Remote Locations and the use of AEDs

‘Cardiac arrest is the second most common cause of death in the mountains.’ - ICAR

During the winter months of the year many athletes and holidaymakers take to the slopes both here and abroad and enjoy skiing across a fresh layer of snow.

But many of these locations are remote and challenging to get to for just sport – let alone in a cardiac emergency.

In urban locations across the United Kingdom, Ambulance Services targeted response time for  a cardiac emergency is 11 minutes, so it’s incredibly easy to see that if you find yourself in an emergency situation in the mountains – its more than likely going to be a longer response time.

This makes the placement of lifesaving automated external defibrillators even more important, but in the vastness of some locations – where on earth do you keep a defibrillator and who is going to be CPR trained in an emergency?

In 2006, the International Commission for Alpine Rescue released their guidelines on ‘The Use of Automated Electric Defibrillators and Public Access Defibrillators in the Mountains’ and confirmed that the need for defibrillators is essential.

‘Presently, over 75% of persons who experience cardiac arrests in urban areas do not receive adequate care. Because of logistic and local reasons, this percentage may be even higher in the mountains; therefore the numbers of successful outcomes may be lower.’

‘Public access defibrillators have been shown effective in urban areas, but early defibrillation should also be feasible in the mountains.’

‘It is important that the general population know the availability, location, and use of PADs, and they should be encouraged in CPR and PAD training.’

The Commission also went on to advise those who like to take to the mountains to have had the correct medical checks before doing so in an effort to reduce the likelihood of a sudden cardiac arrest in a location which could prove tough to get to for emergency services.

‘There is an increasing trend to advise and encourage people with medical conditions such as hypertension, other cardiac problems and diabetes to hike and exercise in mountainous areas resulting in a increasing number of people at risk.’

‘A person’s risk in the mountains increases over the age of 40, and vigorous exercise, dehydration, and hypoxia at higher altitude combined with medical problems may increase this risk.’

‘Also, there are increasing number of persons at risk of sudden cardiac death performing winter sports and attending mass events.’

Their recommendations for the use of AEDs in the Mountains include:

Winter Olympic athlete Zoe Gillings-Brier keeps a defibrillator unit with her at all times during her snowboard cross training and events throughout the year for the safety and protection of herself and the team around her.

‘Knowing that I’m coming to some of the most remote places on Earth to train means that we have to think about every eventuality – no matter how small the risk or chance. Having a defibrillator with me at all times provides the best protection we can have against sudden cardiac arrest.’

‘It was a no-brainer to have one of these devices by my side when you think that it would take the emergency services a lengthy amount of time to get to a member of my team should they suffer a cardiac arrest and their survival chances decrease rapidly without treatment.’

‘There’s definitely more pressure put on the individual in remote locations to learn first aid skills and CPR – but you just hope that everyone realises this and as a community, we realise that we need these skills to be able to come to this part of the world and be safe.’

‘We made the choice to enjoy the scenery and to get away from urban areas; we can’t depend on the emergency services so much.’

Recent research in Sweden backs this idea and suggests that it is more common for bystanders in remote and mountainous areas to perform CPR on a person with cardiac arrest, compared to urban areas.

It is believed that the knowledge of knowing the chances of emergency services arriving in time to help someone who has suffered a cardiac arrest in some areas in slim, therefore communities have taken it upon themselves to learn CPR and lifesaving skills to help each other.

‘We don’t know the reason, but perhaps people in remote areas are aware that emergency services can be miles away and so they need to help each other.’ – Anneli Stromsoe; Sahlgrenska Academy, University of Gothenburg.

5,000 people collapse after suffering a cardiac arrest in Sweden per year whilst up to date figures indicate that over two million Swedes have been trained to perform lifesaving CPR due to the launching of a nationwide educational CPR programme.

And yet in the UK, the Government recently blocked a bill where every child in the UK would receive compulsory first aid training as part of the schools national curriculum for fears it would be putting extra pressure on schools which already have loaded schedules.

If a scheme like this was implemented, it could mean a million new first aiders per generation as school leavers and would drastically improve survival chances from cardiac arrest, in urban, rural and remote locations.

