Can social media contribute to emergency prehospital care?


I saw this article this morning and retweeted it, thinking “isn’t is a good thing to get new technologies to work to help people in emergencies”?

I was challenged by someone who suggested that telling “anyone with an iPhone” that someone in close proximity needs CPR would be problematic for several reasons:

  1. The quality of CPR might be insufficient
  2. The identification of need for CPR may be substandard by either a) call-takers or b) responders
  3. There is a potential for exploitation of vulnerable persons

I’ll concede all of these points, and still assert that the benefits of such a programme outweigh the risks.

First, the single most effective indicator for recovery from cardiac arrest is early, effective CPR. If CPR doesn’t happen, too much heart muscle dies for any other interventions (defibrillation, ALS drugs) to be effective. Given that cardiovascular disease is a major killer, getting someone to someone in need of CPR quickly can have a significant impact on mortality.

Second, for very practical reasons, you can’t always get an ambulance to someone within 3 minutes of them going into arrest. Given that it is impossible for this to be solved as a problem (short of being able to beam a paramedic to the scene of an emergency), alternatives must be considered. Indeed, Community Responders of various varieties who are (typically) lay people with training activated to emergencies are key to many ambulance service response plans.

Third, the cost of a life always outweighs the potential for harm. However, this doesn’t mean there isn’t a duty of care to minimise the harms; I would want, for example, to see participants trained to a specified standard, with annual refreshers; these might not be provided by the consuming service, but are essential for effective CPR. Remember, participants would ONLY be doing CPR (and possibly using a defibrillator). No need for drugs/gases training.

It’s also vital that call-takers are able to effectively identify cardiac arrest; at the moment, it’s more or less based on negative answers to “are they conscious?¬†are they breathing?” and there’s evidence suggesting most people don’t know what either of those two questions mean.

It may also be appropriate to include a vetting programme to exclude inappropriate people from the scheme.¬†However, given that these CPR-only responders would only be responding very infrequently to calls – confirmed arrests within, say, 250 meters of the persons current location – I wonder if there is a cost/benefit ratio which may need to be considered. After all, if you had a heart attack in a restaurant, you’re pretty unlikely to demand a CRB check before someone starts jumping up and down you…

A more sober analysis of credible and realistic risk might need to be considered. We normally consider impact and frequency as indicating the risk of a particular course of action; I would consider impact to be relatively low (the chances of CPR making a person truly in arrest worse are pretty small), and given that any individual would respond extremely infrequently the frequency is quite low as well.

We could also consider vulnerability of the patient, but even if their vulnerability is high (unconscious patients don’t tend to stop people taking their purse), the frequency would again be incredibly low. Add to this the consideration that it would likely be very rare that just one CPR responder who would turn up to a call, and the system become self-protecting.

Coincidentally, all three of the arguments could also be used against sending “professionals” to emergencies. After all, a brief perusal of the Health Professions Council, Nursing and Midwifery Council and General Medical Council websites can show you that registered professionals are prone to error and even the odd bit of *cough* extreme unprofessionalism.

In short, I think that the benefits of a lay scheme would benefit the costs, and indeed if people are trained to do CPR and are willing, doesn’t the local service have a moral duty to make use of the resource?

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About David Waldock

Open University graduate, health and life science at undergraduate level, science and society at post-graduate. Interested in how the Internet is transforming the ways in which the public(s) engage with science(s). Also interested in "the skeptical movement" as a form of science activism and it's effectiveness in achieving its goals. Interested in the representation of LGB types in science and in the periscience communities. Work for a well known and loved public institution. Views are mine and not necessarily my employers.

2 responses to “Can social media contribute to emergency prehospital care?”

  1. Graham Martin-Royle says :

    Anything that could possibly be of help to someone that has collapsed has to be a good thing? Should the worst happen to me I think I would like to have as many chances as possible to survive and I would surmise that anyone that downloads an app like this is likely to be aware of any possible dangers and is likely to be interested in this type of action, after all, there are so many apps, people don’t just download all of them, they only download those that are of interest to them.

  2. Brian Kellett says :

    Interesting, and I can see a lot of use for it, however the real trick, as you already highlight, is that initial recognition of someone needing CPR by a calltaker on the other end of the phone.

    I cannot count the amount of ‘not responding, not breathing’ calls that I went to as an EMT that were people faking faints, seizures or having just had an argument with their partner.

    This has two effects, first – that there is the risk of people not responding due to a high number of ‘cry wolf’ episodes (although unlikely given the need for proximity) and more importantly – risk to the responder.

    A responder needs a lot of information to make sure that a scene is safe before turning up – is the patient in cardiac arrest because he’s been stabbed and the assailant is still on scene? Are there panicking relatives who are going to be upset because some random person from out of the blue has just turned up?

    As an EMT you develop a sixth sense as to what calls might be ‘nasty’, but I doubt that people subscribing to this scheme will have this ability.

    So what happens when a responder gets beaten up by a drunken relative of someone who has ‘collapsed’ rather than have sex with said drunk partner?

    The uniform does come in handy, as studies have shown, so people turning up without a uniform on means that they don’t have the ‘authority’ that the professionals have. I know that when I’ve dealt with medical emergencies outside of wearing my uniform the vibe of the scene is very different.

    So I think that it is a good idea, but I think it’ll work better if we solve these other problems first.

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