Monday, May 09, 2011

A CASE FOR AED ( Automatic External Defibrillator ) IN PUBLIC PLACES

A recent paper presented at the just concluded Annual Scientific session of the Heart Rhythm Society 2011, at San Francisco, brings up an important need in our country.
Dr Richard Page's paper is entitled "Sudden cardiac arrest at exercise facilities: survival and implication for AED placement". He is now in University of Wisconsin, but the study is a 12 year study ( 1996-2008), on survivors following sudden cardiac arrest at dance halls and fitness centers. This study was carried out in Seattle ( a city famous for her ability to perform CPR by laypersons. It is often quoted that in Seattle and Miami, 1:4 laypersons in the street can perform CPR. The study was carried out in Kings and Seattle county. The numbers are interesting. There were 960 episodes of reported sudden cardiac arrest during 1996-2008, making about 80 episodes a year, or 6-7 cases a month ( on the average ). The dance and fitness centers were divided into traditional facilities ( I gather that these are the ones where we do Tai-Chi, and Qi Kong etc, and the licensed exercise facilities like the dance halls and gymnasiums. The study found that in the registered facilities, the survival rate was 50%, while in the traditional facilities, the survival rate was 36% ( not bad. Even in our hospitals, the immediate survival rate is about 10-20% and the survival rate upon discharge is only about 1-2% ).
What is also interesting is that, of the sudden cardiac arrest, 16% occurred in the basketball courts, 9% during ballroom dancing, 5% at tennis, 4% at bowling, and 4% at swimming. Interesting. I always thought that bowling and dancing requires little physical exertion.
Anyway. looks like in Seattle, all the exercise facilities have AEDs and the people there know the basics of CPR and use of the AEDs.
This is what our government needs to consider. An AED in Malaysia, cost about RM15K. They are many companies selling them. I have one in my clinic. We ( the Federation of Private Medical Practitioners of Malaysia ) has been carrying out CPR course across the country teaching laypeople who would turn up. This is carried out with the help of the St John's Ambulance. The government should consider carrying out such a campaign, and also bring about legislation that would require public facilities to have AEDs in working condition available. Of course, with AEDs comes the responsibility of how to use them, and also a " Good Samaritans Act" to protect people who try to help, so that they will not end up being sued for trying, should the resuscitation fail ( as is likely ).

I suppose this is what a developed country is all about. For 1:4 of our population, to be able to carry out CPR, and to have 50% of our sudden cardiac collapses resuscitated, to reach a medical facility alive.
I wonder if this will appear in any of our Ministry of Health KPIs?

1 comment:

Alexander Yellen said...

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