List of Figures
Introduction
An Automated External Defibrillator (AED) is an essential part of the chain of survival during the response to sudden cardiac arrest, restoring a normal heart rhythm1. Having public access to AEDs within the community, in case of an emergency, can be lifesaving. Ease of access to AEDs within the borough will give members of the community/community groups a safe, effective and prompt tool in the vital delivery of potential lifesaving treatment. Premature deaths from cardiovascular disease in Oldham is significantly higher than the England average. In 2021 Oldham had an under 75 mortality rate from all cardiovascular diseases at 101.5 per 100,000, compared to England at 76 per 100,000[1].
Oldham Council (Council) is committed to improving health and wellbeing outcomes for its population, and to reducing health inequalities, by supporting equity in health services and programmes.
The aims of the community defibrillator policy are:
- To provide evidence-based information on helping an individual suspected of having an out of hospital cardiac arrest;
- To promote national guidance regarding automated external defibrillators;
- To provide guidance with decision making when applications are made for funding to Council departments or Councillors;
- To set the parameters in which the Council would consider supporting installation of an AED on a Council owned building or site.
References to ‘the applicant’ in this Community Defibrillator Policy includes community groups.
Scope
The policy will apply to Oldham residents and groups within the voluntary and community sector that are seeking financial support from the Council, or approval for installation of an AED in or on Council owned buildings or land. The policy does not cover workplaces in the borough, as these settings are governed by The Health and Safety at Work etc Act 1974. Further information on relevant health and safety matters in workplaces can be found in Appendix C.
Automated External Defibrillator
3.1 Purpose of an Automated External Defibrillator
A defibrillator is a device that gives a high-energy electric shock to the heart of the individual who is in cardiac arrest, helping to restore the heart’s normal rhythm again. In a cardiac arrest, the heart’s steady rhythm is often replaced by disorganised electrical activity called ventricular fibrillation (VF). The sooner VF is treated by an electrical shock (defibrillation), the greater the chance of the person’s life being saved.
An automated external defibrillator (AED) (sometimes referred to as a public access defibrillator (PAD)) is a portable electronic machine that can automatically detect the abnormal heart rhythms, such as VF, that cause cardiac arrest and can deliver the shock that is needed to save the life of a person.
AEDs are compact, easy to use, safe and very effective. They can be used by anyone, whether or not they have had formal training.
An AED gives the person audible and visual instructions and will not allow an electrical shock to be given unless needed. AEDs can be stored for long periods without use and need no direct maintenance. It is important to remember that visual inspection is done regularly to ensure they are ready to use in an emergency.
3.2. Automated External Defibrillator - Location
The location of an AED is essential. When installing an AED in the community, it is important to consider the following:
- Will the AED be clearly visible and easily recognisable, including enough light so people can see the device’s cabinet in the dark?
- Will the AED be placed in a high-quality lockable box?
- Are there any other AEDs nearby?
- Is there an accessible power supply for the AED / AED cabinet? Or is a battery powered AED suitable for the location?
- Are portable devices preferable in certain scenarios?
- Can the device be accessed 24 hours a day 7 days a week?
- Is the device for closed groups only?
In July 2023, over 70 AEDs within the borough of Oldham were registered across the site finders. The number of registered AEDs is considered to be a conservative reflection of coverage in Oldham and local intelligence tells us that the number is likely significantly higher; some AED locations have not been registered.
A list of registered and regularly maintained AEDs situated across the borough can be found at various websites including;
- https://www.defibfinder.uk/
- https://www.heartsafe.org.uk/AED-Locations/
- https://www.thecircuit.uk/ .
As there is more than one site to register AEDs, one site will not capture full provision within the borough, or local area.
There are limitations with the mapping of AEDs, as it can be difficult to distinguish between those that are accessible during hours of operation and those that are accessible 24 hours 7 days a week.
With the government roll out of AEDs across all primary and secondary schools, the number of AEDs in Oldham is likely to increase significantly over the next 12 months.
3.3. Automated External Defibrillator - Installation and Storage
An AED is normally housed within a temperature controlled secure cabinet. Access to the cabinet is via a mechanical digital lock.
When the AED is required in emergency situations the lock access code is provided by making a ‘999’ telephone call to Emergency Services.
3.4. Installation on a Council owned building
Oldham has many AEDs within Council owned buildings. Where the Council is responsible for these, the devices will be registered with a site finder, weekly assessments will be carried out and in addition to this, annual electrical checks will be undertaken by a person appropriately qualified.
