Dáil debates

Wednesday, 15 June 2005

Adjournment Debate.

Medical Aids and Appliances.

8:00 pm

Photo of Michael LowryMichael Lowry (Tipperary North, Independent)
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I wish to raise the urgent need to establish a national programme to provide automated external defibrillators to structured community groups and local sporting organisations. The facts are astonishing.

Photo of Rory O'HanlonRory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Can we have silence please for Deputy Lowry?

Photo of Michael LowryMichael Lowry (Tipperary North, Independent)
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According to the Central Statistics Office, over 11,000 people died in 2002 from cardiovascular disease. It is estimated that outside the hospital system, 6,000 people will suffer cardiac arrest this year. Up to 99% of these patients will unfortunately die. At present, survival prospects are down to 1%. For every one minute delay in treating a cardiac arrest patient, there is a 10% reduction in survival chances. There is almost no chance of survival after a ten to 12 minute delay awaiting treatment. If a patient receives defibrillation, the chance of survival increases to 60%.

Ireland is lagging behind the developed world in the promotion of community-based defibrillators. By comparison, in mainland Europe, a cardiac arrest patient outside of the hospital system has up to a 60% chance of survival. Likewise, in the US there is a 60% survival rate. We regularly hear about tragic sudden deaths. This year it is estimated that 6,000 people will suffer from cardiac arrests, and unfortunately only 60 will survive. The Minister is aware of the chain of survival concept which consists of early access and involves recognising that a person is in cardiac arrest and calling 999 immediately, early cardiopulmonary resuscitation, early defibrillation and early advanced care.

It is essential that every link is as strong as possible because the chain of survival is only as strong as its weakest link. It is worth noting that the first three links take place at the location of a cardiac arrest before professional emergency medical attention is given and that often only the final link of early advanced care is administered by emergency medical technicians or in hospitals.

There are excellent examples of how the availability of defibrillation machines in places where people congregate has saved lives. Dublin Airport installed defibrillation units last year. Since installation, there have been four incidents where they have been used and credited with saving lives.

Defibrillation units are installed in Croke Park, RTE in Montrose and Leinster House. Only two weeks ago, Shannon Airport installed three public access units. It should be the accepted norm that these devices are available and accessible throughout the workplace and at locations where people congregate in large numbers.

AEDs are similar to fire prevention systems in that they are devices which communities and companies should have, but hope not to have reason to use. Unfortunately, while companies spend hundreds of thousands of euro on elaborate fire systems, many do not spend the relatively small amount required to purchase an AED unit and train staff in its use. Many experts agree that we need to reach a stage where public access AED units are as commonplace as the familiar fire extinguisher.

The chain of survival is only as strong as its weakest link, and at present the weakest link is access to defibrillators. In the United States, AED units are carried on all fire engines and in every police squad car. In Ireland, on the other hand, only a handful of fire engines carry AEDs, and it will be years before every Garda car has one.

Communities across Ireland are willing to install these units, but need encouragement and financial support by way of grant aid to make it possible. I urge the Minister to wait no longer but to take decisive action. An AED unit placed strategically in a community ensures that the weakest link in the chain is significantly strengthened. A national programme to encourage public access is needed. The Department should initiate a funding scheme for structured voluntary and community groups which comply with established criteria. With equipment, training and accessories, the average total cost of installing such a unit is €5,000. A sliding scale of funding for groups would act as a significant incentive in promoting wider availability of AED units. Community and voluntary groups face huge obstacles such as difficulties in receiving public liability and medical indemnity insurance cover, the high costs of initial training by professionals and ongoing training and maintaining the interest and commitment of volunteers over long periods of time.

Making more people aware of sudden cardiac arrest and improving access to defibrillators permits an increase in the survival rate for many people. I call on the Minister to take immediate steps to establish a national AED access programme to provide financial assistance for equipment and training to the live-saving and invaluable work being undertaken by community and voluntary groups across the country. Such a scheme will give every cardiac arrest patient the best chance of survival.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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I am replying on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank Deputy Lowry for raising this matter as it provides me with an opportunity to outline details of the work in progress to potentially reduce the number of sudden cardiac deaths in the community.

I am advised that the provision of community-based cardiac defibrillators or automated external defibrillators, AED, including their placement, the ongoing training of relevant personnel and community volunteers and related issues are being examined by the recently established task force on sudden cardiac death. The task force, chaired by Dr. Brian Maurer, was established in September 2004.

In its terms of reference the task force was asked to define sudden cardiac death and describe its incidence and underlying causes in Ireland. It was also asked to advise on the detection and assessment of those at high risk of sudden cardiac death and their relatives, and to advise on the systematic assessment of those engaged in sports and exercise for risk of sudden cardiac death. The terms of reference also asked the task force to advise on maximizing access to basic life support, BLS, and automated external defibrillators and on appropriate levels of training in BLS and use of AED and on the maintenance of that training; identifying priority individuals and priority groups for such training; identifying geographic areas and functional locations of greatest need; best practice models of "first responder schemes" and "public access defibrillation" and the integration of such training services.

The task force is also to advise on the establishment and maintenance of surveillance systems, including a registry of sudden cardiac death and information systems to monitor risk assessment and training and equipment programmes. In addition, it is to advise and make recommendations on other priority issues relevant to sudden cardiac death in Ireland and it is to outline a plan for implementation and to advise on monitoring the implementation of recommendations made in its report.

I am advised that the task force has engaged in an extensive consultation process with key stakeholders, including relevant groups and bodies. As part of this process, the task force wrote to a number of organisations earlier this year seeking their views and suggestions on how the task force's objectives could be achieved. The task force also placed an advertisement in the national media on 11 February 2005 inviting submissions from interested members of the public and private, professional and voluntary organisations and other parties.

I understand that over 80 submissions were received and that most of those who made submissions were invited to participate in a consultation day on 7 April at which these issues were discussed further. Another consultation day was held on 13 May 2005 on issues relating to the task force's fifth term of reference, which is to advise on the establishment and maintenance of surveillance systems, including a registry of sudden cardiac death and information systems to monitor risk assessment and training and equipment programmes. This involved some task force members meeting representatives of the Irish College of General Practitioners, the Central Statistics Office, the Faculty of Pathology and others.

I understand that the task force has received active co-operation and support from all those consulted. I am advised that the report is now being prepared and should be completed by the autumn. Its recommendations will inform future policy in this area.