Special report: Defibrillators in schools

Published:

Plans to help schools buy defibrillator machines at a lower cost have been broadly welcomed. Editor of the British Journal of School Nursing, Caroline Voogd, looks at the implications.

Every year, dozens of children and young people die as a result of sudden cardiac arrest (SCA). Early CPR and defibrillation can help save some of these lives.

Unfortunately, defibrillators are not available in all schools. In light of this, a number of organisations have campaigned to make automated external defibrillators (AEDs) compulsory in schools. Recently, the government has recommended that all schools should consider purchasing the devices as part of its new guidance on supporting students with medical conditions.

Incidence

It is difficult to establish the exact incidence of deaths in children and young people as a result of SCAs. According to the British Heart Foundation (BHF), around 500 young people die with no apparent cause of death and inherited heart conditions are often to blame. The Department of Health (DH) estimates that approximately 88 children a year die of SCA.

The Resuscitation Council UK and BHF guidance, published in 2013, states: “The precise incidence is not known as there is no national registry of such events in children, and post-mortem examinations do not always identify the cause (many of the cardiac conditions that cause SCA in this age group are not detectable after death).”

Although there is a lack of data on the number of SCAs in children and young people in the school setting, a US study in 2007 found an estimated incidence of cardiac arrest in schools of 0.18 per 100, 000 students and of 4.51 per 100, 000 staff members each year.

The government plan

In April this year, the Department for Education (DfE) released new statutory guidance on supporting students with medical conditions in schools.

The guidance states: “Modern defibrillators are easy to use, inexpensive and safe. Schools are advised to consider purchasing a defibrillator as part of their first aid equipment.”

The DfE has also announced plans to enable schools to purchase the equipment at a lower cost, with a “deal to allow schools to buy defibrillator machines at a reduced price” to be organised by the autumn term.

The DfE said: “The government is working to identify a supplier who will offer defibrillators – which cost around £1,000 – to all schools at a competitive price.”

The Parliamentary under secretary of state for schools, Lord Nash, added: “By securing defibrillators at a reduced price, schools will find it much easier to install these potentially life-saving devices. We hope schools right across the country will take advantage of this.”

The move has been welcomed by a number of organisations, some of which have been campaigning for action in this area for some time.

A statement from the Resuscitation Council UK said: “While the announcement by the DfE falls short of a mandatory requirement, we recognise this as a major step forward in the fight against sudden cardiac death. 

“We look forward to working further with the DfE and also the DH in providing guidance for schools on how to deliver training in CPR.”

Anne Jolly, founder of SADS UK (SADS stands for Sudden Arrhythmic Death Syndrome) added: “This school guidance is a major step forward and SADS UK believes all schools must seriously consider the possible consequences of not having a life-saving defibrillator on their premises. SADS UK continues to urge government to legislate to make defibrillators compulsory in all schools.”

Headteachers have also voiced their support for the move. Russell Hobby, general secretary of the National Association of Head Teachers, said: “These devices can save the lives of both pupils and staff. Modern defibrillators are easy to use and very safe.”

AEDs in schools

According to the BHF, for every minute that passes without defibrillation chances of survival decrease by about 10 per cent. Therefore, in the case of a SCA, easy access to a defibrillator in the school setting is crucial.

Sarah Sherwin, senior lecturer and school nursing course leader at the University of Wolverhampton, told SecEd: “Sudden cardiac arrest can affect young people without or with a known history of cardiac problems, and having a defibrillator on site that can be used by trained first-aiders will be invaluable in saving lives.

“Not only will it potentially help save the lives of young people but also school staff, visitors and those using the building after hours to attend clubs and sports events who may also suffer a cardiac arrest. 

“Schools, particularly secondary schools, are often large complex buildings and getting an ambulance to someone within five minutes to administer a defibrillator is challenging and every minute that goes by significantly decreases the likelihood of recovery.”

Although according to the Resuscitation Council UK and BHF guidance, AEDs in schools are likely to be used infrequently and are more likely to be used on adults, there are other advantages to having them. One of these is the simple fact that students will become “familiar with them and can learn about their purpose”.

They recommend that this could be incorporated into classes on first aid, including CPR training.

The guidance continues: “School-age children have been shown to be capable of using AEDs in simulated cardiac arrest scenarios, and all school children should be taught emergency life-saving techniques.”

As AEDs become more readily available in the community, it is important that children and young people learn about the devices. School nurses and members of school staff who provide advice on, or are involved in the delivery of, PSHE and/or first aid training to children and young people can help ensure that AEDs are included.

Training

School staff members, and school first-aiders in particular, should be trained to use AEDs, and ensure these skills are kept up-to-date.

Ms Sherwin continued: “School nurses should also be trained to operate a defibrillator as part of their mandatory CPR and immunisation training.”

However, while training should be encouraged, it is important to remember that AEDs can be used effectively by untrained members of staff or the public. As every minute counts in the case of a cardiac arrest, they should not be discouraged from using the devices. 

The Resuscitation Council UK said: “(AEDs) are very effective at guiding the operator through the process of administering the shock. They have become widely available, are safe and easy to use, and will not allow a shock to be given to a victim who does not require one.

“AEDs have been used frequently by lay people with modest training, and many reports testify to the success of this strategy. Operators without formal training have also used AEDs successfully to save lives.”

It warns: “It is inappropriate to display notices to the effect that only trained personnel should use the devices, or to restrict their use in other ways.”

Location

The DfE guidance recommends that schools which install a defibrillator within their premises should notify the local NHS ambulance service of its exact location. 

This recommendation echoes the Resuscitation Council UK and BHF guidance: “It is recommended that the local ambulance service is made aware that an AED is available at a particular location and whether it can be accessed at all times or only (for example) during office hours; this information can help ambulance call-takers guide those initiating a resuscitation attempt.

“The most important consideration is that those who might need to use an AED know where it is kept and how to access it quickly. No barrier should be put in the way of anyone collecting it when it is needed; it should not be locked away and inaccessible.”

References/useful sites

• BHF (2009) Inherited Heart Conditions: Sudden Arrhythmic Death Syndrome: http://bit.ly/1k1VME4

• BHF (2012) Cardiac Arrests Explained: http://bit.ly/SRvOrN

• Details of the DfE’s plans to provide defibrillators to schools: http://bit.ly/1lRMWo2

• DfE (2014), Supporting Pupils at School with Medical Conditions: Statutory guidance: http://bit.ly/PRfNQv

• Resuscitation Council UK, BHF (2013), A Guide to Automated External Defibrillators: http://bit.ly/1khktqw

• The BHF: www.bhf.org.uk

• The Resuscitation Council UK: www.resus.org.uk

• Cardiac Risk in the Young: www.c-r-y.org.uk

• SADS UK: http://sadsuk.org.uk/

• The Oliver King Foundation: www.theoliverkingfoundation.co.uk


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