Improving Cardiac Arrest Survival Rates

Scotland’s poor survival rates from out-of-hospital cardiac arrest could be dramatically improved by a new law requiring defibrillators to be registered with the ambulance service.

Proposals for a Member’s Bill have today been unveiled by Anas Sarwar that would transform the survival chances for people suffering out-of-hospital cardiac arrests.

The AED Registration Bill aims to introduce a legal requirement for all public Automated External Defibrillators (AEDs) to be registered with the Scottish Ambulance Service.

This would allow 999 call handlers to identify the nearest public AED and direct bystanders to the nearest location.

Currently, there are around 3,500 out-of-hospital cardiac arrests in Scotland every year where resuscitation is attempted, and in only 1-in-12 of those cases will the person survive.

Every minute without CPR or defibrillation leads to a 10 per cent decrease in the patient’s chances of surviving, meaning the use of AEDs can dramatically improve survival rates.

Alongside CPR, easily accessible defibrillators double the chance of surviving in some cases.

But international evidence has shown that the rate of AED use in an out-of-hospital cardiac arrest is a low as 4.3 per cent.

A study in Sweden found that registered AEDs were 15 times more likely to be used in a life-saving scenario than unregistered AEDs.

Members of the public do not need to be trained to use a defibrillator – anyone can follow the simple instructions.

There is currently no legislation in Scotland governing the registration of AEDs, with purchasers only asked to register them with the Scottish Ambulance Service on a voluntary basis.

As a result, out-of-hospital cardiac arrests often take place in the vicinity of a public AED which is unknown to 999 call-handlers, meaning that bystanders are unable to be directed to the nearest defibrillator.

The proposed Bill would place a duty on vendors, purchasers and guardians of public AEDs to ensure that they are registered as soon as feasibly possible following their purchase with the Scottish Ambulance Service.

There are around 1,900 AEDs voluntarily registered in Scotland.

A consultation on the proposal will be launched in the coming weeks, and it will seek views on whether registration should be mandatory.

The discussion has been welcomed by British Heart Foundation Scotland.

Anas Sarwar, Scottish Labour MSP for Glasgow, said:
“This proposal could dramatically improve survival rates in Scotland.
“The evidence of the positive impact of using a defibrillator is overwhelming, doubling survival chances in some cases.
“But there is no current requirement for public AEDs to be registered, meaning the ambulance service may direct a bystander to a defibrillator which is further away, or they may not even be aware of one in the vicinity.
“This Bill would help bystanders save the lives of their fellow citizens and allow Scotland to lead the way in out-of-hospital cardiac arrest survival.
“I look forward to working with others to get this Bill on the statute books.”

Daniel Jones, British Heart Foundation (BHF) Scotland policy and public affairs officer, said:
“BHF Scotland welcomes the launch of this consultation. This represents the first national conversation on the registration of publicly accessible defibrillators (PADs) and we will take a keen interest in the responses and encourage all guardians of PADs to share their views.
“Survival rates from out-of-hospital cardiac arrests in Scotland are worryingly low, with less than one in twelve people surviving.
“Alongside CPR, easily accessible defibrillators double the chance of surviving in some cases. Opportunities to help save a life are often missed because no one knows where the nearest defibrillator is.
“It’s vital that every defibrillator is registered with the Scottish Ambulance Service so that lives are not needlessly lost.”

Miro Dragic, 52, an IT worker from Edinburgh, was playing a doubles game at Drummond Tennis Club in July 2017 with his son and friends when he suddenly collapsed due to a cardiac arrest.
His heart and breathing stopped but his fellow players knew how to perform CPR and carried this out for 20 minutes to keep him alive.
Had they not known CPR, a defibrillator could have saved his life.
Since then, Miro has made a full recovery, captaining his tennis team to promotion.
He has also been raising funds for BHF Scotland, and to provide a defibrillator at his club.

Miro Dragic said:
“I am forever grateful to my rescuers and hospital staff who looked after me so well.
“I was very lucky and I want to do what I can to help others have the same positive outcome from a cardiac arrest. Today I’m feeling well and back to full fitness, but too many other people don’t have that second chance.
“I would like to see more people learning CPR, and it should be taught in every school.
“But if people do not know CPR, they do not need specialist skills to use a defibrillator, and a registration programme to ensure people can access a nearby AED could dramatically increase survival rates.”

Summary of proposed Bill

• The AED Registration Bill would introduce a legal requirement for all public Automated External Defibrillators to be registered with the Scottish Ambulance Service.
• There would be a universal duty on the purchaser or guardian of all AEDs in Scotland to register the defibrillator.
• The proposed legislation would not require organisations or places of business to amend their hours of operation or placement of any current AEDs, with this information included in the registration process.
• The Bill would primarily have an impact on three distinct groups: those selling an/or purchasing AEDs would be expected to guarantee that it will be registered as soon as feasibly possible following its sale; the Scottish Ambulance Service would have an increased awareness of the actual number of AEDs in Scotland and their precise location, allowing them to signpost the nearest AED to the person calling 999; and the Bill would provide increased access to AEDs for bystanders and allow them to be accessed within shorter timeframes than at present.
• The Bill would maintain a free registration service and financial implications are therefore minimal.

Parliamentary process

• A Member’s Bill is a public Bill introduced by an individual MSP. Members’ Bills are distinct from Executive Bills (introduced by Scottish Government ministers) and Committee Bills (introduced by committee conveners).
• Anas Sarwar’s draft proposal has been produced with the support of the Scottish Parliament’s Non-Government Bills Unit (NGBU), and is supported by the Scottish Labour Shadow Cabinet.
• A consultation process will be launched shortly.
• The final proposal will require the support of at least 18 other MSPs from at least half of the parties or groups represented in the Parliamentary Bureau, and if the Scottish Government has not exercised its right to block the proposal (on the grounds that either it or the UK Government will legislate in similar terms), the MSP secures a right to introduce a Bill to give effect to the proposal.
• Once introduced, a Member’s Bill is subject to the same three-stage scrutiny process as other public Bills. If it is passed at the end of the process, it becomes an Act.