Committee
Public Petitions Committee 25 November 2020
25 Nov 2020 · S5 · Public Petitions Committee
Item of business
Continued Petitions
Public Access Defibrillators (PE1707)
Dr Gareth Clegg (Resuscitation Research Group)
Watch on SPTV
Just to clarify the landscape a little bit, I am here today with three hats on. One is as an emergency medicine doctor in Edinburgh. I have worked in cardiac arrest for a couple of decades now, and during the past five years I have chaired a group to deliver Scotland’s strategy for survival of cardiac arrest. Steven Short and David McColgan are with that group, and we are trying to deliver a joined-up strategy for improving survival after cardiac arrest across the country. It is important to highlight that because the strategy is multifaceted, and public access defibrillators is only one component of it. It would be wrong to think that PADs by themselves would solve the problem of cardiac arrest, but they are an important part. In answer to the question, allow me to make two or three important points. One is that public access defibs are not as applicable in all parts of the country. Fixed public access defibs stuck on the side of a building tend to work well in areas of high population density, but they are not so good for rural populations. Where people live more spread out, public access defibs are too far apart and they do not work very well. We need other solutions for that; we need responders with defibs, and other ways of getting a defib to a patient. It is undoubtedly the case that, when defibs are used by people who have been familiarised with them, survival from cardiac arrest is hugely increased. In casinos and airports, for example, studies have shown survival of up to 70 per cent. I am sure that the committee is aware that the national average for survival, in Scotland is currently around 10 per cent. 09:45 The question is how do we deploy PADs so as to make them as effective as possible. I think that the petition’s top-down approach to encouraging defib use is to be encouraged. I say that because we have done some work on where cardiac arrests happen in Scotland. We looked at seven years’ worth of data and we know where the hotspots are for cardiac arrest. We also know where public access defibrillators are currently positioned, and David McColgan makes a good point when he says that there is a mismatch between where the defibs are and where the cardiac arrests are. Currently, about 5 per cent of all cardiac arrests happen within 100m—the working distance, if you like—of a defib. If we took all the defibrillators that are in Scotland and we spread them out using a data-driven approach to where they are most likely to be used, we would cover nearer 50 per cent of cardiac arrests. That tells me is that the current approach of a bottom-up strategy for placing defibs is not working. If we allow people to get defibs and put them wherever they want, we will not cover cardiac arrests. The general public or the philanthropists who buy them and put them on buildings do not live in the places where cardiac arrests happen. There needs to be some kind of top-down influence on that. Steven Short makes a good point that there are more cardiac arrests areas of high footfall, which tend to be in bigger buildings, but not entirely. The majority of cardiac arrests happen in homes. Cardiac arrests that are more likely to be successfully resuscitated happen in the community in non-residential areas. For that reason, encouraging the use of defibs in larger buildings will be a good thing. There is another important component to this that has not yet been aired, and that is the culture around cardiac arrest. Out-of-hospital cardiac arrest is a significant public health problem; it is not a rare event. There are about 60 to 70 cardiac arrests where resuscitation is attempted every week in Scotland, and there are probably two or three times that many calls to the ambulance service for cardiac arrest. At 60 or 70 arrests a week, they are not exceedingly rare, but survival is very low, partly because people do not call for help, they do not do bystander cardiopulmonary resuscitation, and they do not use a defib, even when one is available. There is a pressing need to change the culture around cardiac arrest and I think the visibility of defibs on and around public buildings will help to do that by making people more aware that defibs are a thing, that they should be used, and that it is the normal and right thing to do to take bystander action if someone collapses near you and they are not breathing and not conscious. We need a top-down approach, and we need to change the culture around cardiac arrest. For those reasons, I think something similar to the proposal that is on the table would be a good thing to look at. There would have to be nuance around it and there would have to be training, of course. People in buildings where the defibs are located would need to know what they are and what they are for and so on. It is not just a matter of putting the defibs out there, but I think this will be a good thing. To come to your second question on the research funded by the Scottish Government to look at public access defibs. As I say, we have taken seven years’ worth of data, we have worked with a group in the University of Toronto and international leaders who have done this kind of work, and we have prepared figures that are currently under review for publication, and which will form a report to the Scottish Government that we anticipate submitting before the end of the year.
