Every year in Australia approximately 30,000 people suffer a sudden cardiac arrest away from a hospital, a figure derived from studies in individual Australian states, as nation-wide data is collected. This lack of information is in itself is a problem when it comes to improving the care and survival of cardiac arrest victims: it is impossible to change that which we do not know or understand.
A sudden cardiac arrest can happen anywhere, anytime: at a sporting event, at the beach, at work, at the airport, at home. In Australia, the overall survival rate from a cardiac arrest is less than 10%, yet there are parts of the world where the rate is dramatically higher.1
In Seattle, Washington, USA, intensive efforts have pushed the rate of survival after cardiac arrest to 62%.2 Seattle is a metropolitan area with similar characteristics to modern Australia cities. Elsewhere in North America, system-wide programs have pushed survival rates into the region of 20-30%.
Unfortunately, some people cannot be saved, despite best efforts. These are mainly older people who suffer a cardiac arrest when they are at home alone. This does not explain—or excuse—our national record.
St John Ambulance Australia Queensland, CEO Alex Hutton says “We believe it is feasible to target a survival rate of 50%, which translates into some 12,000 more Australian lives saved every year. It also represents significant social and economic savings,” said Mr Hutton.
We already know the answer to the problem.
The first five minutes holds the key to survival. We need more people, of all ages, who are trained and willing to provide immediate cardiopulmonary resuscitation (CPR). We need more, and easily accessible, defibrillators and more people prepared to use them. We need a coordinated healthcare system, designed to provide the type of care that increases the chance of surviving a cardiac arrest.
Above all, we need more people to be part of the solution. Increasing survival simply will not occur unless we empower the community to drive change from within.
When it comes to saving a life, all the stars have to be aligned—and time is critical.
- Someone has to immediately recognise that a person has suffered a cardiac arrest and begin CPR
- Someone has to call the ambulance
- A defibrillator needs to be nearby, and be used it quickly to treat the patient
- An ambulance needs to arrive and take the patient to a hospital, where the best post-arrest care is available
There are some cases where all of these critical steps occur, however, this is rare. When it does happen, there is often a large dose of luck involved. The crucial factor is that “someone” nearby is trained to recognise cardiac arrest, and to respond the right way, straight away. We can’t have doctors and paramedics everywhere, so we need to massively boost the number of people who can do the job.
At one level this means a significant engagement with the public so we have more trained individuals who understand that they can save a life. It also means overcoming common barriers, such as the fear that CPR may potentially ‘hurt’ a person in cardiac arrest, and the anxiety of being involved in a life-and death situation.
As we know, the best chance of surviving a cardiac arrest occurs when a victim’s care begins immediately and is based on the highest quality evidence. The interventions that have been shown to work are best summarised in the Chain of Survival. This is a useful metaphor for the linked series of actions that, when optimised, give a cardiac arrest victim the greatest chance of surviving without ongoing disability.
The Chain of Survival has five interdependent links:
Early recognition and early activation of emergency services
Effective advanced life support
Integrated post-cardiac arrest care
Of these interventions, immediate and effective CPR and early defibrillation have been shown to be the most crucial. The highest rates of survival occur in communities where defibrillators are widespread and accessible, and citizens are trained and willing to provide CPR.
So, does your workplace, community club or local school have a public access defibrillator?
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1. http://www.takeheartaustralia.com.au/, accessed August 2017.
2. http://www.heartsafeaustralia.com.au/Heart-Safe-Environment/, accessed August 2017.