Devices that shock heart rhythm back to normal were not available 25 percent of time in emergencies
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New research presented at this year's Euroanaesthesia shows that use of public access defibrillation on people suffering cardiac arrest is associated with a large increase in chances of survival. However, despite the great potential, publicly accessible Automated External Defibrillators (AEDs) are not being used enough, concludes research by Dr Marianne Agerskov and colleagues at Rigshospitalet, University of Copenhagen, Denmark.
EVERY high school in the Capital will be equipped with a life-saving defibrillator to ensure that thousands of teenagers never suffer the terrible fate of teenage footballer Jamie Skinner.
City chiefs have teamed up with the Scottish Ambulance Service to spend more than £34,000 on the vital devices for all 23 secondary schools in Edinburgh, following months of campaigning by the Skinner family and the Evening News.
The move has been hailed as a “great legacy” for super-fit Jamie, who suffered a fatal cardiac arrest while making his debut for Tynecastle FC at Saughton in December 2013.
His heartbroken family has fought tirelessly for better defibrillator provision, teaming up with the News to launch the Shockingly Easy campaign in July to ensure the heart-start machines are installed in every sports club in the Lothians.
Residents from the Fulford and district area attended free, two hour Heart Start & Defibrillator awareness courses on Sunday 29th June 2014.
They learnt vital lifesaving skills, which could help keep a person alive until medical help arrives.
The course was provided by Mike Taylor (of Abacus Training), David Thomas and Mel Avis, who are all volunteer responders with the Fulford & District Community First Responder charity. ‘Heart Start’ is a national scheme that is being supported by the West Midlands Ambulance Service across Staffordshire, in association with the British Heart Foundation.
Mel Avis explained,
Participants attending Fulford & District Heart Start and Defibrillator Awareness workshop on Sunday 29th June 2014, outside the village hall, with Heart Start trainer, Mike Taylor.
Acting quickly when someone is in cardiac arrest is crucially important. Early CPR and Early Defibrillation significantly increase a person’s chance of survival. People should not be afraid to learn how to use a cPAD. They are designed specifically for use in community settings and provide a series of voice prompts and illuminated illustrations to guide the rescuer.
says Mike Taylor (of Abacus Training).
says participant, Sarah Cox
says participant, Jacqui Leach
For more information about First Aid courses or the Heart Start scheme, please contact: Mike@fulfordanddistrictcfr.co.uk or visit www.abacustraining.co.uk
Special thanks to:
About Fulford & District Community First Responders:
Fulford & District CFRs can be followed on Facebook and Twitter @FulfordCFR
ALL new schools are to be equipped with life-saving defibrillators to cut the number of child heart deaths.
ALL new schools are to be equipped with life-saving defibrillators to cut the number of child heart deaths.By: Marco GiannangeliPublished: Sun, March 9, 2014
Defibrillators will be supplied to schools to cut down child heart attack deaths [GETTY]
The move, supported by Education Secretary Michael Gove, will be announced in Chancellor George Osborne’s Budget later this month.
More than 270 pupils die after suffering heart attacks at school every year but, according to charity Sads, only 80 of 30,000 schools have automated external defibrillators, which cost £1,500.
Sick youngsters given an electric shock to the heart with the life-saving devices are 50 per cent more likely to survive a coronary than those who have to wait for an ambulance. The odds in rural areas are 75 per cent.
The initiative is being spearheaded by Conservative MP Andrew Percy, a trained first responder who has helped raise funds to buy defibrillators for six schools in his Brigg and Goole constituency. It is backed by the British Heart Foundation, Red Cross, St John Ambulance and Oliver King Foundation.
Mr Percy told the Sunday Express: “It is a national scandal that children are dying unnecessarily in this country because there are not enough public access defibrillators. A relatively small one-off investment could have a lasting legacy, which is why for me it is a complete no-brainer.”Related articlesBoy’s school shooting Tweet was spotted by Dunblane victim’s fatherHigh School of Dundee pupil was not bullied into suicide say parentsIslamic boys' school bars women from applying for job as science teacher
Oliver King was just 12 when he died of a cardiac arrest while taking part in a school swimming race in 2011.
A year after Oliver’s death his family set up the Oliver King Foundation, which wants to see defibrillators installed in all schools, sports centres and other public buildings.
Oliver’s father, Mark, said: “We are losing children who are fit and healthy every week to cardiac arrests.
