I hope to deal with each of the groups' presentations in approximately 30 minutes.
Response to Cardiac Arrest: Presentation by Wicklow Community First Responders
How many groups are there?
There are three important groups at today's meeting. We will get through our work as quickly as we can. The first presentation will be made by the Wicklow Community First Responders. I welcome the members of the group, Mr. John Fitzgerald, Ms Susan Gorman and Mr. John O'Reilly, who were introduced to the members of the committee by Deputy Timmins earlier. Before they begin, I advise the representatives that by virtue of section 17(2)(l) of the Defamation Act 2009, they are protected by absolute privilege in respect of their evidence to this committee. If they are directed by the committee to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter only to qualified privilege in respect of that evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given. They are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or entity by name or in such a way as to make him or her identifiable. I believe the representatives intend to make a high-tech presentation with an overhead projector. We look forward to hearing it. When they have concluded, I will invite members to ask questions.
Mr. John Fitzgerald
I am joined today by Ms Susan Gorman, who is self-employed. She works with her husband in a precision engineering business in Tinahely. I am also joined by Mr. John O'Reilly, who is a self-employed builder. He works for the family business in Dunlavin. He has 27 years' experience with the Red Cross. I also live in Dunlavin and work in an independent hardware shop in Naas. Other than one or two individuals such as Mr. O'Reilly who have some background in the medical field, none of the 500 responders in County Wicklow has any previous medical experience. We are all volunteers.
According to figures provided by the Irish Heart Foundation, approximately 5,000 people per annum or 14 people per day die from cardiac arrest in this country. These are individuals who are carrying out their daily business, whether attending sports events, going to work, shopping or driving, when they simply collapse and die without warning. Between 70% and 80% of such incidents occur in the presence of family and friends. It is disturbing that people known to the victim often stand around and do nothing because they do not know what to do.
The chances of recovery for those who have suffered a cardiac arrest are reduced by between 7% and 10% for every minute that passes. If an automated external defibrillator, AED, is used on a victim or patient within three minutes of going into cardiac arrest, he or she will have a 70% chance of surviving. This is known as the chain of survival, a concept first mooted in the late 1980s by a lady called Mary Newman in the United States as the best approach to tackling a cardiac case or sudden collapse. The chain of survival has four links and like any chain, it is as strong as its weakest link. The first link is early access. When a person collapses, the first step must be to call the emergency services. All too often, family members telephone other relatives or a doctor when they need to telephone the emergency services. The second link is the use of cardiopulmonary resuscitation, CPR, which one often sees on television programmes as doctors, nurses or other health care professionals press on a victim's chest and breathe into him or her.
The third link in the chain of survival is the use of an AED. A person who has suffered cardiac arrest will not be revived by CPR alone. He or she must be defibrillated. The fourth link is advanced medical care, namely, the arrival of an ambulance. An ambulance will not arrive if it has not been called. I recall a black and white television advertisement which informed members of the public about how to make an emergency call to the Garda Síochána, ambulance service or fire service. Perhaps one or two members are old enough to remember the advertisement in question. I would like a similar advertisement to be shown again.
Unfortunately, only 2% of out-of-hospital cardiac arrest victims survive. This figure has doubled in County Wicklow since the Wicklow Cardiac First Responders started in 2005. However, the Pre-Hospital Emergency Care Council, PHECC, carried out a survey in the north west in December 2009 which found it was achieving a success rate of about 7%, mainly due to training, equipment, location of defibrillators and community awareness.
We are proud of our skills and take them very seriously. CPR and the use of an AED are simple skills. We practise them at the highest level, namely, at the same level as the ambulance service. This is what we need to achieve but like any skill, for example, playing hurling or playing the accordion or violin, one must practise to be good at it. We practise a great deal. Most groups train at least once per month and individuals and groups come together and train in each other's houses around County Wicklow. The training provided by Wicklow Cardiac First Responders is so good that we brag about it a little. A national resus conference is held once every two or three years. Our group won the volunteers competition in CPR and AED in 2006 and 2009.
The first meeting of cardiac responders in County Wicklow was held in Shillelagh in 2004 and the first groups launched in January 2005. After 12 months, we had 27 groups live and active in the county. All of them were connected to the ambulance service and were being dispatched by the 999 service. Members can see on their screens the locations of cardiac first responder schemes in the county, highlighted by yellow dots. The blue dots refer to new schemes where we have trained responders and which we hope to have launched before the end of this year. The red dots represent groups we hope to have live early in 2011. The red spot located at the Glen of Imaal on the map represents a new group known as "The Glen", which will go live before Christmas. Mr. O'Reilly will discuss training.