In the same item of business
The Convener (Johann Lamont)
Lab
Good morning, and welcome to this virtual meeting of the Public Petitions Committee. The first item on our agenda today is consideration of continued petiti...
Stuart McMillan (Greenock and Inverclyde) (SNP)
SNP
Thank you very much. Good morning, everyone. The statement that I am about to read out is from Kathleen Orr. “I would just like to add to my statement that ...
The Convener
Lab
Thank you very much, Stuart. I think that we all agree that that is a very powerful statement and we appreciate just how difficult it is for the family to de...
Steven Short (Scottish Ambulance Service)
Good morning, everyone, and thank you for inviting me along today. Mrs Orr has raised a very reasonable point in the petition. Many of the cardiac arrests th...
The Convener
Lab
Who should be responsible for deciding where PADs are positioned?
Steven Short
The key about a publicly available defib, or a PAD as we call them, is that it needs to be accessible 24/7. Studies from around the world show us that if it ...
The Convener
Lab
Thank you very much. Does David McColgan want to respond?
David McColgan (British Heart Foundation Scotland)
Thank you very much for inviting us to the meeting today and a huge thank you to Kathleen and the Orr family for all the work they are doing in bringing the ...
The Convener
Lab
Thank you. In your submission, you noted that you were undertaking to gather national evidence on the subject. Has that work been completed?
David McColgan
That is Dr Clegg and Dr Clyde’s project as funded by Scottish Government at the Resuscitation Research Group. Gareth Clegg will speak to that.
The Convener
Lab
Are you not involved in that work?
David McColgan
No, the British Heart Foundation has not been involved. That is very much Dr Clegg’s territory and I will leave it to him to speak to that.
The Convener
Lab
Thanks very much. In that case, I ask Dr Clegg to respond to my first question, and to speak to where we are with the research.
Dr Gareth Clegg (Resuscitation Research Group)
Just to clarify the landscape a little bit, I am here today with three hats on. One is as an emergency medicine doctor in Edinburgh. I have worked in cardiac...
The Convener
Lab
Thank you very much, that is really helpful. In the context of defibrillators, is there a role for broader first aid training? The committee has looked at th...
Dr Clegg
I am sorry—I did not realise that the question was aimed at me. Are you asking whether we should be trying to increase first aid training generally in the co...
The Convener
Lab
I am wondering whether, from what you said, there might be a false comfort zone if we provide defibrillators but do not do the other things that you talked a...
Dr Clegg
That is an excellent point. I think, if I understand you correctly, that you are saying that it is not enough just to have the PADs out there, and that peopl...
The Convener
Lab
Thank you very much for that. I will bring in David McColgan then Steven Short for views on people having confidence to use a defibrillator.
David McColgan
I will pick up on Gareth Clegg’s point. We know from national evidence that just placing PADs around a community does not encourage people to use them. About...
The Convener
Lab
Thank you. Steven—do you want to say something about the context for your work?
Steven Short
I agree with everything that Gareth Clegg and David McColgan have said so far. The United Kingdom picture and the international picture are fairly consistent...
The Convener
Lab
Thank you. Stuart McMillan wants to come in.
Stuart McMillan
SNP
I just want to make a point regarding visibility of and access to PADs. If people see more of them in their communities, surely a knock-on effect will be tha...
The Convener
Lab
Thank you very much. That might be something that we will come back to when we hear more from our witnesses. I call Maurice Corry.
Maurice Corry (West Scotland) (Con)
Con
Good morning, panel. I thank the petitioner for lodging this very important petition. I will start with Steven Short. The petition calls for the PADs to be r...
Steven Short
We have, as David McColgan mentioned in answer to the first question, a registry of defibrillators called the Circuit. It is a collaboration between the Scot...
Maurice Corry
Con
Yes, it does. However, David McColgan said that by no means are all PADS registered, so there is a gap. I presume that that gap will be filled through Micros...
Dr Clegg
I agree with Steven Short. It is self-evident that if people do not know where a defib is they cannot use it, so defibs need to be well signposted to the peo...
Maurice Corry
Con
Are you saying that the register should include just those that are active and in 100 per cent working order?