“When my own son died we waited more than 20 minutes for the ambulance to arrive and it was a seven-minute journey to hospital. I know that had there been a defibrillator on site, he would be here today.
“My question to the Government is why is there a postcode lottery with children’s lives with there being defibrillators at some schools and not others?”
Seattleites can join in a life-saving scavenger hunt. Players will compete to identify and report the locations of Seattle’s automatic external defibrillators, or AEDs, for a cash reward. Prizes range from $50 to $10,000.
AEDs are electronic briefcase-size devices designed to allow bystanders on scene at a medical emergency to help someone who has collapsed with loss of mechanical activity of the heart, or cardiac arrest.
“Our list of AED locations may be incomplete. We are seeking the public’s help to learn where more of these devices are,” said Dr. Graham Nichol, University of Washington professor of medicine in the Center for Pre-Hospital Emergency Care at UW Medicine’s Harborview Medical Center.
AEDs are cost-effective lifesavers that are often placed where cardiac arrests are most likely, such as airports, sports clubs and shopping malls, according to Nichol, who explained why it is important for a bystander to be able to locate an AED immediately.
“Cardiac arrests are a leading cause of death in the United States but can be treated if recognized and responded to quickly with an AED.”
Often cardiac arrest is due to ventricular fibrillation, in which the lower chambers of the heart quiver instead of contracting in a steady beat. AEDs simplify analysis of the heart rhythm. This enables lay people to recognize and treat ventricular fibrillation before emergency medical services providers arrive. Each device has voice and visual prompts that guide bystanders through the necessary steps.
More than 1.2 million AEDs are now in public places in the United States, and about 180,000 more are installed each year. Sometimes bystanders cannot find the nearest AED during a medical emergency. That’s where the My HeartMap Seattle challenge comes in. Game players will assist UW clinicians by reporting the location of AEDs in community settings throughout Seattle.
Here are the basic rules of the game.The contest starts Tuesday, Oct.15, and ends Friday, Nov. 15. Complete your free registration to participate in the contest. When you locate an AED in Seattle, report a brief description of it on the contest website, including the building address for the AED, its location within the building, and whether the device appears to be ready for use. A $10,000 grand prize will be awarded to the individual or team that identifies the most unique AEDs. “Unique” means no other player or team has already found the AED. The grand prize will be “unlocked” when at least one individual or team identifies 500 AEDs or all contest participants collectively identify 750 AEDs. Twenty $50 prizes are also available. Twenty AEDs in the city of Seattle have been pre-selected by the research team as “Golden AEDs.” These are unmarked, and those who are first to report a “Golden AED” will win $50. You can follow MyHeartMap Seattle on twitter (@cprnation, #MyHeartMapSeattle) or at the CPR Nation website.
The AED scavenger hunt aims to build public awareness about AEDs, which are commonly contained in a clear glass wall box, sometimes near a fire extinguisher. The spot is generally marked with a symbol of an electrical charge passing through a heart shape.
The contest is modeled after a similar Philadelphia County project at the University of Pennsylvania, which in turn adapted an approach from the Defense Advanced Research Projects Agency for its Red Balloon Challenge. Dr. Raina Merchant, University of Pennsylvania assistant professor of emergency medicine, directed the My HeartMap Philadelphia Challenge. She is the director of the Penn Medicine Social Media Lab and an expert in the use of digital strategies to educate the public on at-the-scene emergency aid. Merchant is collaborating with UW scientists on the My HeartMap Seattle Challenge.
“This is an exciting collaboration that could have a real impact on access to emergency care in Seattle and other regions throughout the country,” noted Merchant.
During the MyHeartMap Philadelphia challenge, participants submitted data about AED locations via a website and a phone app. Some 313 individuals and teams reported more than 1,400 AEDs. Prizes were given for reporting the most AEDs found or for being the first to report the location of specific previously selected devices.
“Most people realize that AEDs are simple enough to use,” Nichol said. “Just follow the voice and visual prompts. They are designed to provide a shock only when needed.”
An AED is usually activated by opening its lid. The commands then begin with visual, recorded and text instructions for baring the patient’s chest and sticking on the pads. Then the machine asks everyone to step back while it analyzes the heart rhythm. It repeats the request to stand clear if it decides to administer a shock. If the rhythm suddenly normalizes before a shock is delivered, the machine will report a rhythm change and announce that no shock will occur.
