DOI: 10.12809/hkmj175074
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
EDITORIAL
Public access defibrillation: the road ahead
Axel YC Siu, FHKCEM, FHKAM (Emergency Medicine)
Resuscitation Council of Hong Kong, Room 809, HKAM
Jockey Club Building, 99 Wong Chuk Hang Road, Aberdeen, Hong Kong
Corresponding author: Dr Axel YC Siu (siuyca@ha.org.hk)
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Hong Kong is regarded as one of the cities with the
most advanced medical technology. The survival for out-of-hospital cardiac
arrest (OHCA), however, remains far from ideal. From a series in
2012-2013, only 2.3% of all OHCA patients survived to discharge, a rate
considered low compared with other developed countries in Asia.1 2 Meanwhile,
the survival-to-discharge rate for OHCA in Singapore has doubled over the
last 10 years because of the improved emergency medical services response
time and the successful public access defibrillation (PAD) programme.3
Early defibrillation is one of the most important
elements in the Chain of Survival.4
Hong Kong has had a PAD programme for more than 20 years although there
are no formal statistics for the number of automatic external
defibrillators (AEDs). According to an estimation of one of the AED
locator mobile app developers, there are approximately 5000 AEDs installed
in publicly accessible areas. This is only one quarter of the number per
population in Japan.5 Nonetheless,
number of AEDs installed is not the only factor that dictates the success
or not of a PAD programme. The accessibility of the AED will affect the
time to first defibrillation. In other countries, AEDs can be accessed by
anyone. They can be found in convenience stores, vending machines, and
even in taxis. On the contrary, a number of AEDs in Hong Kong can be
accessed only via security staff or customer service personnel. This
indirect approach will inevitably delay the time to first defibrillation.
Even worse, despite the established benefit of AED in early
defibrillation, misconceptions remain about individual liability when
using an AED. This is evidenced by the disclaimer, which restricts use of
AEDs to trained persons, that accompanies some locally installed AEDs.
Despite the availability of AEDs, a PAD programme
is doomed to failure if AEDs are not used. A local study showed that
public knowledge about AEDs was inadequate and fewer than 20% of
respondents to a survey would use one.6
The lack of enactment of a Good Samaritan law may not reassure members of
the public about possible liability when using an AED, even though they
are designed to be operated by a layperson. On 1 October 2017, Mainland
China enacted this law under Cap 184 of the Civil Law of the People’s
Republic of China.7 There is a real
need for Hong Kong to explore a similar enactment. We should also consider
broadening the spectrum of cardiopulmonary resuscitation (CPR) and AED
promulgation, eg mandatory CPR and AED training in secondary schools to
teach this life-saving skill and relieve anxiety about initiating help.
Scientific research can also facilitate the PAD
programme. In Singapore, national data revealed that the majority of OHCAs
occur at home. The government responded by installing AEDs in all public
housing estates.8 Lack of a
territory-wide cardiac arrest registry and AED registry in Hong Kong may
affect the cost-effectiveness of the PAD programme. The study by Fan et
al1 is a good start but we need a continuous registry, like the Cancer
Registry, to observe the ongoing trend of cardiac arrests.
At an international level, the Global Resuscitation
Alliance (GRA) was established in 2016 and comprised a group of
international experts in resuscitation. It aimed to improve the survival
of OHCA by modifying the system in the community for response to an OHCA.
Establishing a PAD programme was one of the 10 steps identified by the GRA
for improving survival.9 At a local
level, we need a strategic plan for a PAD programme, including using local
OHCA data to coordinate the placement of AEDs as well as establishment of
an AED registry. Together, these will facilitate technological advances
such as a mobile phone app and enhance the accessibility of AED.10 The Resuscitation Council of Hong Kong was
established in 2012 with the aim of promoting CPR and AED in the
community. As well as routine public promotion activities, the Council
also advocated relevant policy change in Hong Kong to promote a CPR- and
AED-friendly environment. In the near future, the Council will focus on
the establishment of an electronic AED Registry and enactment of the Good
Samaritan law.11
Declaration
The author has disclosed no conflicts of interest.
References
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