The charity, the Community Heartbeat Trust (CHT) has been in the forefront of supporting the placement of community defibrillators ever since they were deregulated in 2009. However, the keenness of communities to take up the provision of these devices has led to a plethora of different project types, styles, equipment and generally a lack of awareness of governance issues. It is estimated that some 30% of community projects are currently out of service at any point in time.
Best Practice has not featured widely in these projects, and few communities follow a standard process for installing community defibrillators, addressing the equipment, liabilities and governance. Best Practice includes the right equipment for untrained users, addressing liabilities and particular disability regulations, and building a sustainable and resilient long-term programme.
Working with the national and leading charity, The Community Heartbeat Trust, ensure that all projects now have the possibility of long-term resilient and governance led approach that includes:
- A standard high specification defibrillator choice, that provides maximum support to the rescuer, has features enabling good CPR to be undertaken, allow easy access to the clinical data and are cost effective over the life of the unit, typically 10-15 years. Older designs are unlikely to have these modern features, or may not comply to the new Medical Device Regulations (MDR) due to be enacted in 2020.
- A full governance programme to address all aspects of the provenance of the equipment and its support, including training records and in/out of service notifications.
- A full community awareness and training programme, to ensure members of the community are fully aware of how and when to use these medical devices, and to give community confidence.
An Automated External Defibrillator (AED) is a powerful device and if used correctly as part of a system of integrated events, can save a great many lives and every community should have access to one, but done with the knowledge and resilience and not just done to "tick the box".
All local government, publicly funded (via grants) or local government supplied projects should also show sustainability for at least 10-15 years. Most ambulance services now also insist on evidence of governance, and many will require a local contract to be agreed before they will activate.
There are now many defibrillators to choose from for placement into the public domain. Most members of the public will not know or necessarily understand the subtleties in the differences of defibrillator equipment. Therefore, CHT helps communities by undertaking a review of all common defibrillators, asking some 53 questions of the device in its relation to use by untrained members of the community. A score is applied and the top third are deemed as being very suitable for community use (we call these group 1 devices)
We do the same for cabinets, applying the ShockBox marque. Whilst cabinets can be locked or unlocked, the choice should be based upon the need and local factors, and if a locked cabinet is used, it should have a marine grade, vandal resistant lock or similar - you cannot afford to have a cabinet jam in a rescue.
It is unwise to use mild steel single skinned cabinets within five miles of a coastal location, and if in Wales, Scotland, Ireland, Cornwall and some inner cities, dual language may be a requirement - for example, adherence to the "Welsh Language Act".
Government departments, or ambulance services, should not insist or misrepresent defibrillator devices due to commercial agreements or misleading NHS supply chain regulations. The best equipment for a particular situation may not be the cheapest, particularly when it comes to schools for example.
Undertaking a sustainable community project
Firstly, all aspects of the project need to be considered, including the sustainability aspects, and a full understanding of the project and a map of the process to undertake.
In the recent project undertaken by Bedford Rotary Club, an analysis of the marketplace was undertaken, consultation with the local ambulance service and parish councils undertaken to ensure the placements were not duplicating already placed resources, and an analysis of suitable equipment undertaken. In this case, the Cardiac Science G5 was chosen as this matched another project undertaken with CHT and the Bedfordshire Fire service to place G5 devices throughout Bedfordshire, thus allowing compatibility and ease of support and training. At least one life has been saved by this Rotary Project, with a successful rescue in October 2017.
Secondly, communities should also realise that community defibrillators are covered by the "Activation Radii" set by the local Ambulance service. In the East Midlands this is 500 metres, but in South West, it is only 200 metres. this can have an impact on the equipment chosen, how it is activated and also whether it is supported by a localised group of trained volunteers.
The ambulance service also will not activate a community defibrillator if there is only a lone rescuer present.
Defibrillators and children
A child in defibrillators terms is anyone under 25kg in weight. Typically, in the UK this means seven and under, although a six-year-old weighing 29Kg would be an adult. Cardiac Arrest occurs very rarely in this age group, and for community placement ambulance services recommend only using adult devices in the public domain. this reduces the liability of incorrect usage of paediatric devices on anyone over 25Kg.
Some devices such as the ZOLL AED 3, have paediatric buttons and the appropriate paediatric algorithms and thus are probably more appropriate than other devices with "child switches" that simply reduce the power of the shock.
About The Community Heartbeat Trust charity (CHT)
CHT invented the concept of the community public access defibrillator - cPAD, as well as the concept of using redundant telephone kiosks.
As a national charity, working across the UK and also supporting placements in Greece, we began by setting high standards and quality at a time when everyone else was trying to just cut costs.
As such we work to a high level, ensuring communities are protected, use the right/best equipment and making sure the projects are long-term sustainable.
In addition to Rotary, we also work with the Rugby Football Union, cricket, many commercial organisations such as Mid Counties Co-op, and about 800+ town and parish councils.
To date, we have delivered approximately 4500 sites across the UK, with the vast majority governed by the WebNos Governance system, the UK's only defibrillator governance system.
We are advisors to NHS England and also the Welsh Government, and also work with all 11 of the UK ambulance services, as well as many fire and police. In 2018 we established the only governance led National Defibrillator Database in the UK (www.nddb.uk), a non-commercial free service to all.
Sustainability - Resilience - Governance - in community defibrillation
For more information or to obtain a "Guide to Community Defibrillation" please contact us.