Most machines also instruct in CPR and coach the timing of compressions and breaths.
“My HeartMap Seattle will help us improve care for patient with out of hospital cardiac arrest,” Nichol said. “The methods and results of this AED scavenger hunt in Seattle will be applied to scavenger hunts in other large cities throughout the United States. In the future, we will have a comprehensive record of AED locations throughout the country.”
My HeartMap Seattle is funded by the U.S. Food and Drug Administration, Zoll Medical Inc., Philips Healthcare Inc., Physio-Control Inc., HeartSine Technologies Inc. and Cardiac Science Inc.
The collaborating sponsors include the American Heart Association, Medic One Foundation, Nick of Time Foundation, University of Pennsylvania and University of Washington.
Portable, heart-shocking defibrillators are not fail-safe.
Like any machine, automated external defibrillators, or AEDs, need to be maintained. Batteries run down and need to be replaced.
Electrode pads that attach to a patient’s chest also deteriorate and have to be replaced every year or so. Circuitry can fail. And maintenance can be spotty.
SHNS photo courtesy American Red Cross Universal symbol and sign for an AED — a heart with a lightning bolt in the middle.
The U.S. Food and Drug Administration has received more than 45,000 reports of “adverse events” associated with failure of AEDs between 2005 and 2012, although only some of the events involved the fully automated devices put in public areas. The others were defibrillators limited to medical use. Manufacturers also conducted more than 80 recalls during the seven-year period.
The number of AEDs sold in the U.S. has been rising steadily, from around 100,000 a year in 2010 to between 500,000 and 1 million this year, according to the Sudden Cardiac Arrest Foundation and industry officials. There are about 2.5 million deployed.
“Survival from cardiac arrest depends on the reliable operation of AEDs,’’ said Dr. Lawrence DeLuca, a professor of emergency medicine at the University of Arizona in Tucson.
He led a 2011 review of more than 40,000 AED malfunctions reported to the FDA between 1993 and 2008. The analysis found that 1,150 deaths occurred during those failures.
No one knows exactly how often someone attempts to use an AED, but with an average survival rate of 2 percent to 4 percent from sudden cardiac arrest outside a hospital, according to studies, the devices help save roughly 3,500 to 7,000 lives each year, although not all of the rescues are performed by untrained bystanders. If AEDs were more widely available, the number of saved lives could triple or more, experts say.
“AEDs can truly be lifesavers, but only if they are in good working order and people are willing to use them,’’ said DeLuca, who had a personal experience with batteries failing on a device when he was trying to revive a fellow guest at a resort in 2008.
It took nine minutes to retrieve a second AED, which did work. The patient was not revived.
Problems with pads, cables and batteries accounted for nearly half the failures — mistakes that could have been due to poor maintenance. Forty-five percent of failures linked to fatalities occurred when the device was attempting to charge (power up) and deliver a recommended shock to someone in cardiac arrest, DeLuca said.
But there also were incidents reported to the FDA when the devices shut down without analyzing a patient’s heart rhythm.
Regulators and watchdogs believe some victims were not revived when the machines failed, but it’s difficult to say whether any particular patient would have had heartbeat restored.
The FDA said the most common malfunction reports involved design flaws and manufacturing of the devices using poor-quality parts such as capacitors and software.
AED failures have raised enough concern that the FDA is ending the medium-risk status that AEDs have had since they first became widespread more than 20 years ago.
Now, they’ll be classified high-risk equipment that reflects their use to support and sustain human life — and their greatly increased sophistication over the years. Manufacturers will have to provide more safety evidence and FDA inspectors will be allowed to inspect plants where parts are made.
The tighter rules don’t mean the public should lack confidence in the lifesaving devices. Dr. William Meisel, the FDA’s chief scientist for devices, stressed the essential role AEDs play when he announced the new rules in March.
“These devices are critically important and serve a very important public-health need,” Meisel said, noting that none were being taken out of service beyond the recalls manufacturers have already issued. “Patients and the public should have confidence in these devices and we encourage people to use them under the appropriate circumstances.”