In the US, ‘Camp AED programs’ are implemented to help bystanders and first responders on campsites to assist anyone who has suffered a cardiac arrest on site.

‘More and more camps are buying and deploying AEDs in an effort to prepare for sudden cardiac arrest emergencies. AEDs alone, however, do not save lives. Rather, the rapid retrieval and use of AEDs is critical for the devices to be effective.’

For some locations however, there will be some obstacles.

How do we ensure that AEDs are always in good working condition in remote locations? The obvious solution of storing your defibrillator is within an AED cabinet, and with some models utilising a heating function – you can leave a defibrillator unattended for long periods of time and it will be secure and at an optimum working temperature, no matter what the conditions outside.

But what about replacing the battery?

Most AED batteries last approximately two years before they will need replacing in the defibrillator, but one theory which has been considered is the use of a ‘solar powered defibrillator’, ensuring that an AED can be left in a cabinet for an extended period of time without the need of replacing the battery.

In terms of managing a defibrillator in a remote, mountainous location, this could prove extremely useful – allowing the unit to be left unattended, but protected in a cabinet, whilst the unit will remain rescue ready at all times.

This would also reduce the cost of maintenance and could also increase the overall lifespan of the defibrillator.

‘Mountain regions have strong fluctuations in population with resulting fluctuations in the incidence of Out of Hospital Cardiac Arrest – Ventricular Fibrillation. In small communities, the response time of a [emergency response] team is usually more than five minutes.’

‘The Medical Commission of Mountain Emergency Medicine (ICAR MEDCOM) suggests that AEDs should primarily be installed in ski areas in the winter and in mountain huts near cable cars or popular hiking trails. The location determined by the sport type, risk factors of the general participant and environment conditions’

‘A survey reported that AEDs have been widely implemented by mountain rescue services worldwide and some mountain rescue backpacks are now equipped with AEDs’

‘High-altitude base camps such as Mt. Everest or Aconcagua also have seasonal fluctuations in the population, easy tourist access, and a daily population up to >1000. Visitors to these areas should be accessed for risk of coronary heart disease and seek individual pre-travel advice to reduce the incidence of sudden cardiac arrest. Mechanical CPR could be helpful if no helicopter rescue is available and terrestrial rescue is technically difficult or rescue time is >30min.’  - The American Journal of Emergency Medicine

A little closer to home, four public access defibrillators have been installed in four tiny Scottish villages to ease concerns about the distance from emergency services and an ageing population.

“We feel the defibrillators will also potentially benefit the many visitors who cycle or walk through the area and also be available for major events such as the Jedburgh Half Marathon and wheelchair race involving around 1,000 competitors.” Sheila Campbell, Secretary of Crailing, Eckford & Nisbet Community Council.

“The Council has been greatly impressed by the community’s response to this initiative with over 30 people, around 20% of the local population, already stepping forward to volunteer to learn how to use the defib.”

When someone suffers a cardiac arrest, their survival chances decrease by 10% per minute unless the correct treatment (CPR and AED) is administered. The inclusion of defibrillator technology in rural and remote locations is vitally important.

What seems clear to us is, if you live in or are visiting a remote location – there is even more emphasis on having first aid and CPR skills and knowledge. Because in the event of needing the emergency services urgently – it is likely that response times will be longer, and anyone needing immediate treatment will have a greater chance of survival if the first responder can assist.

Having a defibrillator stationed in the area is also essential, whether it be in a tourist hot spot or a local community – it provides you with the necessary medical equipment to treat a sudden cardiac arrest and places less emphasis on the emergency services arriving quickly to provide initial medical care.

For more information on defibrillators, cardiac arrest, the heart and everything in between, contact the friendly and impartial defibshop team on 0161 776 7422. We’ll provide you with all answers you’re looking for and help you find the right medical equipment to suit your requirements and your budget.

defibshop are committed to equipping everyone with the skills and knowledge to save a life. Speak to one of our Product Specialists on 0161 776 7422 or fill out our Contact Form.Learn more about defibrillators