P.E.I. needs a survival plan for heart attacks

Jim Day jday@theguardian.pe.ca
Published on February 6, 2016

Without AED, chance of survival drops by seven to 10 per cent with each passing minute, says expert

Tick tock, tick tock, tick — too late.

Time to save a person suffering from cardiac arrest ticks by so quickly, warns health economist Chris Robinson.

Automated external defibrillators (AEDs), if readily available, can keep the clock ticking for a person whose heart short-circuits and stops pumping blood.

"The cruel truth is that without timely access to an AED within five to seven minutes of cardiac arrest you will likely suffer brain damage and die,'' says Robinson.

"Without AED, your chance of survival drops by seven to 10 per cent with each passing minute.''

Robinson has focused his 20-year career, including a dozen years with Health Canada as senior health economist, on "reducing the burden of disease either by addressing risk factors directly or looking at value for money propositions associated with different health investments.''

For his money, the mobile device app PulsePoint could offer the P.E.I. government a great lifesaving bang for its buck.

Robinson says the cost is modest to implement a system that alerts CPR-trained individuals who have downloaded the app when someone nearby is in cardiac arrest -- $10,000 to $15,000 to rejig the software at 911 dispatch and an annual $5,000 licencing fee.

"At such a low cost and such a potential benefit, I estimate at least a dozen or more lives would be saved by doubling the survival rate from say 10 to 20 per cent,'' he says.

"I think the question is not can P.E.I. afford it, rather it is can P.E.I. afford to do without it?''

Charlotte Comrie, CEO of the Heart and Stroke Foundation of P.E.I., notes the PulsePoint is an interesting application but adds it is not widely used in Canada.

"It needs to be considered,'' she says, adding cautiously "it can't be thought to be the answer without further investigation.''

The province certainly is not ready to jump on board - at least not yet.

"Health P.E.I. is familiar with the product,'' says James Sullivan, director of emergency health and planning services.

"We are not using it at the present time but we are exploring the use of emerging technologies to advance the quality of care in emergency health.''

AEDs certainly save lives, but only, Robison stresses, if accessed in a timely fashion.

When he recently surveyed Islanders, he found in case of full-blown heart attack or other cardiac arrest at home, only one in five knew where to locate the nearest defibrillator available 24/7.


He adds P.E.I. is the only Maritime province that doesn't have a provincial registry of publicly accessible AEDs.

"So there is an issue of knowing where one is and having very timely access to it,'' he says.

Comrie would like to see an effective, Island-wide central registry for AEDs.

"When push comes to shove what you want from an AED...is a system that provides a better outcome for people who suffer sudden cardiac arrest,'' she says.

Comrie adds the Heart and Stroke Foundation of P.E.I. is starting to work with the province on developing better approaches to addressing cardiac arrest.

"We are looking at a whole system,'' she says.

"There is a whole system that needs to be in place to improve an outcome.''

Sullivan says Health P.E.I. is open being part of discussions with other government departments on a longer-time plan for the province.

Robinson need not hold his breath in his hope to see paramedics given the green light to speed up when responding to cardiac arrest calls in P.E.I.

Sullivan says the speed limit for ambulances on P.E.I. is in keeping with most other jurisdictions in Canada.

"Ambulances carry medical supplies and equipment, including oxygen tanks, which can pose a risk to patients, paramedics and the general public when the vehicle is travelling at an excessive speed,'' he says.

"Emergency treatment begins when paramedics arrive on-site and continues while on route to hospital. An ambulance travelling at an excessive speed compromises the ability of paramedics to provide safe, quality care to patients in an emergency situation.''

P.E.I. Chief Coroner Des Colohan recently noted in a guest opinion piece in The Guardian that good outcomes depend on an interlocking series of events occurring rapidly and effectively. When one link is weak or missing, he notes, it can't be compensated for elsewhere.

"Advanced life support and rapid access to a cardiac centre are of no use to a patient who has been in cardiac arrest without basic life support for more than 10 minutes,'' writes Colohan.

"We know that every minute without CPR before defibrillation means an almost 10 per cent decrease in survival, and that we get the biggest bang for our buck from immediate and effective CPR followed by defibrillation.''