Google Glass has made its way into healthcare. Its use in the operating room and in medical education has been profiled here. Yet the magic of Glass will be found in the applications that can make this “technology” into real-world solutions for health and medicine. It’s a bit like the smart phone and how its realization is a function of the countless apps that bring the device to life.Inside The Operating Room
Christian Assad, MD has taken the next step with Glass and developing a practical app that can turn Glass into a real life-saver. He recently profiles this application on his blog and I believe it’s an important turn of events that showcase just how technology can be applied to medicine and public health issues. Here’s how it presents the concept in his blog–Google Glass and augmented CPR:
Dr. Assad combines science, technology and popular culture to create a platform that is as simple as it is important. From the scientific underpinning to the driving musical beat, he’s part of a generation of clinicians ushering in digital health and the interesting and evolving role of Google Glass.
A DEFIBRILLATOR has been installed in a rural red call box after locals bought the kiosk from BT for a pound.
AN old phone box has been transformed into a potential lifesaver after being purchased by villagers for £1.
A defibrillator, which gives the heart an electric shock in some cases of cardiac arrest, has been installed in the red call box.
And as the nearest accident and emergency department is 20 minutes' drive away, the machine could mean the difference between life and death.
The call box in Arnprior, Stirlingshire, was bought by the community from British Telecom under the company’s Adopt a Kiosk scheme.
Funding for the defibrillator came from various organisations, including Stirling Council and the Sandpiper Trust, who aim to provide Scotland’s rural doctors and nurses with emergency medical equipment.
A BT spokesman said: “We’re very pleased to hear that the villagers of Arnprior have found a new lease of life for one of our old, rarely used boxes.
“Over the years, many people have described their local phone box as a lifeline. Now that everyone has a phone at home or a mobile, that’s no longer true.
“But kiosks fitted with defibrillator machines could be real life savers for the community in the future.”
The Scottish Ambulance Service and the Community Heartbeat Trust, a charity dedicated to the provision of defibrillation services to local communities, gave their help to the project.
Backing also came from the community council and Stirling Council’s Community Pride fund. Villagers were given advice and training on how to use the defribillator.
And children from the local primary school will be on hand to help open the lifesaving installation on Monday.
A spokesman for the Sandpiper Trust said they were delighted to have been involved in the Arnprior project.
He said: “It has become increasingly clear over the past decade since the trust was set up that working together with all these organisations is what saves lives.
“We are also pleased that the children of Arnprior School have been involved in this project.”
More than 100 traditional red kiosks in Scotland have been adopted by their local communities for £1.
Arnprior is the second community in Scotland to have a defibrillator fitted in their call box.
Glendaruel Village, Argyll, was the first in 2011.
Visitors and employees at the Houses of Parliament can now be assured of receiving the very best in service from the first aid team, following the installation of 16 new defibrillators.
Part funded by the British Heart Foundation, defibrillators are machines that can deliver a shock to restart a patient’s heart should they suffer a cardiac arrest – when the heart stops pumping blood around the body.
The newly qualified six-strong HeartStart training team and the current first aid team at the Houses of Parliament will now be on hand to deliver this lifesaving care 24 hours a day.
London Ambulance Service is responsible for over 800 public-access defibrillators around the capital, placed in tourist attractions, transport hubs, shopping centres and sports facilities.
Last year the scheme helped to save 11 patients who had suffered a cardiac arrest to be discharged from hospital. Overall in London, almost a third of patients suffering cardiac arrest survived in 2011/12 – the highest in the country.
The study centres around a class of 25 school children from Vienna's 16th district. In first grade, the children were given a professional first aid lesson as part of a project organised by Thomas Uray from the University Department of Emergency Medicine which involved practical exercises, video clips and questionnaires. After it, 47.8 per cent of the children were able to execute an emergency call perfectly, 56.6 per cent were able to operate the defibrillator correctly and 28.6 per cent were able to perform chest compressions appropriately. The class has now undergone further training and testing in fourth grade by a team led by Katrin Steiner from the MedUni Vienna. "The children were able to remember the practical, hands-on actions very well and tackled the problems in a very motivated way without any inhibitions. Only the theory side of things had slipped a little in their memories," explains Steiner. Three years later, 100 per cent of the children were able to operate the defibrillator correctly after a refresher course, 95 per cent made the emergency call clearly and understandably, while 72.2 per cent were able to perform chest compressions correctly. Parents learn from their children "The results clearly speak in favour of first aid training at primary school," says Steiner. In Austria, this training is not currently on the curriculum - unlike countries such as Canada, the Czech Republic or Norway, for example. Just two to three hours of training per academic year are enough to perfectly prepare children for these types of emergency. The added bonus is that "parents learn from their children and benefit from their lower inhibitory threshold for providing first aid," says Steiner. First aid courses for children are currently provided by the Austrian Red Cross Youth, the Samaritans and as part of the Children's University programme at the MedUni, which is held every year during the summer holidays. One third can be saved A recent study by the MedUni Vienna has shown that someone who is given cardiac massage by a first aider straight after a cardiac arrest has a 70% higher chance of survival. "Unfortunately, there is often no first aider on hand, or people are afraid of doing something wrong during resuscitation. Chest compressions never do any harm, unlike doing nothing," says Fritz Sterz from the University Department of Emergency Medicine at the MedUni Vienna. In Vienna alone, around 3,000 people die every year from cardiac arrest.