Mr. John O’Reilly
When a group decides it wants to have a community first responder scheme in its area we set out to train between 14 and 20 people to manage a roster and provide coverage 24 hours per day, seven days per week. The training lasts approximately 2.5 days and is usually provided on a Saturday and Sunday, with the half day provided shortly thereafter over a couple of evenings. The training is done under PHECC cardiac first responder and Irish Heart Foundation protocols. It includes cardiopulmonary resuscitation, the use of a defibrillator and oxygen therapy which is used in nearly every call to which we respond. Responders are also trained to use suction and the administration of aspirin in the event of someone experiencing chest pain. We also provide training on dealing with choking and stroke recognition. All training is provided under ambulance service protocols. We work with the ambulance service and under its guidance.
After training has been successfully completed, all members must obtain Garda clearance. Once this has been provided, the group can get up and running. We then organise the group's kit bag, the bag each volunteer will carry or have at home or in his or her car. The most important item in the kit bag is the telephone because we communicate and make and receive calls on it. Ms Gorman will elaborate on that. The kit bag contains an automated external defibrillator, oxygen, suction, aspirin and a mobile telephone. That is how our training is done. Ms Gorman will discuss operations.
Ms Susan Gorman
In the event of somebody suffering cardiac arrest or respiratory difficulty, a member will immediately call the emergency services using the 999 or 112 emergency telephone number. The central control will then dispatch an ambulance and then immediately call the number of the dedicated telephone in the kit bag. The responder who is on-call will answer the call and will be asked to go straight to the scene of the emergency. As we live in a relatively rural area, it can take between 30 minutes and one hour for an ambulance to arrive. As members will be aware, every second counts in the case of cardiac arrest. A responder will appear on the scene within less than five minutes.
Typical call-outs we are asked to attend include cardiac arrest, stroke, heart attack, any respiratory difficulties or choking, to name but a few. We have attended cases involving infants, right up to those involving elderly people. To date, we have trained approximately 500 community first responders in 31 villages in County Wicklow. As members will see from the map, more groups are ready to go on call. We have attended more than 800 call-outs and our average response time is less than five minutes. This is in line with the ILCOR recommendations of attending a cardiac arrest in under eight minutes. Our response times are, therefore, well within these recommendations.
Mr. John Fitzgerald
Community first responder, CFR, schemes were recommended in the sudden cardiac death report which was published in March 2006. Wicklow Cardiac First Responders went live in January 2005, 13 months earlier than the report's publication date. CFR schemes were also recommended in the HSE corporate plan, 2005 to 2008, and in its service plans for 2006, 2007 and 2008. The American Heart Association also recommends CFR schemes, as does the Irish Heart Foundation and the European Society of Cardiology. The PHECC has produced several spatial analysis reports across the country and it too recommends community first responder schemes.
The HSE budget plan from 2007 allocated €1.5 million to fund the rollout and development of targeted sites nationally to enhance the first responder and resuscitation training programmes and provide education and promote awareness. It is a system, however, that works well. In my area, a six-year old boy, Caoimhghín Lonergan, demonstrates to the public how easy it is to use an automated external defibrillator, AED. It is always good when there are exchanges of information with other systems across the country. In my area, we are fund-raising again to replace the batteries in our AEDs. We are fortunate to have the support of Abbott Vascular and Boston Scientific.
What is the next step for the Wicklow Cardiac First Responder group? I would like to see these types of programmes extended across the country, particularly in rural areas in which access to hospitals can be difficult.
I thank the delegation. When the Wicklow group set up, it could not go live because the ambulance service in the old south–east regional health area could not tie up with it. It is important to ensure the backing up of such a service with the relevant statutory authorities.
Many new houses have been built in areas such as Ballyneill or Mullinavat. If a first responder group were established in such an area, would they have a pack from An Post with the addresses so they know where they are going?
In a nutshell, the Wicklow system allows a volunteer with an AED to assist someone before the ambulance reaches them. There is also a debriefing session after the call-out has been dealt with.
Committee members are supportive of this initiative. The network the group created across County Wicklow is an enormous achievement in itself. While there are many volunteers in worthwhile endeavours, it must be enormously worthwhile to be in a position to save a life. I congratulate the Wicklow Cardiac First Responders on its work.
Does the delegation see a role for the planning process, for example, to require developers of facilities to locate AEDs in them and train staff in how to use them?
