AIBU to disagree with PTA buying defibrillator for primary school?

[Babylon1]

That's it really.

I'm on the governing body at local primary school and the PTA have decided they are going to purchase a defibrillator for the first aid kit.

This is really down to one member of the PTA having suffered a terrible loss due to congenital heart defect which was undiagnosed in a child. NOT a child at this school I hasten to add.

Now, as a governing body, we have a wish list of what we would ideally like the PTA to help purchase, and at the moment we are prioritising interactive whiteboards, a new reading scheme and some new phonics materials - resources that will be used EVERY day by the pupils.

The PTA are insistent in buying the defibrillator ASAP, and I am equally insistent that we neither want/need it for the following reasons:

1. The likelihood of it EVER being used is hopefully very very slim

1. There is an ambulance station with trained medics less than 5 mins away at normal driving pace. On blues and twos an ambulance would/could be present inside of two mins.

1. There has been no consultation with staff, yet 5 of them would be expected to be happy to be trained to administer the defibrillator if it

was required.

1. There has been no consultation with parents to ascertain if they would be happy for their DCs to be defibrillated at school by a non-professional medic (I certainly wouldn't be)

Before I would be in the slightest happy about this, I want a demo from the company providing the equipment on how easy it is to use, bearing in mind it is a paediatric defibrillator.

I want to know who will make the decision that the defibrillator is required - ie who is going to diagnose the child with a failing heart?

What happens if/when it goes wrong? Will the administrator of the defibrillator be held responsible?

So am I being unreasonable?? Really appreciate your thoughts here as I need to feed back to governors at next meeting.

YANBU. While it may NBU to think about getting a defibrillator for a public space, the PTA seem to have rushed into this and YANBU to ask questions.

1. The foolproof issue. A doc on this thread (gasman) has said that even AEDs are not necessarily safe for users. Say if you had a situation where a child collapses on a wet playing field. Is it possible that people around could be badly injured by the shock if in the heat of the moment they don't think to move the kid off the grass? (NB I do not KNOW this, I'm just asking if they are really as foolproof as people are claiming)

2. Effectiveness. Again, docs here have said the chances of getting a case with a shockable rhythm in a child are vanishingly small. Would the money be better spent training people in respiratory arrest in children?

3. Whether staff will be happy to take on the responsibility of maintaining it, using it and what insurance you will have if something goes wrong, whether injury to a person using it or if a child fails to be revived.

4. The issue of getting a paediatric only defib - seems a bit silly for a public space and if the chances of being able to revive a child are so low. There is perhaps a stronger case for getting one that can handle adults too.

5. Security. How are you going to keep it accessible yet secure?

No WW that was in repsonse to the "what price a child's life" comments - "if it can save a life then it's worth any amunt"
plenty of people have said that

do you see the difference? I know a paramedic would cost a lot more, but plenty of people are saying that no price too high when it comes to the slightest chance a child's life will be saved. That's what I'm taking issue with, and yet no one seems to get that!

SteaklthPolarBear, even if you had a ready-to-go paramedic in your school, he would want to use a defibrillator if anyone's heart stops. The best paramedic-applied-CPR is never as good as a defib shock. What do you think the paramedics do first when they arrive at a place where somebody has suffered a cardiac arrest? I will tell you: they use a defibrillator on the person.

They are a doddle to use. You put the pads on and do as it says. Children aged 6 have been shown to be able to use them.
They don't shock unless there is a shockable rhythm. They talk to you and tell you what to do.
The best chance of getting someone back from cardiac arrest is very early on.
Having said that, children are less likely to have shockable heart rhythms in the arrest situation - it's more common in adults with ischaemic heart disease.

is an internal defib a pacemaker? Or are they completely different things?

A ICD (defib) can pace as well but a pace maker cannot defib.

All of you saying that they are fool proof - if that is the case why are there still accidents in hospitals where highly trained people are working as a team to ressuscitate someone?

