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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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