Out of hospital cardiac arrest: strategy 2021 to 2026

4. Getting Scotland OHCA Ready

We will ensure people in Scotland can identify the signs of a cardiac arrest.

Aims:

1. The idea that OHCA can be a survivable event is embedded in the public perception.

2. There is an increased awareness of signs and symptoms of cardiac arrest enabling prompt bystander action.

3. Common misperceptions about CPR and defibrillation are addressed.

A cardiac arrest occurs when the heart stops pumping blood around the body. Someone who is having a cardiac arrest will suddenly lose consciousness and will either stop breathing or stop breathing normally.

It is estimated that every minute of delay in bystander action reduces the likelihood of survival after OHCA by 10%^[16]. Therefore, early recognition of cardiac arrest by those nearby and prompt call for help followed by bystander CPR are key to survival. Yet in a poll of adults living in Scotland more than 20% of respondents felt they would not know when to use CPR and half would not be confident to administer it^[17]. This uncertainty and reluctance to act is exacerbated in communities and age groups most affected by OHCA^[18].

To address this, we will work to ensure that people understand that OHCA can be a survivable event and are aware of the symptoms of an OHCA. This will enable them to act quickly and potentially save a life.

Inequalities

We are already aware of inequalities in health^[19], particularly affecting outcomes after OHCA. Over the last five years, we have started to understand more clearly the association between measures of socioeconomic position and decreased survival after OHCA^[20].

People from more deprived areas in Scotland are almost twice as likely^[21] to have an OHCA and are 60% less likely to survive to leave hospital than those from less deprived areas^[22]. Around 11% of the population of Scotland live in a rural area^[23] and are 32% less likely to survive to leave hospital after OHCA than those living in urban areas^[24].

We also know that ethnicity can be a factor in how likely a person is to experience an OHCA. For example, people from South Asian backgrounds have up to 50% higher risk of developing coronary heart disease than white Europeans^[25]. Coronary heart disease can lead to a heart attack or cardiac arrest.

In addition, we know from international studies that women are less likely to have CPR performed on them^[26], a pattern we also see in Scottish data^[27]. The misconception that breasts make CPR more challenging, fear of doing harm, fear of inappropriate touching and fear of being accused of sexual assault have been given by the public as reasons for this gender discrepancy ^[28]. It is important that over the next 5 years, the partnership works to combat these fears and embed the knowledge that CPR is a gender neutral life-saving technique.

We will also work to ensure that we do not exclude disabled people and/or those living with a long-term health condition from the work that we do. Whilst we know that the physical aspects of CPR may present a challenge for those with limited mobility, everyone can play a role in the chain of survival either by calling 999 or by guiding other bystanders to perform CPR and retrieve a PAD.

As part of this targeted work, the Scottish Ambulance Service have piloted a "CPR skills for disabled people" course. It is hoped that, if successful, this course can be made available across Scotland in addition to the development of digital training materials.

Language concerns may also affect the ability of the partners to meet with certain groups - for example, British Sign Language (BSL) users, non-native English speakers or Gaelic speakers across Scotland. Partners will consider how to address this barrier.

By acknowledging these inequalities and working with communities we can ensure that everyone has the best chance of survival.

GoodSAM

The GoodSAM smartphone app is a mechanism that can be used to increase readiness to respond to OHCA, and allow the ambulance service to alert responders in the community to a nearby OHCA^[29]. In 2020 the Scottish Ambulance Service began using GoodSAM to alert trained responders and off duty ambulance service staff. We will develop our use of GoodSAM to enable communities to respond more effectively to OHCA.

Actions:

1. We will continue our public awareness campaign, with a focus on increasing awareness of:

• the signs and symptoms of cardiac arrest.
• the importance of prompt bystander action (calling 999, CPR and defibrillation).
• that CPR is a gender neutral intervention.
• that aftercare resources are available for those who intervene in an OHCA.

2. We will focus our public awareness campaign on reaching those who we know experience inequalities in bystander CPR rates and survival from OHCA.

3. We will raise awareness of the potential of the GoodSAM app to be used to alert responders in the community.

"We never thought anything like this would ever happen to us, which is silly, of course it can happen to anybody."

The Newton Family

Judy Newton's husband Gregor walked up the stairs in their home around 9pm after lighting the log burner. A few moments later their 11 year old son Harry yelled for help from upstairs. Gregor had collapsed and his face was blue. Judy rushed up the stairs to help and Harry's older sister Eilidh called for an ambulance. Gregor was fit and well when he experienced his OHCA.

Judy began CPR, "I knew that I needed to try something and doing the first compressions, hearing his ribs breaking, I didn't realize I had that much strength in my body. I couldn't remember the ratio, that we get taught, so I made it up as I went along I just did compressions and was praying to everybody"

Sandy, a first responder arrived quickly after the 999 call and brought the defibrillator to deliver a shock to Gregor, about 45 seconds later Gregor gave a cough and regained consciousness.

"And then I kind of knew he was ok when he started to swear profusely" said Judy.

From Harry recognising something was wrong and calling for help, Eilidh calling 999, Judy delivering CPR, Sandy arriving with a defibrillator, and the ambulance arriving to take Gregor to hospital, everybody played their part and did it 100%.

"It shows the Chain of Survival is not just some theory, it really does work if everything takes place.''