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Professor Nolan et al raises a topical and worthy issue.(1) The literature strongly supports evidence for the positive effects that the lay bystanders can have on cardiac arrest outcomes.
An important certitude presented was that 'defibrillation within 3-5 minutes of collapse can produce survival rates of 50-70%'.(1) Given this, we are fortunate that many London Underground stations now contain automated external defibrillators (AEDs); as of June 2015 there were 146 stations equipped, with up to 11 units at large stations such as Waterloo.(2) It makes sense that many of these units are positioned at central London stations – for here the footfall is greatest so a large number of people are within close proximity to an AED. Similarly, AEDs are becoming more common place on the high-street, with retailers such as Marks and Spencer introducing units to some of their stores.
This however raises an interesting public health inequality. With many AEDs being found in busy locations, often within close proximity to hospitals and advanced help, one must question why comparatively few of the more distant Underground stations have an AED? Moreover, we wonder how many AEDs are available to the locals in the Outer Hebrides of Scotland where it may take an hour for an ambulance to arrive? We suspect the answer would be few given that the introduction of a single AED made the local news when installed for the first time on the Isle of Scalpay in November 2014.(3)
We suggest that the interventions made possible by local training and AEDs are of critical importance in remote communities, maybe even more so than in urban areas, because the time for advanced help by ambulance crews vastly exceeds the 8-minute target set in many cities. It is exactly these remote communities which currently have poor access to potentially life-saving AEDs.
We propose that local governments and healthcare organisations should urgently improve access to AEDs in rural settings and train members of the community to help minimise the current inequality.
Out-of-hospital and Out-of-range
Response / E-Letter
In response to: http://www.bmj.com/content/351/bmj.h4989
Authors: A. C. Turnbull & A. J. Turnbull
Out-of-hospital and Out-of-range
Professor Nolan et al raises a topical and worthy issue.(1) The literature strongly supports evidence for the positive effects that the lay bystanders can have on cardiac arrest outcomes.
An important certitude presented was that 'defibrillation within 3-5 minutes of collapse can produce survival rates of 50-70%'.(1) Given this, we are fortunate that many London Underground stations now contain automated external defibrillators (AEDs); as of June 2015 there were 146 stations equipped, with up to 11 units at large stations such as Waterloo.(2) It makes sense that many of these units are positioned at central London stations – for here the footfall is greatest so a large number of people are within close proximity to an AED. Similarly, AEDs are becoming more common place on the high-street, with retailers such as Marks and Spencer introducing units to some of their stores.
This however raises an interesting public health inequality. With many AEDs being found in busy locations, often within close proximity to hospitals and advanced help, one must question why comparatively few of the more distant Underground stations have an AED? Moreover, we wonder how many AEDs are available to the locals in the Outer Hebrides of Scotland where it may take an hour for an ambulance to arrive? We suspect the answer would be few given that the introduction of a single AED made the local news when installed for the first time on the Isle of Scalpay in November 2014.(3)
We suggest that the interventions made possible by local training and AEDs are of critical importance in remote communities, maybe even more so than in urban areas, because the time for advanced help by ambulance crews vastly exceeds the 8-minute target set in many cities. It is exactly these remote communities which currently have poor access to potentially life-saving AEDs.
We propose that local governments and healthcare organisations should urgently improve access to AEDs in rural settings and train members of the community to help minimise the current inequality.
References:
1. http://www.bmj.com/content/351/bmj.h4989
2. https://www.whatdotheyknow.com/request/number_of_public_access_defibril
3. http://www.hebrides-news.com/defibrillator-installed-in-scalpay-181114.html
Competing interests: No competing interests