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Dude, where's my AED? - John C. Kirk

Oct. 23rd, 2008

11:50 pm - Dude, where's my AED?

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Two years ago, I had some trouble at East Croydon: they put out an announcement on the tannoy asking for medical assistance, but the person on duty at the platform didn't know anything about it. I never got round to writing a letter about that, and sadly the situation hasn't improved much since then.

As part of my St John Ambulance training, I've been taught how to use an AED (Automated External Defibrillator). These are the machines that you can use to give someone an electric shock if they've gone into cardiac arrest (e.g. after a heart attack), and there are some photos on the HeartStart website. Early defibrillation is an important part of the "chain of survival": roughly speaking, someone's chances of survival drop by 10% every minute until the machine is hooked up. The good news is that there are quite a few of these machines dotted around in public places, particularly in railway stations, so if I was off-duty then I might still be able to get hold of one. However, I never noticed them until I'd done my SJA training; it's a bit like the game Civilization, where you can't detect certain mineral resources until your technology has advanced far enough. So, I'm guessing that most people walk past the AEDs without being aware of them.

If I was with an SJA colleague, and we had to deal with a casualty who wasn't breathing, one of us would start CPR while the other person went to get an AED. Typically it would be the more senior person who gets the AED (since that's a more advanced skill), but it doesn't really matter. However, if I was on my own then things get a bit more tricky; assuming that nobody else knows CPR, is it better to start that myself and send someone else to fetch the AED, or to abandon the casualty while I go dashing off? If I was completely alone, the correct answer is to go for the AED myself: as I said above, you need to start using it as soon as possible, and CPR alone isn't going to be effective. On the other hand, CPR is useful to "stall for time" while someone else fetches the equipment, if they know what to do.

So, my approach is to plan ahead. If I just ask someone to fetch an AED, they probably won't know what to do, whereas if I can give them explicit directions then they're more likely to find it. For instance, I know that there are at least three AEDs on the concourse at Victoria station, so I could point in the right direction and say "It's over there, on the wall next to Ixxy's Bagels".

At Clapham Junction, there are three locations for AEDs:
1) On the overpass, by the stairs that lead to platforms 7 and 8.
2) On the underpass, by the tunnel that leads to platforms 7 and 8.
3) On the underpass, by the ticket barriers (near platform 2).
So, the first two are central, while the third is at one end. I'm not sure whether there's one at the other end (by platform 17); if there is, it's outside the ticket barriers.

I like to keep an eye on these, and there are sometimes problems, particularly with the third one. For instance, I've noticed a ladder leant against the wall, so that it's blocking access to the AED's cabinet. That's not ideal, but it wouldn't be too hard to move it out of the way in an emergency, so I didn't say anything. A couple of weeks ago, I noticed that the cabinet was empty. There might be a good reason for that, e.g. someone might actually be using the machine, or maybe they'd done a risk assessment and decided that two AEDs were enough. Last week the cabinet was still empty, so I spoke to the members of staff near the ticket barrier and asked whether it was coming back. One of them hadn't noticed that it was missing, and the other person said that nobody knew where it was, so they were trying to find it. This week, I checked on Monday evening and it was still missing, but yesterday (Wednesday) morning it had reappeared. This is rather worrying, and it could cause a dangerous delay in an emergency situation; if I had to send someone off to fetch me a machine, I'd just tell them the nearest location rather than a list, so if they have to come back and ask me for new directions then it's an extra round trip. It also implies that I can't rely on uniformed staff to know where the machines are. I have to wonder whether anyone's checking that the pads are replaced when they go out of date...

This type of thing bothers me, but I don't have any authority to demand explanations; that would best be handled at a higher level, e.g. by the SJA district commissioner. So, I can try passing messages up the chain of command, but it will probably take a while to get any real results. In the meantime, all I can do is keep thinking about contingency plans, so that I'm prepared to deal with a worst case scenario.

So, this seems like a good time for a poll; if I'm out and about with friends, it would be useful for me to know your skills. Just to clarify, there's no "wrong answer" here, and I'm certainly not trying to criticise anyone who doesn't know first aid; my goal is to delegate where I can, without making unreasonable requests. (And sorry to anyone reading this on Facebook - the poll only works in the original LiveJournal post.)

Poll #1284147 CPR/AED

Do you know CPR?

Yes, I practice every week
1(16.7%)
I did some training years ago, but I'm pretty rusty
4(66.7%)
I've seen it on Baywatch
1(16.7%)
No, but I could shout at people not to give up
0(0.0%)

Would you recognise an AED if you saw one?

Yes, definitely
4(66.7%)
Maybe; I could probably figure it out if I saw a cabinet on the wall
2(33.3%)
No, all these gadgets blur together
0(0.0%)

At your local station (or shopping centre), do you know where the AEDs are?

Yes, I could go straight to the nearest one
1(16.7%)
I know the general area, but it might take me a couple of minutes to find one
2(33.3%)
I don't remember seeing any
3(50.0%)

Tags: ,

Comments:

[User Picture]
From:sammoore
Date:October 24th, 2008 08:09 am (UTC)
(Link)
There is a missing option on your first question. I have to have a first aid certificate to hold my professional qualifications. At the moment I have Rescue and Emergency Care 2 but I tend to vary which one I do depending on what I did last. I don't believe there are absolute opinons in first aid so I like to get a mix.

I renew my certificate every 2 years but so a Basic Life Support refresher every year. So not "every week" but hopefully not too "rusty"

I have no idea where the nearest AED is to here, athough there is a police station 5 doors down. In Llanberis I would have jsut phone one of the mountain rescue team since most of them carried them in their cars.

Sam

(Reply) (Thread)
[User Picture]
From:johnckirk
Date:October 24th, 2008 09:29 am (UTC)
(Link)
I tend to deliberately exaggerate my poll options, to avoid the situation of "Do you slightly agree, agree, or strongly agree?" In this case, I don't practice every week, although I'd say that I do it at least once a month. Putting it another way, if I asked you to do CPR on an annie right now, would you immediately know what to do, or would you have to think about it for a minute, trying to remember the ratio?
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