Could you save a life in Singapore?

What would you do if you were on the MRT and someone had a heart attack? Approximately 15 people die each day from a heart attack in Singapore. Hopefully, there would be an AED nearby that you could use to help the victim survive. An Automated External Defibrillator (AED) is a small portable device that analyzes potentially life threatening cardiac rhythms in a patient and deal with it by defibrillation through the application of an electrical shock to allow the heart to re-establish normal rhythms. While the usage of AEDs are not limited to only trained professionals, basic knowledge of the device and certain training is recommended to enable more accurate and appropriate use of the device.

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How to use AEDs. Picture from Creative Commons

The third critical link in the Chain of Survival, early defibrillation can greatly improve survival rates for cardiac arrests that are out-of-hospital caused by ventricular fibrillation. Defibrillation works best in the first few minutes after the onset of cardiac arrest. Fast and quick judgement is crucial in the usage of AEDs. It is crucial to reach the victim as quick as possible for every minute of delay in giving CPR and defibrillation decreases the survival rate expediently as it can go down by seven to 10 percent in a matter of sixty seconds.

Once defibrillation is initiated too late, the heart may not respond even to the electric therapy. Thus, the installation of an Automated External Defibrillator in many places is pivotal  because it is one of the first few steps that could save a friend, family member or a bypasser.

There are approximately 100 SMRT taxis that have been installed with Automated External Defibrillators as part of a program called the SMRT-Temaset Cares AED on Wheels. This is a three-year program that aims to increase the availability of AEDs in the community including the taxis as cardiac arrests happen everywhere. Supported by the Singapore Heart Foundation, Singapore Civil Defense Force and the National Taxi Association, this program has been launched in 2012 and has since thrived due to the popularity and accessibility. Participating taxi drivers who were under the program went to learn basic information in a four hour certification course with the Singapore Heart Foundation.

Rani Krishnasamy was one of the many taxi drivers who participated in the installation of AEDs in the SMRT taxis. “It does not take up space, it’s just a small bag below my seat. It’s a good thing because to save a life is very important and if those few minutes count, I think it’s very important.”

This program has focused on teaching them CPR techniques as well as how to use the AEDs on the victims of cardiac arrest. This program has further expanded and developed as the drivers who are within a 1.5 kilometer radius of a cardiac arrest case will be alerted by a mobile application implemented by the Singapore Civil Defense Force.

By the end of this year, this program will undergo a short process of how this application/system is working and will focus on broadening the program so that the majority of the SMRT taxis will have been installed with the AEDs. According to Channel News Asia, Ms. Woon Saet Nyoon, the general manager of Temasek Cares, stated that “the service will look at how the response will be from the taxis and if it is successful, [we] the service will bring this program to our partners and (look at) how we can ramp it up to include more taxis.”

These devices installed in taxis is a small step taken to further notify the citizens of the risks of not having these devices available in a walking distance of around three minutes. From the article called “Resuscitation” written by David Chee Guan Foo, a national research survey was done on May 2013 on the prevalence of first aid, respondents’ beliefs on First Aid, CPR and AED training; whether they have ever been trained and lastly, whether they possess a valid certification to perform any of these life saving skills.

Surprisingly, the numbers came out much lower than expected. Only 34.3% of the people who believed adults should be trained in the First Aid had been trained in first aid. And 31.4% of people who believed adults should be able to perform CPR had been trained to perform CPR. Only 10.7% of the people knew how to function an AED. Not surprisingly, only 9.6% of the people had verified certifications on First Aid, 9.6% had verified certifications to perform CPR and only 3.7% of the sampled population had a verified certification to function an AED properly.

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Survey on Responders’ beliefs on first aid and life saving skills. Picture from ResearchGate.

When I asked Eric Chung, a senior, he was unsure of what the device was and what it was used for. “Isn’t it the thing when you use gel so that the person doesn’t receive too much electricity? You rub the two pads together and when it charges up, you shout ‘clear’?”  

John Choo, also a senior was also unsure of what an AED was. “Isn’t it something to do with attention disorder?”

These numbers and interviews accurately describe the lack of knowledge people have about these life saving skills and devices. Although it is not necessary to be a paramedic to perform any of these skills or function the AEDs, basic knowledge of what could be done to a victim of cardiac arrest, seizures or other various sudden illnesses could prevent further harm/damage to a huge population of people.

Each year on average, around 1.5 million Americans suffer from heart attacks. This sudden illness is a dominant cause of deaths in women and men. Nearly 30% of the deaths in Singapore in 2014 had been due to cardiovascular diseases, mostly from Ischaemic Heart Disease. Approximately 15 people die each day due to heart attacks in Singapore.

There have been so many cases and studies on the importance of AEDs and how much the installations have increased the survival rate of many patients. In 2002, Kenward published a primary research on in-hospital usage of AEDs and the resuscitation outcome of the patients who were suffering from cardiac arrests in Atlanta. In the 17 sample size in the five studies done, Kenward had identified that the combination of biphasic manual and automated defibrillators, the survival of all patients with resuscitation events improved 2.6-fold, from 4.9% to 12.8% which was a significant change for both the hospital and the patients.

Tiny bits of knowledge about AEDs could ultimately make a difference in a patient’s life – whether the person is a family member, friend, or a bypasser. Each second is important to the patient’s life and is a matter of life or death.

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