to lobby for a national approach from the Government to ensure that all citizens know about CPR and have access to a defibrillator nearby. Otherwise, whilst there will continue to be pockets of excellent practice, there will also be large areas of the UK where survival rates will remain dismal. This postcode lottery is unacceptable – every citizen should be equipped with the skills and available equipment to be a lifesaver.
1 Malhotra A and Rakhit R. We can improve survival after cardiac arrests. BMJ 2013;347:f4800
3 Caffrey S. Feasibility of public access to defibrillation. Curr Opin Crit Care 2002;8:195–8.