A VIDEO reconstructing how a man was saved by a heart-starting defibrillator will be used to encourage more organisations to install the life-saving machines.
Debra Chaffin, 59, was at risk for a sudden cardiac arrest, but fortunately she had the protection of a wearable defibrillator, a white undergarment that she credits with saving her life.
Schools Minister David Laws backs Mail on Sunday campaign to introduce vital CPR lessons in schools
Lib Dem MP Sir Bob Russell, chairman of the all-party parliamentary group on first aid, said he hoped the other two main parties would also add the proposals to their pre-Election manifestos.
THE heroic actions of a quick thinking woman from Alcester and her friend saved a cyclist's life when he collapsed on a country road.
The man was cycling along Fish Hill near the Cotswold village of Broadway last March when he collapsed.
Fortunately he was spotted on the side of the road by Gemma Guedes, 30, from Alcester, and her friend Katie Nightingale, who were only travelling down the road by chance after taking a wrong turn on their way to take Gemma's pet puppy for a walk.
The pair spotted the man receiving CPR from a fellow cyclist and immediately remembered that there were defibrillators kept at the nearby Farncombe Estate, where they both used to work.
"It was very worrying to see someone receiving CPR as it was the first time that I have ever been in that situation," said Mrs Guedes. "We were just very lucky that Farncombe Estate was so close and that they have trained people to use the defibrillator."
The friends called ahead and were met by security supervisor Tony Haines, of Pensham, near Pershore, who had grabbed a defibrillator.
They dashed back to the stricken man with Mr Haines - an experienced St John Ambulance volunteer - in tow and used the defibrillator to re-start his heart.
He was then rushed to Worcestershire Royal Hospital, where grateful medics confirmed the cyclist would not have survived without the defibrillator and their quick-thinking actions.
"When we arrived the man was starting to turn blue around the lips - Tony gave him a single shock and his heart re-started. After a few minutes the man started talking, which was a huge relief to everyone.
"We waited for the Air Ambulance to arrive and once the man was airlifted to the hospital you could feel that everyone felt a great sense of achievement," added Mrs Guedes.
Mr Haines said he was glad the estate had the vital life-saving equipment . Both he and St John Ambulance are now urging more places, especially in isolated rural locations, to get equipment of their own.
Mr Haines said: “We gave the man a single shock and his heart restarted. Within a few minutes he was talking, it was amazing.
“This incident just goes to show what a difference a defibrillator can make and I would urge as many organisations as possible to have one on hand in case of emergency.”
The FINANCIAL -- Each year, approximately 300,000 people suffer out-of-hospital sudden cardiac arrests (SCA) that require revival from an automated external defibrillator (AED). Although many workplaces have AEDs on site, it’s likely that a majority of workers would not be prepared to locate and use the units, according to the results of a survey commissioned by Cintas Corporation, one of the leaders in first-aid and safety programs.
The survey, conducted online by Harris Interactive among 2,019 adults ages 18 and older (of whom 916 are employed), found that 79 percent of employed adults do not know where their workplace’s AED is located.
Less than 1 in 5 (17 percent) feel confident that they could reach the nearest AED in their workplace and return to the victim quicklyEighty-six percent would not feel comfortable using the AED during an emergency such as cardiac arrestEighty-eight percent have not received training on the proper use of the workplace AED
Mike Taylor's insight:
An article from the US, but I can't see the UK being much different.
People who suffer a cardiac arrest in Denmark today are three times more likely to survive than a decade ago, thanks largely to a national effort to teach people CPR, a new study says.
