World Health Day 2023: #HealthForAll

Seventy-five years ago, the World Health Organisation (WHO) formed a medical allegiance. Since 1948, the membership states have worked together under the mission statement that ‘everyone, everywhere can attain the highest level of health and well-being’. This World Health Day, Friday 7 April 2023, WHO are celebrating over seven decades of successful medical invention and innovation. However, they are also using World Health Day as an opportunity to highlight global health inequalities, and how, together, we can tackle them under the tagline #HealthForAll.

At Great Western Air Ambulance Charity (GWAAC), our mission is to deliver cutting-edge pre-hospital care to everyone who needs us. How we provide this care expanded in 2022 to include our public access defibrillator programme. The vision behind the programme is that we can strengthen the links in the chain of survival during an out of hospital cardiac arrest (OHCA) before the arrival of emergency responders.

A History of defibrillation

In 1947, just one year before WHO was founded, Claude Beck performed the first successful defibrillation, restarting the heart of a 14-year-old boy on his open chest during surgery. The first successful closed chest defibrillation was tested on a dog in in 1954 by William Kouwenhoven and William Milnor. Two years later, in 1956, Paul Zoll successfully resuscitated a human patient through closed chest defibrillation. Then in 1967, Professor Frank Pantridge innovated this technology by suggesting that we bring ‘emergency coronary care to patients’; this led to the invention of the defibrillator in 1978, before they were then made publicly available in 1980. In 2022, seventy-five years after the first successful defibrillation, we launched GWAAC’s innovative community defibrillator programme.

Like Pantridge we understood that early defibrillation at the scene of an OHCA enables early intervention in the chain of survival, prior to  emergency responders arriving. GWAAC’s defibrillator programme has a simple but critical aim: to reduce avoidable and unnecessary deaths from cardiac arrests. By equipping people with CPR training, and places with publicly accessible defibrillators, the programme works towards improving health outcomes in OHCA cases.

Out of Hospital Cardiac Arrest (OHCA): A ‘global health issue’.

Publicly accessible defibs have proven to be an effective and efficient way of improving OHCA health outcomes. If one is used on an OHCA sufferer ‘within 3–5 min of collapse’, their chance of survival increases by ‘rates in excess of 50%’. On the other hand, survival chances decrease by 10% per one minute delay to defibrillation*.

On the surface, defibs are effective, yet OHCAs remain a ‘global health issue’ suffered by approximately ‘3.8 million [people] annually’, with average survival rates at only 10%**.  Research shows that defibrillators are ‘underperforming, considering their potential’; where they are publicly available, use remains low.  In the UK, only 5% of OHCA cases are treated by a publicly accessible defibrillator prior to the arrival of emergency responders.***

Health Inequalities

Research suggests that deprived areas receive a lower standard of care when it comes to preventative public health initiatives. This leads to these communities experiencing higher mortality and ‘premature’ death from OHCA; this particularly impacts people of marginalised ethnicities.

A wealth of research conducted in a variety of countries has established that there is a ‘poor correlation’ between defibrillator placement and need. Overwhelmingly, defibs are being placed in locations that fail to reflect OHCA risk and therefore they remain inefficient as tools to improve OHCA survival outcomes globally.

Currently, defib placement fails to prioritise risk assessment. Moving forward researchers stress the importance of using historical OHCA data from the previous 3 to 5 years to inform public access defibrillator placement. Targeting residential areas is also more effective in increasing coverage of both in-home and public OHCA*. Using such historical data to inform defib placement would also see an ‘alignment between efficiency and equity’ because when they are distributed based on risk, OHCA outcomes are improved for everyone, but especially for those from lower socio-economic areas.

Achieving #HealthForAll

To achieve #HealthForAll these disparities need to be redressed globally and locally. By using historical OHCA data, identifying areas of disproportionate OHCA risk, and inequal access to education and defibs, GWAAC hopes to be part of a bigger movement within the communities we serve, working towards closing disparities in OHCA outcomes so that the 7/10 survival rate is accessible to all.

We hope to contribute to this by making our defibrillator programme accessible to anyone in our region, regardless of the community or area they live in. We also closely partner our defibrillator work alongside our Great Western Heartstarters work, teaching as many people as possible how to administer CPR and use a defibrillator when they witness a cardiac arrest.

*https://pubmed.ncbi.nlm.nih.gov/34757059/

** https://www.ahajournals.org/doi/10.1161/CIR.0000000000001013

*** https://doi.org/10.3390/ijgi9080491