Applications to install an AED within a Council owned building, should receive the permissions of the facilities manager. The facilities manager should consider several factors when deciding about the appropriateness of the installation, including:
- Is the proposed site for installation more than 500m from an existing AED?
- When considering proximity to existing AEDs the site finders should not be the only source of information as local knowledge is likely to identify more AEDs which are installed – but not registered.
- Is the applicant, willing to take full responsibility for the AED to include but not be limited to: regular checks (weekly and annually), ongoing maintenance, registration and update to the site finder sites, and financial responsibility should the AED and associated casing be vandalised?
- Additional insurance costs to the Council.
If the answer to the first two bullet points is ‘no’ and the answer to the third is ‘yes’, permission should be denied.
If the answer is the first two bullet points is ‘yes’ and the answer to the third is ‘no’, the Council would permit the installation of an AED within a Council owned building but would not have responsibility for the device. Approval would be for an AED that does not require access to the Council’s power supply.
The facilities manager would have the right to decide if installation would be most appropriate inside or outside a building balancing opening times and accessibility availability with likelihood of vandalism.
Should agreement be gained to install an AED, the device and appropriate outer security box must be fitted by a Council approved contractor. Approval and commencement of the installation process will be through the Council’s estates team contactable via email at Estates@oldham.gov.uk. The estates team will be able to ascertain the cost of installation which will be chargeable to the applicant. The applicant will also be required to pay for the annual electrical checks of £70 per year, this fee is subject to annual review.
The viability of the installation should be reviewed by the facilities manager after 3 months, taking into account incidents of vandalism.
3.5. Installation within a Council owned Site
Council owned sites, that have no buildings are often outdoor spaces, for example parks. These locations are often more concealed which increases the possibility of vandalism. Should an application/ request be made to install an AED on Council owned land the following factors should be considered:
- Is there a reasonable confidence that the installation will not contribute to an increase in vandalism in the area?
- Is the proposed site in a well-lit area?
- Is the proposed site for installation more than 500m from an existing AED?
- When considering proximity to existing AEDs the site finders should not be the only source of information as local knowledge is likely to identify more AEDs which are installed – but not registered.
- Will the applicant take full responsibility for the AED including but not limited to; regular checks (weekly and annually), ongoing maintenance, registration and update to the site finder sites, and financial responsibility should the AED and associated casing be vandalised?
- Will the AED be installed within an appropriate defibrillator cabinet?
If the answer is ‘no’ to any of the above, the permission to install an AED should not be granted.
If all the above have been answered ‘yes’ the Council would permit the installation of an AED within a Council owned site but the Council would not have responsibility for the device. Approval would be for an AED that does not require access to the Council’s power supply.
A mutually agreeable location within the site would need to be finalised between the site manager and applicant before installation takes place. This would need to balance accessibility, footfall and likelihood of vandalism.
The viability of the installation should be reviewed by an officer from the Council’s environmental services team after 3 months taking into account incidence of vandalism.
Approval and commencement of the process for installation will be through the Council environmental services team contactable via email on enviornmentalservices@oldham.gov.uk
3.6. Responsibility
It is important for all, that an AED is installed safely and maintained to enable the best chance of it functioning optimally when required. An organisation or community group installing an AED has the overall responsibility for the AED. This includes:
- Before installing the AED, checking the location desired. Check if consent from the premises owner or landlord is needed.
- Registration with the NHS via the national defibrillator network, The Circuit.
- Checking the AED regularly to establish that it is in good working order and that the defibrillator pads are in date. AED sites should have at least one guardian but preferably two. The guardian(s) where possible should check the site and logging their checks on The Circuit. A simple checklist template to help with maintenance checks can be found in Appendix A.
- Ensuring insurance for AED is sought to protect against vandalism.
- Ensuring maintenance costs of the AED are covered, including new pads when they go out of date or they have been used. Maintenance should be in accordance with the recommended guidelines and any manufacturer’s instructions.
- Aligning all activity to the current UK’s Resuscitation Guidelines.
- Noting that the Council will only have responsibility for AEDs that are located within or on Council buildings/ sites where the Council have identified a gap in provision and sought out installation. The Council reserves the rights to remove AEDs where applications have been made for installations in or on Council owned land/ sites and agreements have not been adhered to regarding regular checks and maintenance.
