Keeping more WA hearts beating

Opportunity

Cardiac arrest has a variety of cardiac and non-cardiac causes which result in the heart function stopping and consequently halting blood flow through the cardiovascular system [1].

Research shows that in Australia, only one out of 12 people will survive an out of hospital cardiac arrest, and the chances of survival decrease by 10 percent each minute that goes by without interventions to maintain blood flow to the brain and restart the heart [2].

Bystander CPR performed within the first seven minutes following a cardiac arrest is thought to be crucial in determining patient outcomes [3]. Increasing community access to CPR training and providing defibrillators for immediate treatment of cardiac arrest greatly improves the chance of patient survival.

Approach

The Heart Grant Program provides AEDs to not-for-profit sporting or community groups around the State for $249 (12.5 percent of the retail price of $2,000). A condition of the grant was that the AED be placed in an area where it is available to the public in an emergency 24/7.

Along with the AED, grant recipients were also provided with a St John safe assessment to evaluate their preparedness to provide rapid and effective first aid when needed. This included understanding the first aid training skill level in the group, the equipment on hand, readiness, facility set up, and the effectiveness and integration of emergency action plans. St John then created a bespoke first aid training and services package to prepare the organisation for a medical emergency with the organisation receiving a $300 voucher towards the cost of a recommended first aid training program.

Impacts and outcomes

The program was able to roll out AEDs to 1001 not-for-profit organisations around the state with 40% of the devices going to regional areas and 1,000 assessments conducted.

Thirteen Aboriginal organisations received a $249 co-contribution subsidy provided by St John, enabling them to participate in the initiative free of charge.

By the end of 2021, St John documented six cases of cardiac arrest where the use of the grant funded AEDs resulted in positive outcomes. One example was a 60-year-old man who collapsed while playing hockey at a coastal recreation centre. He was unresponsive, with a loss of consciousness and breathing but after receiving care at the scene, including an electric pulse from the nearby defibrillator, he was taken to Sir Charles Gairdner Hospital where he recovered due to the quick responses from bystanders.

What worked

Combining equipment and training
An important component of the initiative was to build organisational capacity both through improved access to equipment as well as access to training in first aid delivery. Participants in the grant initiative told St John that the training had given them increased confidence to respond appropriately in the event of a first aid emergency.

Multiplying the impact
The design of the program ensures that the benefit of the defibrillators is felt beyond the grant partner’s organisation. AEDs rolled out under the program form part of the St John Community First Responder System. This means that when someone calls 000 to request an ambulance for a cardiac arrest, an ambulance is dispatched, then a first responder can be directed to the incident or the caller can be notified of a nearby AED and given access to the lockbox containing the defibrillator. The network has increased to 7,000 locations around the State following the implementation of this grant.

Key challenges

Logistical issues with supply and delivery
Initial logistical difficulties were experienced due to the volume of demand and under-resourcing of the supply, delivery and installation of the AEDs. A questionnaire was designed to better manage customer interactions and clear instructions provided to enable the customer to carry out a self-assessment based on their first aid capability. Staff were also trained to provide guidance over the phone.

Targeted geographical roll-out
St John determined that a staggered roll out of the program by geographical area might have enabled these issues to be resolved earlier and with greater customer satisfaction. This would also have enabled a more location-based, rather than state-wide, marketing campaign.

REFERENCES

1. Myat, A., Song, K.-J., & Rea, T. (2018). Out-of-hospital cardiac arrest: current concepts. The Lancet (British edition), 391(10124), 970-979. https://doi.org/10.1016/S0140-6736(18)30472-0
   
   
2. Naccarella, L., Saxton, D., Lugg, E., & Marley, J. (2021). It takes a community to save a life in cardiac arrest: Heart safe community pilots, Australia. Health Promotion Journal of Australia. https://doi.org/https://doi.org/10.1002/hpja.482
   
   
3. Breckwoldt, J., Schloesser, S., & Arntz, H.-R. (2009). Perceptions of collapse and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA). Resuscitation, 80(10), 1108-1113. https://doi.org/10.1016/j.resuscitation.2009.06.028