Horses for courses - John C. Kirk
Jun. 7th, 2008
04:23 pm - Horses for courses
Today I was out on SJA duty, for Trooping the Colour. That went pretty well: there were no casualties, and it was nice weather to stand around and watch the parade go past. Some of the soldiers on horseback were playing musical instruments, and I was particularly impressed by the people playing trombones, since they had to rely on their knees to guide the horse (rather than using the reins).
There were lots of police on duty, and some of them were on horseback too. This gave me an idea: maybe there should be a mounted division of St John Ambulance. I'm not talking about carrying people to hospital, so this would be the equivalent of our cycle responders; the idea is that you get to a casualty as quickly as possible, carrying an AED and oxygen tank with you, then start treatment while you're waiting for the ambulance to arrive. Particularly in rural areas, if you had to reach someone in the middle of a field then a horse might be faster than a bike. I quite like the idea of galloping to the rescue, but my colleagues weren't entirely convinced.
Following on from that, another approach would be a hang glider squad. If you have a wide area to cover, you just need to find a suitable high point near the centre, then you can launch in the appropriate direction. Or maybe a microlight...
Quoting from the HEMS site: "London Air Ambulance's philosophy is to bring the hospital to the patient". As I understand it, they fly doctors out to accident scenes, so that they can operate in situ. (Press release of one case they covered.) However, it also takes them a little while to reach the scene; according to their FAQ, it's "usually less than 12 minutes".
By contrast, a rapid responder is there to help with the "chain of survival":
Early Access
Early CPR
Early Defibrillation
Early Advanced Care
According to the HeartStart website: "For the best chance of survival, a shock to the heart should be delivered within the first 5 minutes. The likelihood of successful resuscitation decreases by approximately 10 percent with every minute that passes. After 10 minutes without defibrillation, few attempts at resuscitation are successful." (3rd question on that page). Admittedly, they're slightly biased as an AED manufacturer, but I've also heard that statistic elsewhere.
I don't think it would be realistic to get a helicopter on site within 5 minutes, and the LAS only aim for 8 minutes with their ambulances. Also, bear in mind that the clock starts ticking when the person actually goes into cardiac arrest, so you've already lost a chunk of that 5 minutes by the time a bystander has called for help and the relevant person has been dispatched.
That's where the bikes come in, and I've seen LAS/SJA cycle response units at various big duties (e.g. Marathon, Notting Hill, Trooping the Colour, Last Night of the Prom). Community first responders are another approach, the idea being that if you live around the corner from the casualty then you can get there before the ambulance. So, I think it's reasonable to consider other ways of reaching the same goal.