3.7 Grant funding
The Council has no centrally allocated budget to financially support the purchase or installation of a community defibrillator. Should a Council department or Councillor feel there is strong justification to consider a contribution of funding from a budget, they should consider the following in the first instance
- Is the proposed site for installation more than 500m form an existing AED?
- When considering proximity to existing AEDs the site finders should not be the only source of information as local knowledge is likely to identify more AEDs in existence – but not registered.
- Is it a site that would have high footfall and increase likelihood of need?
- Is the applicant willing to take full responsibility for the AED to including but not limited to; regular checks (weekly and annually), ongoing maintenance, registration and update to the site finder sites, and financial responsibility should the AED and associated casing be vandalised?
If the answer to any of the above is ‘no’, a request for funding should be denied.
If the answer is yes to all, and funding or part funding is available within a department or councillor’s budgets, and the budget holder agrees, then a grant may be awarded in line with the template attached within appendix B to demonstrate all key requirements have been covered.
Background Information
4.1 Cardiac Arrest & Chain of Survival
The heart is controlled by an electrical impulse which helps it to maintain the correct rhythm. During a cardiac arrest, the normal rhythm of the heart is disrupted. The heart stops beating properly, and normal breathing is disturbed.
In response to a suspected cardiac arrest, the Resuscitation Council promotes the ‘chain of survival’[2] – which overall increases the chances of a person surviving a cardiac arrest. The chain of survival is:
- Early recognition and call for help - to prevent a cardiac arrest and receive instructions on how to perform cardiopulmonary resuscitation (ring 999);
- Start early cardiopulmonary resuscitation (CPR) - to buy time (especially chest compressions);
- Early defibrillation - to restart the heart (if located nearby and other bystanders are nearby to help, use an automated external defibrillator);
- Post resuscitation care - to restore quality of life (let the emergency services/ NHS/ Public Services take over).
The annual incidence of out-of-hospital cardiac arrest (OHCA) in the UK is approximately 55 per 100,000, with most cardiac arrests (72%) occurring in the home. Evidence suggests that where bystanders start defibrillation, survival rate is higher. This is because bystanders are likely to arrive at the scene and start the chain of survival and defibrillation faster[3] .
4.2 Prevention
Whilst the ‘chain of survival’ is vital in preventing poor outcomes associated with a cardiac arrest, such as death, it is important to promote healthy behavioural factors to support a healthy heart. These include maintaining a healthy weight through a balanced nutritional diet, and regular physical activity. As well as avoiding tobacco use and substance misuse, including harmful use of alcohol.
Other determinants of cardiovascular diseases, a risk factor associated with cardiac arrests, include poverty, stress and hereditary factors, some of which are more preventable than others.
Emphasising the need locally and importance of prevention, Oldham in 2021 had a significantly higher rate of CHD admissions 2021/22 490 per 100,000 compared to the England average of 367 per 100,000[4].
Legal Considerations
Organisations and Community Groups are advised to keep up to date with guidance:
Publication: CPR, AEDs and the law | Resuscitation Council UK
This publication sets out the legal position in relation to potential liability around the provision and use of an AED. Organisations are encouraged to review this publication and in particular to note the need to correctly maintain the equipment to avoid any potential liability occurring.
Training
The crucial factor in the resuscitation of an individual from VF is to provide a shock from a defibrillator with the minimum of delay. Time should not be wasted if a trained person is not available immediately. Untrained people have used AEDs successfully to save lives and lack of training (or of recent training) should not be a barrier. If someone is willing to use the AED they should do so, and by calling 999 and requesting the ambulance service information and advice will be given to initiate emergency life support.
AEDs can be used safely and successfully by people with no specific training. Untrained members of the public have saved lives in this way, so lack of training should not deter people from using an AED.
Familiarisation with AEDs is included in first aid and CPR training, as it gives people confidence to send someone to fetch an AED and to use it without delay.
The Resuscitation Council UK and British Heart Foundation recommend that the poster shown in Figure 1 is displayed beside or on an AED cabinet, to inform and encourage members of the public to use the AED when it is needed, regardless of whether or not they have received any familiarisation or training.
