It’s not the same if your heart stops in Stockholm or in Madrid

– the use of ‘apps’ to alert people nearby a cardiac arrest in order to locate defibrillators raises the chance of survival

This is a translation of an article published on 29.11.16 by Spanish newspaper El País at – Original article in Spanish by Ana Alfageme

May 24, 2015. 6:55 p.m. The Mass at Saint Justin Church in Santa Clara, California ends. Kory Trebbins closes the doors. The usher, 53, turns and collapses. His heart has stopped. Someone calls 911. The emergency centre sends an ambulance. But they also send an alert to certain mobile phones through an app. The phones whose owners (who know resuscitation techniques) have downloaded an application called PulsePoint and are at a quarter of a mile (400 meters) from the church.

« An emergency doctor received the notice. She was close to the cardiac arrest playing with her children. She left them playing and arrived there in two minutes. Meanwhile, a parishioner had already started to perform cardiopulmonary resuscitation. The doctor continued with cardiopulmonary resuscitation without success.” “Then firefighters came with a defibrillator and gave me four defibrillator shocks to try to make my heart beat again, « Kory continues.

In the last attempt a very weak heart beat gave them some hope. « I regained consciousness on the stretcher entering the hospital. I feel it was a real miracle to return to life without complications or damage. I have fully recovered and I’m happy to be alive. Many things had to go the right way for me to survive such a life threatening episode. PulsePoint paved the way and was essential to my recovery. Otherwise I would not be alive now. » Kory, a very religious man, signs his e-mails with the word « Miracle ». He says the doctor told him that he had been practically dead for 18 minutes.

The story of Kory is both frequent and also exceptional. It is common because it occurs once every 20 minutes in Spain, that is, 25,000 times a year, according to official data. Cardiac arrest outside the hospital affects 326,000 Americans a year, according to the latest statistics from the American Heart Association. This very serious statistic over cardiovascular diseases, makes it the world’s most serious disease, responsible for three out of 10 deaths.

The Californian case is also unusual. If your heart stops, your chance of survival depends, within an environment of a developed countries, where you live. You would have more options in Santa Clara, where Kory collapsed, than in Madrid. Or in Stockholm than if you lived in Barcelona. There are places where an app of this type works. Kory received help almost from the first moment, and also, from an emergency medical specialist who was very close.

Quick help is crucial. « For every minute that someone is in cardiac arrest, the possibility of survival decreases by 10%, » warns Santiago Doménech, head of Pulmonary Cardiopulmonary Resuscitation (CPR) of the Spanish Society of Emergency and Emergency Medicine (Semes). « And at 10 minutes that possibility is practically non-existent. »

It is a miracle Kory survived, it would not have been possible without digital technology … and a good idea. The one that Richard Price, the fire chief of San Ramón Valley, in California had.

Seven years ago, Price was sitting in a deli with some colleagues at lunchtime. He heard a familiar sound, the siren of the fire department, and saw one of the red cars in the building next door. Since he was the boss, he did not receive the alert. Someone had suffered a cardiac arrest a few meters from him. « The man died, » says Shannon Smith, a spokesperson for PulsePoint Foundation, a non-profit organization that runs the app, « and Price, who had a defibrillator in his car, decided that this should never happen again. » He contacted a computer science faculty in Kentucky to develop the technology that made it possible to put the patient in contact with those trained to perform cardiopulmonary resuscitation and to automatically localise defibrillators. The result was the PulsePoint app, which was launched in 2011 and which is now available in 2,000 cities in the United States and in Canada; In total 28 states and 900,000 mobile phones.

View slideshow of the mobile ‘apps’

PulsePoint works integrated with emergency services, which in the United States are alerted by dialling 911. When someone suspects that someone has suffered a cardiac arrest in a public area (the app does not work in people’s homes, although 70% of these episodes occur inside the places of resident) the emergency number is dialled. « Simultaneously they send the notice about the incident to both the ambulance and to the users of the app who are within a quarter of a mile of the patient, » explains Smith, « the alert reaches two or three people. On their screen they also see where the automatic defibrillators (AEDs) are.  » What happens if you cannot go to the rescue? « The person can indicate by the app that he or she is not available and the system will keep looking for more persons to help. There are no legal implications, » he replies. Integrating such a system within the Emergency network costs $ 10,000 and then, depending on the size of the community, it is necessary to pay up to $ 28,000 a year for a population of more than 1.5 million people for technical support and to support of the foundation.

Digitization has also been used to crowdsourcing for an undoubted social good: the platform has a second app, PulsePoint AED, where users can photograph, locate and report the status of defibrillators in buildings and public places. The information is then verified and used for rescuers to pick them up on their way to the patient’s location.

“An initiative like this is important, interesting, essential and very valuable, » says emergency specialist Doménech. « The only way to get the patient out of ventricular fibrillation is with defibrillators, » he warns. Therefore, he believes that it is fundamental that there is a good network of automatic devices present in public spaces. « Spain is at the tail of European countries in this type of equipment, » he complains, « and also people cannot use them, even if the risk of making a mistake when using them is zero. There is no chance of doing any harm. In addition, there are 16 different legislations, each in an independent community. » Doménech adds that the survival after a cardiac arrest depends on the illness that caused it, but to restart the person’s heart is « to give him or her the opportunity to arrive alive at the hospital and if possible, to be fully recuperated ».

In Spain he assures, there is an initiative similar to the American one in the Basque Country. This is an app that was launched in August by Osakidetza, the Basque health service. It is called PCEH and provides the geolocation of defibrillators, training in CPR and assistance guides and diagnosis of cardiac arrest. But it does not alert potential rescuers who are nearby.

Within Europe, the most similar initiative to the American one can be found for example in Stockholm. This is SMS Lifesaver, which is the sequel to a research project that five years ago enlisted volunteers to send text messages (SMS) when they were near a cardiac arrest.

This week version 4.0 of the app was released. « We already have 25,000 people registered in Stockholm and we have plans to launch the app first in Gothenburg, then in the rest of Sweden and in Denmark, » says Morten Seliussen, vice president of Technology and Innovation at UMS, the company that develops the app. « Our goal is to get registered helpers and defibrillators to where the affected person is within five minutes, which increases the probability of survival to 70% if the defibrillator is used. Now only 12% of those who suffer from a cardiac arrest in the street survive, because an ambulance takes an average of 15 minutes to arrive. The app is part of a study led by Karolinska Institute. »

Citizens, as in the US application, have the possibility to reject the notice and find detailed geo-information on a map of the situation of the 40,000 automatic defibrillators that exist in Sweden. The app also has a reminder of the cardiopulmonary resuscitation and even an option to set the pace for compression on the patient’s chest. And the cost of installing this system within the emergency services? « Between 100,000 and 200,000 euros, » answers Seliussen. It does not sound a lot.

Read more about the SMS Lifesaver project and app

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