Bystander Cardiac Pulmonary Resus

LTP Priority: Prevention

Population Intervention Triangle:Segments (link to Section 1 PHE PBA): Service

Type of Interventions: CVD – out-of-hospital cardiac arrest (OHCA)

Major driver of health inequalities in your area of work

CVD is one of the conditions most strongly associated with health inequalities. If you live in England’s most deprived areas, you are almost four times as likely to die prematurely than those in the least deprived. CVD is also more common where a person is male, older, has a severe mental illness, or ethnicity is South Asian or African Caribbean. Those in the most deprived communities are 30% more likely to have high BP, the biggest single known risk factor for heart attack and stroke.

Target groups

Deprivation, Inclusion health groups and protected groups

Intervention

Commissioners should be directing providers to provide good quality data on OHCA incidence and bystander cardiac pulmonary resuscitation (BCPR) through the out-of-hospital cardiac arrest outcome registry to support national and local analysis.

Commissioners should analyse their local data to identify any high-risk areas that experience a high OHCA incidence and low BCPR. Once identified locally, those high-risk areas should be targeted for programmes of training in CPR, and automated external defibrillator (AED) use.

Commissioners should also support provider’s clinical staff locally to become first responders utilising online platforms such as GoodSam.

Both interventions will support the improvement in the OHCA to hospital discharge survival rates

Evidence

Data from the Out-of-Hospital Cardiac Arrest (OHCA) Outcomes (OHCAO) project for 2014 indicate that bystander cardiopulmonary resuscitation (BCPR) is undertaken, on average, in only 40% of OHCA in England. A low BCPR rate may, in part, explain why survival to hospital discharge (SHD) from OHCA in England is also low, 7.9%, as BCPR, a resuscitation attempt performed by a layperson who is not part of the organized emergency response system, more than doubles the chances of survival from an OHCA.

Information collected by the Department of Health has shown large differences in the number of people that survive an OHCA depending on where they live. In simple terms people in some parts of the country are twice or three times more likely to survive than in other areas.

Recent research identified several high-risk Post Code Districts in England where there was a high incidence of OHCA and a low rate of BCPR in bystander-witnessed OHCAs. These areas were characterized by a greater residential population density and lower workday population density; increased urbanization; a greater proportion of people working in intermediate and routine occupations, and lower proportion in managerial occupations; greater proportion of mixed and non-white ethnic groups, and lower percentage of white ethnicity; lower proportion with high educational qualifications; and a greater level of deprivation (lower IMD).

The GoodSam website explains that “operating internationally, GoodSAM (Smartphone Activated Medics) incorporates the world’s most advanced emergency alerting and dispatching platform with a community of over 40,000 highly governed trained and trusted responders. The GoodSAM Cardiac system integrates with ambulance service CAD (computer aided dispatch) systems to trigger bystander response while the ambulance service is on route. GoodSAMPro provides a Community First Responder (CFR) dispatch system dispatching advanced care beyond cardiac arrest. Now with “Instant-On-Scene” – the emergency services can see the scene/patient via a video link. The system is now used by police, fire and other services for a host of emergency situations.”