Automated External Defibrillators and simple airway devices can be used by bystanders to help victims of cardiac arrest and drowning
Recent deaths on popular Cape Town beaches point to the need for defibrillators and simple airway devices which can be used by bystanders. On busy beaches like Mnandi, Strandfontein and Clifton, the easy-to-use Automated External Defibrillator (AED) could save lives.
Most mornings after sunrise, you see them on certain Cape Town beaches: men and women, young and old, all shapes and sizes, plunging into the frigid Atlantic waters. Three months ago, crossing the beach on one of those mornings, you would have seen a small group of people taking turns to do chest compressions on a fellow swimmer lying near the water's edge. He had been assisted out of the water, in distress, then experienced a cardiac arrest - his heart stopped. His comrades immediately went into action with cardio-pulmonary resuscitation (CPR) to try to save his life.
Chest compressions were done for about 30 minutes before paramedics arrived with equipment, including AED, in hand. But sadly, efforts to save the 57-year-old man were unsuccessful.
A hundred fellow swimmers and friends gathered next morning at the beach to remember him, a person who loved being part of the vibrant Atlantic seaboard aquatic community.
About two months later, another dramatic scene at the same beach: a woman was found floating face down in the water by other swimmers about 20 metres offshore. She was brought back to the beach by a swimmer who fortunately had a flotation device with him and knew the correct method for doing this safely. Attempts were made to revive her. But in spite of 40 minutes of resuscitation, including mouth-to-mouth breaths, and attention from five paramedic crews who responded to the call for help, the drowning victim, also in her 50s, died too.
What to do when someone's heart stops
Promptly recognising a cardiac arrest (sudden collapse, no pulse, no breathing), is key. When confirmed, the rescuer should follow with chest compressions, with the victim lying flat on a hard surface.
Doing compressions is hard work but if done effectively (pushing the chest down at least 2 inches (5cm)) and continuously (100 times per minute), enough blood goes to vital organs (brain and heart) to sustain life until the heart can be restarted.
Rescuers first need to make sure of their own safety. And call for help.
When paramedics arrive, they bring more specialised items - bags, masks, tubes, scopes (airway visualising devices) - to support breathing while chest compressions continue.
Crucially, their kit includes a defibrillator, a battery-powered device that administers electric shocks through the chest wall to the heart. If the heart has stopped because of a rhythm disturbance (fibrillation), an electric shock may restart it; chest compressions alone cannot do this.
AEDs - Automated External Defibrillators - are resuscitation assistants. The voice instructs the rescuer to call for emergency medical help and how to correctly place pads on the chest, and analyses the heart rhythm. If a life-threatening rhythm disturbance is present the AED can automatically give a shock or tell the rescuer when to press the button. Untrained bystanders can easily and successfully use an AED.
With good chest compressions and early defibrillation, survival from cardiac arrest is possible but each minute of delay seriously reduces the odds.
Around the world, survival from cardiac arrest is low, about 7-8%. To change this, defibrillators are sited in public places - Australian beaches, for example - and made easily accessible. Their prompt use at least doubles the odds of survival.
Devices cost about R30,000, though less expensive versions are coming on the market. The concern in South Africa is that AEDs not stored securely will be stolen, as has sadly happened with Pink Rescue Buoys placed by the National Sea Rescue Institute (NSRI) to prevent drownings.
But there are ways to prevent this. For instance, the NSRI has installed boxes containing a first aid kit for shark attacks which can be opened with a PIN code obtained by calling a 24-hour number. AEDs could be placed securely in a similar way.
Life-saving equipment in a box
Other items such as pocket masks and face shields, which cost only a few rands, could also be placed in boxes. These are essential on a beach, where drowning may be more likely than cardiac arrest, and rescue breaths need to be given. (Clearing the airway and giving five rescue breaths is vital if drowning has occurred, but is no longer recommended for a cardiac arrest unless an airway device is available.)
Pocket masks and face shields allow a bystander to give breaths without direct mouth-to-mouth contact. One-way valves prevent the rescuer from inhaling the victim's exhaled air and minimise the risk of contamination. Both items are compact and portable, easy to carry and use in emergencies.
Regular swimmers could also obtain their own and take them down to the beach, just in case.
About 1,500 people die of drowning on our beaches each year. With sensible precautions these deaths are largely preventable. Bystanders who see a swimmer in trouble can save a life by calling for help (112 for emergency services) and taking action if they know first aid and CPR.
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Making defibrillators, airway devices and other key rescue items available in public places, such as local businesses, along with community awareness and user knowledge can create safer spaces for everyone to enjoy.
Cape Town beaches like Clifton and Camps Bay that are well resourced, visited by tourists, and surrounded by affluent communities will find it easier to make AEDs and airway devices more available. But the need is as great or greater at popular beaches like Mnandi, Alpha, and Nine Miles which also have dedicated volunteer lifesaving clubs.
A cardiac arrest can happen to anyone - not just older people doing challenging outdoor things but young athletes. Prompt recognition and defibrillation are the only way these lives can be saved.
Tragic deaths from drowning on public beaches in summer are common and bystanders can make a difference by giving rescue breaths safely using inexpensive masks or face shields.
A successful resuscitation is a celebration. It has profound effects not only on people who are brought back to life but on people who gave them that gift.
Dr Kantor is an anaesthesiologist and healthcare industry consultant.
Views expressed are not necessarily those of GroundUp.
