Out-of-Hospital Cardiac Arrest - A Strategy for Scotland Review 2015 - 16

Shared Commitments

Improved Public Response to OHCA.

Many more people who witness an out-of-hospital cardiac arrest possess the skills and confidence to know what to do.

The Save a Life for Scotland partnership includes a wide range of organisations from the public and voluntary sectors:

• The Scottish Ambulance Service
• Scottish Fire and Rescue Service
• Defence Medical Services
• Police Scotland
• The British Heart Foundation
• The British Red Cross
• St Andrew's First Aid
• Chest Heart & Stroke Scotland
• The Royal Life Saving Society Scotland
• Trossachs Search and Rescue
• Lucky2BHere
• The Resuscitation Research Group at the University of Edinburgh

and includes affiliated supporters including BASICS Scotland, NHS Scotland, Higher Education Institutions, Heartstart ( BHF) and Council representatives.

It has coordinated activities that raise awareness of cardiac arrest and CPR training, primarily through establishing and actively using:

• The campaign website www.savealife.scot
• Facebook (Save a Life for Scotland) and Twitter (@savealifescot, #savealifescot)
• Vimeo, YouTube and Flickr sites Save a Life for Scotland.

The message on OHCA and CPR was relayed to thousands of people at large scale events, such as rapid CPR training at the Tattoo and a promotional video at the Edinburgh Castle Runrig concert.

Training in the use of CPR is more readily available through schools, work places and voluntary groups.

Save a Life for Scotland has recorded that in excess of 60,000 people in Scotland have learned CPR provided by partner organisations since it's launch in October 2015. The Save a Life for Scotland delivery partners and numerous others have helped deliver CPR and PAD training workshops across Scotland. In many instances this is to voluntary and community groups and in schools and even public places such as shopping centres across Scotland. This has laid the foundation for building CPR activity across the country

The British Heart Foundation is working in partnership with Glasgow Airport to achieve their commitment to train their 500 staff members in CPR using the 'Call, Push, Rescue Kits' purchased. The British Heart Foundation is also engaging with other businesses to raise awareness and RBS, Nationwide, Airbus and Barclays have all made commitments to provide CPR training to staff.

CPR training has been taken up by 440 staff in Scottish Government locations, in Edinburgh and Glasgow.

• Public Access Defibrillators ( PADs) are more easily accessible and more people have an understanding of what they are for and a greater willingness to use them.

The Scottish Ambulance Service PAD mapping project will enable call handlers to direct OHCA bystanders to the nearest PAD. The partners, including Police Scotland, SFRS, community organisations and businesses, have already provided information on PADs for input to the ACC computer system. The enhanced system data on mapped PADs will be operational from April 2017.

BHF have provided part funding for 1200 PADs across Scotland in the last 12 years

• It is the norm for families, friends and even strangers to take prompt and effective action when faced with an OHCA.

The overarching ambition for the Strategy is a cultural shift to 'nomalising' the public to respond to OHCA; including CPR and defibrillation. This will embed the Strategy's aims and sustain the successes.

The current situation in Scotland was established by research (Scottish Government, 2015) and has informed actions. This found there a strong base to improve the response to OHCA with:

• Over half the population already trained in CPR.
• An overwhelming majority of people stating they would try CPR rather than do nothing and would do so if they were the only person there.

There are many factors that can influence people's response; hypothetically and in an actual situation. Individuals report concerns about intervening, often misapprehensions, such as they would make the situation worse or fear of disease transmission. Contextual factors, such as where the OHCA happens and wider social dimensions influence responses to someone having a cardiac arrest.

The training and awareness raising activities are addressing these matters and progress so far has been encouraging. The real return on investment, an increased rate of public response to OHCA and associated actions will help enable people to live longer, healthier lives, will be measured going forward.

Better Care for Survivors and Families

• People who have survived a cardiac arrest and their families are offered individually tailored high quality information about their underlying condition and the potential physiological, psychological and social impact of cardiac arrest.

The causes and consequences of OHCA are diverse. In order to better understand the care, support and information required to facilitate and enhance recovery and adjustment, Chest Heart & Stroke Scotland have been working in partnership with survivors, families, and care providers, over the last year, identifying areas of good practice and exploring opportunities for addressing gaps in current care provision.

• Timely and appropriate care and advice is made available to the families of those who do not survive to discharge. This should include where possible, an explanation of the underlying cause and referral of family members to screening services where necessary.

Several organisations presently offer guidance and support services to bereaved friends and family, although accessing these can be challenging. In some cases the potential risk of inherited conditions requires specific care and attention; there is scope for improvement in some areas such as access to information on genetic counselling and specialist support such as that offered by the Familial Arrhythmia Network Scotland. Key agencies are developing partnerships to explore opportunities which may lead to improved access to sources of support.

• All survivors are offered a formal systematic assessment of their needs, using validated and clinically appropriate methodology.

There is evidence of good practice within the NHS in relation to assessment of rehabilitation needs, but there are areas for improvement. A range of partners working in OHCA are seeking ways to highlight good practice and to share these nationally, through the development of the new online resource for health care professionals which will be available in Autumn 2017.

Assessments are conducted within the early post-discharge phase, within an environment which is conducive to effective communication.

The background work conducted to shape the ambitions of the OHCA Strategy highlighted the high quality of care delivered to patients during their hospital stay, while suggesting that post discharge support appears to be lacking in some areas. In order to improve this, partners are working to ensure the transition between hospital and home is managed in an integrated and seamless way.

• Survivors are offered personalised support to meet their needs, including referral to specialist services, such as cardiac rehabilitation as appropriate.

Advances in heart-related care have seen a significant reduction in mortality. Cardiac rehabilitation services are established but some areas have experienced capacity issues leading to limited capacity to accommodate the needs of some people. A national cardiac rehabilitation 'champion' has been employed since 2014 to promote the modernisation of rehabilitation services. As part of the OHCA Strategy, the partners aim to work with cardiac rehabilitation and other relevant aftercare services to enhance the support being provided.

• Survivors and their families are offered opportunities for peer support.

An initial scoping exercise to assess the needs of survivors and their families, carried out by Chest Heart & Stroke Scotland, identified the benefit of peer support amongst survivors. Following a successful bid to the Scottish Government to joint fund a web-based resource for survivors, families and those bereaved, Chest Heart and Stroke Scotland plan to explore the role of peer support and use this, where possible during resource development.

• Additional information and support is provided to those requiring further investigation and/or therapeutic interventions, e.g. implantable cardioverter defibrillator ( ICD).

All OHCA have an underlying cause and for some, this pathology may require complex treatment and ongoing intervention. NHS Scotland and third sector partners provide advice and support to survivors who may require detailed review and further interventions. Future work will focus on enhancement of this support to ensure all those in need receive the care required to regain quality of life.