Thank you.
St. John Ambulance trains over 500,000 Canadians annually in first aid, CPR and the use of AEDs, and 2018 marks the 135th year that St. John Ambulance has been training people in Canada.
My name is Shawn McLaren and I'm the chief learning officer for St. John Ambulance. My counterpart is Andrew Stanzel. Andrew is the council commissioner for the federal district council. He leads all of our medical first responders, is a medical first responder himself and is a registered nurse.
CPR is often what comes to mind when people think of first aid for a cardiac arrest. However, CPR is only part of the picture. St. John Ambulance teaches the chain-of-survival approach, which has five steps that are important when helping someone in cardiac arrest.
Step one is immediate recognition of a cardiovascular emergency and calling 911. Step two is early CPR with a focus on chest compressions. Step three is rapid defibrillation.
I would like to break here and give more specifics on the use of an AED, considering the nature of this committee. During the initial compressions and breaths of CPR, we instruct that someone should locate and then prepare an AED for use. Time is a critical factor in determining survival from cardiac arrest. The heart will only stay in fibrillation a short period of time before all electrical activity ceases. Defibrillation must be performed early to be effective.
CPR can keep oxygenated blood flowing to the brain and help extend the length of time the heart will remain in VT or VF—the only arrhythmias an AED will shock. CPR can then buy some time for the casualty until the AED is attached and can deliver a shock. Thus, the more readily available an AED is, the sooner it can be used. The sooner an AED is used in this situation, the greater the chance of survival for the casualty.
The steps then resume. Step four is effective advanced life support. Step five is integrated post-cardiac arrest care.
Each one of these steps is as important as the others. Time is the vital ingredient. To give a casualty in cardiac arrest a reasonable chance of survival, CPR must be started immediately, followed by defibrillation as soon as possible. For both procedures, the sooner they happen, the better. A first aider who is willing to act is crucial to the first three links in the chain of survival.
Beyond the use of AEDs in response to a casualty in cardiac arrest, there are two other factors that need to be addressed: the availability of the AED, and the confidence or effectiveness in the use of the AED. Having more AEDs in the community equates directly to reducing the time it takes to put one into use. Having AEDs in RCMP vehicles places an AED in prime position to be used quickly.
Optimum confidence and effectiveness require annual recertification in CPR and AED, and this is recommended, though few in the public follow this recommendation. Without annual certification of the public, it is even more important that AEDs are placed in the hands of those who are certified annually in CPR and the use of AEDs. To the best of my knowledge, RCMP officers are among that population. If they are not currently recertifying these officers annually for CPR and AED, they should be if the finding of this committee is that AEDs should be placed in all of their vehicles.
To illustrate the importance of training in the use of AEDs, we have included a survey from February 2018 conducted in British Columbia. People were asked, among other things, about the likelihood of their having to use an AED, as a bystander, in a medical emergency. Sixty-seven per cent of those polled said they would be “very likely” or “somewhat likely” to use an AED.
For contrast, compared to using an AED, those polled were more likely to take the following actions as a bystander in a medical emergency. Ninety-eight per cent said they were “very likely” or “somewhat likely” to call 911. Ninety-one per cent said they were “very likely” or “somewhat likely” to check if the individual was breathing normally. Seventy-two per cent said they would provide CPR, so that the use of an AED ranked fourth in those stats.
The main reasons the people in this survey were less than “very likely” to use an AED as a bystander in a medical emergency were as follows: 56% said they didn't know how to use an AED; 53% were worried about using it improperly and causing harm; 36% said they would not know when to use the AED; 19% were worried about being sued by the casualty; and 13% were worried about hurting themselves in the use of an AED.
These responses are telltale signs of people who have not had training or have not been trained recently. Proper training on how to use an AED could eliminate the majority of these fears of taking action. The issue in this particular survey, though, is that only 23% of people in British Columbia have taken AED training.
With less than a quarter of the people having taken AED training, and even fewer having taken it in the last year, presumably, there is a small number of people who would feel confident in using an AED in an emergency situation. This is all the more reason to place AEDs into the hands of first responders, who are not only receiving annual CPR and AED recertification but would have them readily available for their use.
To illustrate the benefit of having an AED in close proximity to potential emergencies, I would like to share the details of an event that happened on September 23, 2018. In support of the Canada Army Run here in Ottawa, our medical first responders were part of a team tasked with providing first aid at the finish line for all the races that day. During the half marathon, one of our volunteers witnessed the sudden collapse of a runner in the last 100 metres.
Shortly after the collapse, the MFR team was at the side of the casualty, where CPR was started and an AED—which is part of the first aid equipment our MFRs carry when on duty—was prepared for use. After the application of one AED shock, the casualty regained breathing and normal sinus rhythm prior to the arrival of EMS. He was transported by Ottawa paramedics to the heart institute, where he successfully underwent an emergency angiogram.
In closing, being able to provide rapid defibrillation is a key component in the chain of survival. In order to provide rapid defibrillation, an AED must be readily accessible, and having AEDs in RCMP vehicles helps make that a reality.