Defibrillators

Lord Bishop of St Albans Excerpts

Tuesday 24th June 2014 Grand Committee

[The Lord Bishop of St Albans]

My Lords, I am grateful to the noble Lord, Lord Storey, for raising this important issue and for keeping it to the forefront. When I was training to be ordained, I became used to some people going off for a little doze while I was preaching. What I did not know was that, during my very first sermon, somebody—a very nice lady—would have a heart attack. Fortunately, she did not die and I got to know her and her family very well during her convalescence. I saw something of the impact of such events on families; indeed, my sympathy goes out to those who know something of this in their own family.

Each year in the UK, some 60,000 people suffer a sudden cardiac arrest. Ambulance services are able to attend on average only 25,000 of those and the corresponding survival rate is depressingly low. Sudden cardiac arrest is therefore a key issue for us.

Time is of the essence in such instances. Survival is often dependent on quick access being gained to medical assistance in the form of CPR, defibrillation and then excellent follow-up care. I am told that, for every minute that elapses following a cardiac arrest, the victim’s chances of survival decrease by 23%. If CPR alone is available, the survival rate remains alarmingly low—at around 5%—but if defibrillation is conducted within five minutes of the arrest, the survival rate soars to some 50%. Given the stretched resources of our ambulance services and the large and often complex geographical areas that they serve, it is not always easy for professional medical assistance to be with the victim in that very short timeframe. Even the current eight-minute general response target is reached in only two-thirds of incidents. It is obvious, therefore, that for assistance to reach the victim before time runs out, we need some more help to be available locally.

The technology of defibrillation, as many of your Lordships will know far better than me—I am not a medic—has advanced in spectacular ways in recent years. The development of automated external defibrillators—AEDs—represents a huge step in the right direction. AEDs allow ordinary people like me to administer defibrillation to victims of SCAs. They are fully automated and include audio and sometimes visual instructions so that defibrillation can be carried out safely and effectively.

In recent years, thanks to the hard work of charities such as the British Heart Foundation and the Community HeartBeat Trust, many AED schemes have been initiated, which have served communities to good effect. For example, the villages of Wooburn Green and Bourne End in Buckinghamshire recently set up their own AEDs to provide the communities with the ability to treat those who suffer from SCAs in the area. In my own diocese, Buntingford Cougars Youth Football Club, which provides football training in East Hertfordshire for over 200 people, recently acquired a defibrillator for its ground thanks to money given to it by the local council. Thanks to the British Heart Foundation and the Football Association, 11 Hertfordshire football clubs recently acquired their own AED units. These things are happening; it is just a question of whether we can encourage them to happen even more often. These examples show just how much awareness has increased and how the chance of survival for those who suffer SCAs has likewise increased. The tragic case of Oliver King and the almost miraculous incident involving the former Premier League footballer Fabrice Muamba just go to show how increased awareness of cardiac arrests and the need to administer defibrillation is making a difference.

That awareness, as has been pointed out, has extended far beyond sports clubs and into schools, which are providing both defibrillators and the training that has been referred to. I will give two other examples from my diocese that I know of: Bishop’s Stortford College and the Robert Bloomfield Academy in Shefford both have AED units and are able to administer defibrillation if required. Those local examples show that things are moving. Why are we not thinking about what we can do in our churches and church halls? I want to think more about that; indeed, this debate has made me think more about it. On a typical Sunday in my diocese, we have about 30,000 people in our churches and, over a week, it is probably double that number. With the church halls, many of which have lots of events, we are certainly talking in excess of 100,000 people. These sorts of debates make a number of us ask hard questions about what we can do ourselves rather than just looking to government to do things. Sometimes we just need local communities to get on with it.

I commend the work of community first responders—volunteers trained to administer basic medical assistance, including defibrillation. They carry AEDs with them and are often able to treat the victim before the emergency services have arrived. In the east of England alone there are over 2,000 community first responders, who are able to reach those who have suffered SCAs. They are, however, only able to reach about 20% of them, which is where the work of groups such as the Community HeartBeat Trust comes in. They help to fund the installation of community AED units and provide education and training so that people are able to spot the signs of an SCA and are able to use the AED units effectively. For example, the Community HeartBeat Trust has worked with the authorities in Central Bedfordshire—part of my area of responsibility—to develop plans to install units in a number of towns and villages.

For all of this work to have maximum effect, it is essential that there are good levels of communication between the emergency services, the community first responders and AED volunteers. In many cases, the emergency services alert the community first responders in the event of an SCA, who are able to respond and treat the victim if possible. That is a great example of bringing help to patients promptly, which maximises their chances of survival, rather than simply relying on bringing them to hospital. The Community HeartBeat Trust also works in collaboration with ambulance services to ensure that all parties are aware of where AEDs are located and that those AEDs are properly maintained and ready for use.

I am convinced that the growing use of AEDs should be seen as a great and positive development in tackling the relatively poor survival rate of SCAs. However, AEDs certainly should not be a replacement for the emergency services, nor are they an alternative to improving access for all to emergency medicine. They are not suitable for all types of SCA, so it is critical that calling 999 is still the first action taken upon witnessing an SCA or coming across a victim who has recently suffered one. None the less, as part of our integrated emergency care system, in the hands of trained volunteers, community-based AEDs have the potential to save many thousands of lives each year and their deployment in schools and sports clubs as well as in public places—and, yes, I hope in churches and church halls as well—ought to be encouraged and supported. I hope that we can move that forward.