In the UK each year 60,000 people suffer a sudden cardiac arrest outside hospital, according to figures from NHS Digital. Approximately half of these receive a resuscitation attempt from the ambulance services, however the recovery rate remains disappointingly low with only 9% surviving to leave hospital.
Awareness raising events such as Restart a Heart Day, which takes place each October, aim to educate the public in how to help someone who has suffered a cardiac arrest. In 2019 an impressive 291,000 people were trained in CPR throughout the day with the support of Resuscitation Council UK together with the British Heart Foundation, British Red Cross, St John Ambulance, UK ambulance services and Save a Life for Scotland.
The CQC says that all GP practices must be equipped to deal with a medical emergency, including resuscitation, and to have a resuscitation lead. This means all staff should be suitably trained, which can include online training. Resuscitation Council UK has suggested a minimum equipment list for primary care and this includes an automated external defibrillator (AED) which should be available for immediate use.
Have a practice policy on emergencies
The presence of defibrillators in public places is now commonplace, making them more accessible to the public when needed. Training more people will give them the confidence to use them, however, it’s not unusual for members of the public to approach a GP practice for help in an emergency which has occurred near the surgery.
If this happens it is important that reception staff, who are likely to be the first port of call, know what action is expected of them, particularly if clinical staff are not immediately available.
It is helpful for the practice to have a policy setting out expectations and to ensure that all staff are familiar with it. The fact that clinicians may be busy seeing patients or with other duties should not prevent assistance being given to a member of the community in acute need of attention.
Professional obligation to help
Doctors and nurses also have professional obligations to help with a medical emergency in the vicinity, such as a member of the public having a cardiac arrest. In Good Medical Practice the GMC states: ‘You must offer help if emergencies arise in clinical settings or in the community, taking account of your own safety, your competence and the availability of other options for care.’ The NMC code states that nurses should 'always offer help if an emergency arises in your practice setting or anywhere else'.
There would be an expectation that relevant staff attending the emergency would be able to use an AED – either the surgery’s own device or one that is available to the public and located nearby.
If your practice has a defibrillator, it should be in working order and regularly checked. All parts, including the pads, should be in date. The CQC requirement is for surgeries to be able to respond immediately in an appropriate manner to meet the needs of a person who becomes seriously ill.
Public access to practice defibrillators
Best practice, is for surgeries to have rapid access to defibrillators to ensure the welfare and safety of patients. If a practice doesn’t have their own defibrillator, it’s important for all frontline staff to be aware of the closest publicly accessible one.
The CQC does not require practices to be a general first responder but the presence of a defibrillator at the practice can be put on the list of public access defibrillators and linked to the 999 service. There is no legal obligation for defibrillator owners to link their AED to the 999 service, however, not doing so could prevent nearby members of the public accessing the care they need.
Practices can register their public access defibrillator via the Circuit, which is the national defibrillator network, should they wish to do so.
The CQC and Resuscitation Council UK have useful resources on expectations when dealing with medical emergencies which will help practices in formulating or updating their protocols. Your medical defence organisation can provide further support and advice.