Figure 1: Location Defibrillator Training Poster
However, there are advantages of having a core number of appropriately trained personnel in the vicinity of any AED. Training people to use an AED can be achieved quickly with minimal cost and gives these people the confidence to act quickly and use the AED to try to save a life. Nevertheless, use of the AED by others should never be discouraged or prohibited. People should not wait for a trained responder to arrive before calling 999, starting CPR, sending someone to retrieve an AED, and using an AED.
The Resuscitation Council UK has produced ‘Lifesaver’ (www.resus.org.uk/apps/lifesaver) and ‘Lifesaver VR’ (www.resus.org.uk/apps/lifesaver-vr), interactive video educational apps, which teach people how and when to give CPR and use an AED. These resources are free of charge and are very useful educational resources for this type of training. Lifesaver can be used easily on any computer, and on most popular smartphones and tablets.
The following links are available that give a short presentation and demonstration on how deliver basic life support and the use of an automated external defibrillator, for the North West Ambulance Service NHS Trust:
Adult Emergency Life Support video:
Learn how to restart a heart - YouTube
Learn how to restart a heart (with British Sign Language) - YouTube
Child and Infant Emergency life support video:
Learn how to restart a heart (children and infants) - YouTube
Review
The policy will be reviewed annually to ensure it aligns to national guidance. The next review point will be July 2024.
Appendices
Appendix A - Defibrillator Maintenance Checklist Template for Council funded/ part funded AED, Council owned buildings or sites
Location:
AED Type:
Serial Number:
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Check battery status |
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Check cabinet light |
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Check spare adult/child electrode pads are sealed and in date |
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Check disposal gloves are present |
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Check scissors are present |
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Check razor is present |
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Check towel is present |
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Check location sign above AED |
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Remarks / Issues: |
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Corrective Actions: |
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Inspected by: |
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Appendix B – Grant funding application for Defibrillator or installation of defibrillator – key requirements
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Name of Applicant: |
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Contact Details of Applicant:
Address Email Address Telephone Number
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Are you applying on behalf of a Community Group?
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YES/NO |
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If yes, what is the name of the Community Group?
Include any details as to registered Charity number and address if applicable
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Do you have the permission of the Community Group to submit this application?
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YES/NO |
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Please outline where you like the automated external defibrillator to be installed, and why?
Please outline, if relevant, the name of the building (including any permissions granted), address etc.
Top tips to consider:
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What is the value of the grant application?
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What do you intend to use the grant monies for?
For example, funding towards the purchase of an AED or towards the installation, or maintenance.
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What other funding sources do you have?
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What date do you intend to have the AED installed by?
Don’t worry if you don’t have an exact, please just give such as approx. time period (e.g. Spring 2024, or as soon as possible).
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Who will be the named guardian of the AED?
Please provide their contact details.
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Please can you confirm that you will:
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Appendix C – Health & Safety in Workplaces (further information)
While there are no legal requirements to provide automated external defibrillators in the workplace and no specific regulations which cover the provision or use of automated external defibrillator at work. The Health and Safety (First-Aid) Regulations 1981 requires employers to provide equipment and facilities which are adequate and appropriate in the circumstances for enabling first-aid to be rendered to their employees if they are injured or become ill at work. According to the Health and Safety Executive (HSE), where the needs assessment identifies the need for automated external defibrillators in the workplace, the Provision and Use of Work Equipment Regulations 1998 will apply. This requires the employer to provide information and written instructions on how to use the automated external defibrillator and keep records of the device being regularly checked.
Appendix D –- Grant conditions
The Council will audit all grants awarded and will maintain a record.
Following a successful application and in order to ensure that monies are used in an appropriate manner an appropriate form of grant agreement including submission of a monitoring report following completion of the project or activity that was grant funded, will be required.
The Council reserves the right to monitor the use of the grant and ask for evidence to support an application. The funded organisation must allow reasonable access to premises/accounts upon request from the Council.
Organisations must retain records relating to the grant for an appropriate period. If organisations do not supply satisfactory monitoring reports and supporting information in full and within the set time scale, they may be asked to repay the grant funding to the Council.
Failure to comply with the conditions of the grant may be taken into account when considering any further applications for grant funding made by the same organisation in the future.
[1] Public health profiles - OHID (phe.org.uk)
[2]https://www.resus.org.uk/sites/default/files/2020-05/Resuscitation%20To%20Recovery.pdf
[3] https://evidence.nihr.ac.uk/alert/use-of-public-defibrillators-linked-to-out-of-hospital-cardiac-arrest-survival/