In the most deprived areas of England and Scotland, the nearest 24/7 accessible defibrillator is on average a round trip of 1.8 km away — over a mile — according to a pioneering study supported by the British Heart Foundation (BHF).
The researchers, led by Dr Chris Wilkinson, senior lecturer in cardiology at Hull York Medical School, used data from national defibrillator network The Circuit to calculate the median road distance to a defibrillator with unrestricted public access across Great Britain's 1.7 million postcodes.
Among the 78,425 defibrillator locations included, the median distance from the centre of a postcode to a 24/7 public access defibrillator was 726.1 metres – 0.45 miles. In England and Scotland, the more deprived an area was, the farther its average distance from a 24/7-accessible defibrillator – on average 99 metres more in England, and 317 metres farther in Scotland for people living in the most compared with the least deprived areas.
There was no link between defibrillator location and deprivation in Wales.
The researchers said they hoped the findings, presented at the European Society of Cardiology (ESC) Congress in Amsterdam and published in the journal Heart, would lead to more equal access to defibrillators. They noted that there were over 30,000 out-of-hospital cardiac arrests (OHCA) annually in the UK; in England nearly 30% happened at weekends, and 40% between 6pm and 6am.
Greater Distances to a Defibrillator "Putting Lives at Risk"
The overall survival rate was less than 10%, and every minute's delay between arrest and defibrillation reduced survival chances by up to 10%. "The postcode a person lives in may have an important impact on their or a loved one's chance of surviving a cardiac arrest," the researchers commented.
Dr Wilkinson said: "By calculating how far every postcode in Great Britain is from its nearest defibrillator, we've shown just how much deprivation levels affect the public's access to these lifesaving devices out-of-hours in England and Scotland."
Co-author Chris Gale, professor of cardiovascular medicine at the University of Leeds, said: "Our research shows that community defibrillators are not an option for many people who suffer cardiac arrest, especially those living in areas of deprivation. This is putting lives at risk."
Defibrillators "Disproportionately Placed in More Affluent Areas"
In the past, ambulance services have only been able to locate defibrillators using their own regional databases. Research published last year from the University of Warwick had shown similarly that defibrillators registered with English Ambulance Services were "disproportionately placed in more affluent areas", sometimes with a "mismatch" between defibrillator density and OHCA incidence.
The Circuit is a joint venture between the BHF, NHS, Resuscitation Council UK and St John Ambulance, in partnership with the Association of Ambulance Chief Executives. Its aim is to map all public access defibrillators across the UK for the first time, to help ambulance services direct bystanders to their nearest one.
Data show that defibrillators are currently used in fewer than 1 in 20 OHCAs. The ESC also heard from a new Lancet Commission aiming to reduce the global burden of sudden cardiac death and address the "unacceptably low chance of survival" from OHCA – less than 10% in most parts of the world.
Defibrillators Could Be Delivered by Drone
The Commission recommended that public access defibrillators be targeted in locations with high OHCA incidences, registered, accessible 24 hours a day, and linked directly to emergency services. The possibility of mobile defibrillator delivery by taxis or drones "should be further explored", it said.
Last year the Government promised £1 million extra funding for defibrillators "in areas most in need", to ensure they were "evenly spread throughout communities", for example in town halls, community centres, shops, post offices, and parks.
Asked to comment on the new study by Medscape News UK, a Department of Health and Social Care spokesperson said: "We are committed to increasing the number of defibrillators in public areas. We recently announced funding to provide around 1000 new defibrillators in community spaces across England, and all state schools now have access to an on-site defibrillator. We have also written to local authority leaders urging them to ensure defibrillators in their area are registered on The Circuit."
Many Defibrillators Unknown to Ambulance Services
Meanwhile it remains up to their guardians to register defibrillators on The Circuit database. The BHF said there were likely to be "tens of thousands of defibrillators in locations still unknown to the ambulance services". Judy O'Sullivan, BHF director of health innovation programmes, said: "We are proud that data from The Circuit has helped to highlight that deprived communities need better support to help improve response times to an OHCA.
"Bystander CPR and defibrillation can double the chance of survival from a cardiac arrest, so it is crucial that we address the unequal access to defibrillators in order to improve survival rates."
Yet according to Adam Greenwood, community engagement manager for St John Ambulance, 47% of people still don't know where to find their nearest defibrillator. "More work is needed to help increase cardiac survival rates and access to defibrillators, especially in deprived communities," he said.
Dr Wilkinson added: "Making existing defibrillators accessible to the public 24/7 would make a big difference to the average distances people need to travel in an out-of-hours emergency, and would improve equality of access – which can help save lives.
The Circuit partner organisations urge all defibrillator guardians to register their device immediately (at https://www.thecircuit.uk/) so that it is visible to ambulance services.
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