Denmark launched a national effort in 2005 to teach its residents to perform CPR, or cardiopulmonary resuscitation, in order to save people who suffer a cardiac arrest outside a hospital. The country gave out 150,000 instructional kits; kids began learning CPR as early as elementary school. Teens were required to learn CPR in order to get a driver’s license.
The results have been dramatic, say authors of a study in today’s Journal of the American Medical Association, or JAMA. About 300,000 people in North America each year suffer a cardiac arrest, when the heart stops beating, outside of a hospital.
In Denmark, the number of cardiac arrest victims who received “bystander” CPR — from someone other than a health professional — more than doubled, from 22% in 2001 to 45% in 2010.
In the same time period, the percentage of cardiac arrest victims who arrived at a hospital alive increased from 8% to 22%.
The percentage of patients alive after 30 days tripled, growing from 3.5% to 11%. The percentage of patients alive after one year also more than tripled, from 3% in 2001 to 10% in 2010.
Those findings are impressive, says Michael Sayre, a professor of emergency medicine at the University of Washington and a spokesman for the American Heart Association.
Although other studies have looked at smaller, community efforts to promote CPR, Sayre says the new study is striking because it involved an entire country.
Thanks to efforts by the heart association, Washington and a handful of other states now require students to take a CPR class before graduating from high school, Sayre says.
Still, study authors say that Denmark’s CPR initiative can’t take all of the credit for improving survival.
That’s because Denmark also made other important changes aimed at increasing survival after a heart attack, such as improving the care provided both by hospitals and emergency medical services.
“Teaching bystanders the importance of CPR can make a difference,” says Suzanne Steinbaum, director of the program on women and heart disease Lenox Hill Hospital’s Heart and Vascular Institute, in New York.
Performing CPR is actually easier than ever, Steinbaum says. That’s because the heart association now recommends a “hands-only” CPR procedure, in which bystanders concentrate on performing chest compressions, instead of alternating compressions with mouth-to-mouth breathing.
“Those who witness a cardiac arrest and start CPR can actually change the outcome of what happens to the victim,” she says.
Dr Aseem Malhotra, from Manchester, a cardiology specialist registrar at the Royal Free Hospital in London, says the machines could save thousands of lives.Former footballer Fabrice Muamba’s life was saved as medics used a defibrillator when he suffered a heart attack on the pitch
A cardiologist has called for defibrillators to be placed in all public buildings in a bid to improve the low survival rates for heart attack victims.
About 60,000 heart attacks happen outside of hospitals in Britain each year – but the survival rate is between just two per cent and 12pc.
Dr Aseem Malhotra, from Manchester , a cardiology specialist registrar at the Royal Free Hospital in London, says the machines could save thousands of lives.
The former Manchester Grammar pupil said: “There should be defibrillators in all public buildings. They should be there like you have fire extinguishers.
“We know that, with defibrillation, the chances of survival increase to 75 pc. They are simple, computerised, tell you what to do, and it analyses the heart rhythm for you, shocking patients out of the abnormal rhythm.”
Dr Aseem and colleague Roby Rakhit, consultant cardiologist and clinical director at the hospital, have written an article in the British Medical Journal which says scientific evidence to support early defibrillation is overwhelming.Dr Aseem Malhotra
They say lessons can also be learned from Seattle in the US, which has the world’s highest rate of survival for cardiac arrests. Children in Seattle are taught CPR in schools.
They say there should be more CPR training in Britain and steps should also be taken to ensure that patients are sent to the right hospitals where they can be treated by specialist cardiologists.
The call for more machines also comes after the Bolton Wanderers footballer Fabrice Muamba nearly died during a match but was saved thanks to prompt treatment and the use of a defibrillator.
Surveys have revealed that only one in 13 people in Britain feel confident enough to carry out emergency first aid.
Campaigners including leading doctors, health experts and MPs have written to the prime minister asking him to consider changing the law to make the life-saving machines compulsory in every community.
Sudden Cardiac Arrest (SCA) is a life-threatening condition that must be treated within minutes if the victim is to survive. The only therapy which can treat the life-threatening arrhythmia that occur during SCA is defibrillation; the earlier the better. Various studies have determined that for every minute defibrillation is delayed survival falls rapidly. In one study it was determined that this fall in survival was around 7 to 10% while the British Heart Foundation (BHF) have concluded that the fall in survival percentage is 14%.