Mr. John Fitzgerald
The cost of training a first responder is frightening. We fund-raise for everything and some years we get a little funding from central funds such as the county council. This year, for example, we received €500 from the council. Last year we received nothing but did receive €2,000 the year before.
With our funding we organise training sessions, meetings and send out regular newsletters. People need motivation because there can be long periods of inactivity. Some groups can be very busy while others may not be.
Tomorrow night we will do an information night in Rathdangan, County Wicklow. My opening statement will be that the community can have a first-responder scheme but it will have to want it. It must, in short, be community led. It is the community's role to raise funds for the AED while the HSE's role is to manage it and set down the training guidelines.
An AED can cost anywhere from €1,350 to €2,500 for one with bells and whistles. They all save lives in the end, however. Each community buys its own AED. The kit bag and the oxygen and suction device, aspirin, breathing apparatus and other medical devices are all supplied and kept up to date by the HSE ambulance service. Under procurement policies, the ambulance service or the Irish Heart Foundation cannot recommend a specific AED to a community. Ultimately, all AEDs do the same, however.
How much does an AED cost?
Mr. John Fitzgerald
An AED can cost anywhere between €1,350 and €2,500. Local communities have many fund-raising activities such as head shaving and hill walks. Some people just make a donation which always touches me.
In my area, a local hotel allows us the use of its facilities for free when we do a training session over two days. The instructors will have been trained under the guidance of the HSE ambulance service, so the only expense will be for refreshments over the two days of training. It costs €23 to train a community first responder. Last year, we trained 39 responders. The ambulance service will train the responders in the use of oxygen apparatus. Training is cheap because it is community driven.
I do not believe millions of euro will be provided to roll out this service because there are so many other deserving causes. This model we have created in Wicklow, in conjunction with the ambulance service, works for our county. We are well-intentioned volunteers but we need to be managed.
Mr. Fitzgerald referred to Shillelagh as an example. How many AEDs are located elsewhere?
Ms Susan Gorman
Each village in the scheme will have one kit bag. Tinahely, for example, has one kit bag with 20 volunteers. People will take a night or a day slot, depending on what suits them. They must live within a three-mile radius of the community so they can get to the response in or under five minutes. There are 31 kit bags in Wicklow.
A smaller scheme similar to ours has been set up in Clonakilty, County Cork. Until then, we were a unique scheme by being the only one linked to the ambulance service. There are other excellent public access AED schemes like in Clonmel but ours is unique in that sense.
While we accept there have been problems along the way with embargoes and so forth, the recommendation was for the €1.5 million signed off by the Minister for Health and Children in the 2007 HSE service plan to be returned to the ambulance service training school budget. We need that budgeted back within the ambulance service training school so that it has a dedicated budget for the community first responders. We need their skills to teach instructors. On the ground, we can keep teaching regular volunteers, but we need instructors to be trained all the time because there is a fall-off. If there are no instructors on a scheme to come for the weekend on their own time, we will not be able to train up any more villages because we will not have anyone to instruct them. We are all instructors here today, so we can teach people, but we are not qualified to teach people to become instructors. We need someone from the ambulance service to come in. That costs money and we do not have the money to pay ten paramedics to come in for a weekend. If a budget was allocated every year within the ambulance service, it could be allotted to that. We would also need one employee to manage us from the inside and give us the time to run the scheme.
Deputy James Reilly asked about response time. It is less than five minutes.
Mr. John O’Reilly
We have 24 trained people in our group, but we also train once a month for a two-hour period. The training can consist of checking the kit bag and acting out scenarios of a heart attack, chest pain or choking. The practice would also include the use of the defibrillator itself. We would take it down, look at it, handle it and learn how to switch it on and deal with it. We also have to check the machines regularly to ensure they are up to standard.
I think we have covered most matters. Do the witnesses wish to make any further points before we conclude?
Mr. John Fitzgerald
The community first responder guide has been produced by the FEC in conjunction with the HSE, while it has also produced the training standards required. The HSE ambulance service has rolled out the model in County Wicklow. All the work has been done and we know exactly what to do. It is a simple process of going to the next step and pushing on to roll it out nationally. It needs to be managed by the health service. The service has the expertise, the logistics, the knowledge and the experience of what exactly is required.
We will certainly take up these matters with the Department of Health and Children, the Minister and the HSE. I thank the delegation for their presentation. They are displaying an admirable commitment to a valuable community initiative. Keep up the good work and we will try to be of assistance.
Mr. John Fitzgerald
Thank you.
Sitting suspended at 3.43 p.m. and resumed at 3.45 p.m.