Defibrillator use by young people
Automated External Defibrillators (AEDs) are being increasingly installed in public locations across the UK. They are available in places where there are large numbers of people (airports, railway stations, shopping centres, sports stadiums, schools), people with potentially increased risk of cardiac arrest (gyms, sports facilities) or where access to emergency services is delayed (aircraft and other remote locations). To reach more potential users, owners of defibrillators are encouraged to register the location and availability of their devices with their local ambulance services.
Most devices operate in a way that allows anybody to use them, without having had any prior training. When activated, visual and voice prompts guide anybody who is giving first aid to a person having a cardiac arrest with easy-to-follow instructions.
Less than 5% of people, suffering from a cardiac arrest, survive with CPR (cardiopulmonary resuscitation) on its own but these odds rise to 50% with the prompt use of an AED and effective CPR. So, the quicker a person helping can deploy a defibrillator, the better. So can just anybody help?
Who should operate a defibrillator?
The simple answer is that if somebody is having a cardiac arrest, anybody in the vicinity should be prepared to step up; a quick response is vital. Any worries that the incorrect use of a defibrillator can somehow make the patient's situation worse should be dispelled. Voiced instructions are easy to follow and in the unlikely event that they are not carried out properly they will not put the person having a cardiac arrest in greater danger. The machine is able to detect heart rhythms and will not deliver a shock unless it is necessary. Nevertheless, it is important to consider whether children should use a defibrillator, and whether they would require training first?
Training in the techniques of basic life support (BLS) has been standard practice for school children in many European countries (e.g. Germany, Denmark and Italy) and in many of the states of the USA for several years. Norway made the subject a compulsory part of the curriculum in all schools as long ago as 1961. Since then a staged program starts when children are seven years old.
Several studies have demonstrated that school children learn the techniques readily and retain the skills well. The Resuscitation Council (UK), along with other organisations (British Heart Foundation, St John and British Red Cross amongst others), has been campaigning for the mandatory inclusion of CPR training and AED awareness on the school curriculum across the UK. Whilst this goal is yet to be fully achieved, there has been a move from the current Westminster government to increase the availability and affordability of AEDs for school premises. This provides an ideal opportunity for schools to provide training to ensure that they get the best value for money for these purchases.
Teaching the use of the Automated External Defibrillator (AED) is a logical extension of basic life support training and in some countries is considered an integral part of such education. Where the use of AEDs is taught, the subject has usually been reserved for older children with a starting age of 16 being common, although some programmes in the USA start at 13. Ultimately, there is a clear need to improve the general awareness of the benefits of AEDs as well as a need to counter the myths that lead to them not being used (e.g. the fear of doing harm).
A number of studies have been carried out to verify how safe the use of defibrillators by children is and how well children can carry out CPR:
Study 1 – Use of defibrillators by children
A study from Seattle compared the use of defibrillators by untrained 6th grade children (11 - 12 year olds) with ambulance technicians and paramedics in a mock cardiac arrest scenario. The study aimed to improve understanding of defibrillator use in naive users by measuring time-to-shock and appropriateness of pad location.
AED use by 15 children was compared with that of 22 emergency medical technicians or paramedics. The primary element of the study centered on the time from entry onto the cardiac arrest scene to delivery of the shock for simulated ventricular fibrillation. The secondary element was appropriateness of pad placement. All subject performances were videotaped to assess safety of use and compliance with AED prompts to remain clear of the mannequin during shock delivery. Mean time to defibrillation was between 59 and 111 seconds for the children and between 50 to 87 seconds for the ambulance technicians/paramedics. Electrode pad placement was appropriate for all subjects. All remained clear of the "patient" during shock delivery.
During mock cardiac arrest, the speed of AED use by untrained children was only slightly slower than that of professionals. The difference between the groups is surprisingly small, considering the naïveté of the children as untutored first-time users. These findings suggest that widespread use of AEDs will require only modest training.
Study 2 – CPR delivered by children
An observational study took place at four schools in Cardiff amongst 157 children aged 9-14 years in three school year groups (ages 9-10, 11-12, and 13-14). Participants were taught basic life support skills in a single lesson lasting 20 minutes and were then tested for the effectiveness of three minutes continuous chest compression on a manikin.
No year 5 pupil (age 9-10) was able to compress the manikin's chest to the depth recommended in guidelines. 19% of pupils in year 7 (age 11-12) and 45% in year 9 (age 13-14) achieved adequate compression depth. Only the 13-14 year olds performed chest compression as well as adults in other reported studies.
The study concluded that the children's ability to achieve an adequate depth of chest compression depended on their age and weight. The ability to provide the correct rate and to employ the correct hand position was similar across all the age ranges tested. However, young children who are not yet physically able to compress the chest can nonetheless learn the principles of chest compression as well as older children.
Overall conclusions based on the two studies:
- Children are very adept at learning lifesaving skills from a very young age.
- Resuscitation skills should be learnt at school, since children are easily motivated, learn quickly, and retain skills.
- Younger children (under 13) are unable to perform chest compressions adequately due to their age and weight, although the skill should be taught.
- AED training, on the other hand, can already be taught to children as young as 11 who are able to assimilate the techniques and put them into practice.
Therefore, it would not be inappropriate to teach children as young as 11 to use a defibrillator, even though they may have insufficient strength to use compression techniques.
Comments from interested organisations
The Resuscitation Council (UK) do currently not have a policy on a specific age at which education in life saving skills should start. However, they believe it likely that children aged 11 would learn how to use an AED successfully, and see no reason why instruction should not start at an early age.
St Johns Ambulance do not presently train anyone under the age of 14 formally within the organisation and are therefore unable to comment at this time.
The Girl Guides currently include the use of defibrillators in their 1st Response training, but this is aimed at adults. Some members of the Senior Section may attend this as well (age 14-25).
A representative of the Lincolnshire School Nursing Service stated that it is the responsibility individual schools to determine their first aid policy, including any training in the use of AEDs.