BTW the majority of cardiac arrests end in death, even when they are in hospitals, even when they are in a cardiac cath lab with direct access to the heart for drugs, with paddles already attached and the heart and BP being monitored directly from the person's body.

sassh
An AED is much easier to use than a normal defib, and less potential for error (because it only shocks if it deems it shockable)

Stealth you're just being silly sorry but you are. Obviously you can't employ a paramedic to work there. But you CAN get a defib for emergencies.

Like I said, you can't put a price on safety either but it doesn't mean I'll go employing a police man. An alarm will have to do.

Sash why bother saying that the majority of cardiac arrests die? What is your point?

WHY am I being silly? If you can't put a price on safety, then that means what it means, surely? Or is everyone else interpreting it differently.
And yes, he'd use a defib. But there are millions of OTHER things that can happen to children (with a much higher probability) that a paramedic would ALSO be useful for. If you read this thread you'd assume the no1 killer of primary children was heart conditions. And yes, it is an extreme example, I am not suggesting it, I am using it to show the ridiculousness of "safety at any cost" argument. I can't believe I am having to spell that out YET AGAIN.

And who called anyone mummies? was that me (don't think so but could be wrong)?

Oh and why don't hospitals have these super duper £1000 defibs then, if the ones they use aren't as foolproof?

OK, spelling it out, a paramedic is an extreme example
A first aid box is low cost, likely to be needed and no big deal
A defib is higher cost, unliekly to be neeeded...I am trying to make the point that if you say "safety at any cost" you have bigger risks than just heart disease in 5 year olds.

she is pointing out that defibs are not mircle workers and that even when they are available, the story usally still ends badly :(

I don't understand why people are struggling with such basic logic. Safety at any cost does NOT just apply to heart problems in 5yos. If you think it does you are completely and utterly misinformed about relative risks

Here endeth the rant. Carry on, I'm going to attempt to resist posting again as I do not think I am adding anything any more.

The defib we have on our ward is one of these foolproof ones rather than a specialist hospital one. Actually we have both but on the infrequent times we've had to use it we've not used the hospital grade one as we prefer the one that talks to you.

I suppose one option is to have some fund raising specifically for a defib. Then you are letting the parents decide - if they think its worth investing in they'll donate.

Has your school been told to purchase one?
I work in a primary school and all the staff undertake regular first aid courses.
At the last one the instructor was telling the head that the school had to now have a defib on the premises
So it could be a change of rules

I don't think so, from what the OP has said. And would the school be allowed to dictate what the PTA buys?

wotnow

I tried posting up thread the pure facts without anecdote and guess what? I got totally ignored by a whole pile of people going "but it could save a life...".

Yes a paediatric defib could save a live but the likelihood of it being need is really really rare. I know this. I don't need to reference this but I'm glad you found the time to look for some papers. If there was a cost-benefit argument do you not think that the life support organisations would be campaigning heavily.

There is a an australian paper from resuscitation (Deasy et al, 2010) which shows that in the metropolitan area of Melbourne over a 10 year period only 209 children suffered out of hospital cardiac arrest. This is an incidence of 3:100 000. Only 14 of them were in a shockable rhythm (i.e. would benefit from a defibrillator) In addition, the vast majority of these cardiac arrests were in pre-school children.

The Resuscitation Councils suggests placing an AED in an environment where a cardiac arrest occurs every 2 years (Europe) or 5 years (America). The Australian data shows such a low incidence of paeds cardiac arrest that it does not mandate AED placement in schools. I cannot find any UK data for such out of hospital arrests but suspect the australian population is more comparable to our own.

The situation in adults is patently different - a fact that many of the posters above seem not to have grasped. Adults have a higher incidence of cardiac arrest, they have them for different reasons (i.e. often primarily a cardiac cause) and are often in a shockable rhythm at presentation. There is good data to back up the efficacy of defibrillator programmes for them. This premise is however NOT generalisable to the primary school age paediatric population and is what I was referring to above by the 'mummies comment'. A little knowledge can be a dangerous thing.

I'm going to bow out now as I have other work to do.

but gasman, it can save lives

And you cant put a price on that.

Stealth's points are about the cost effectiveness of having a defib. It's not an unreasonable question to ask. On a cost/benefit point it would be better to have a defib in the community where is likely to get est use not in a school.

But yes gasman - the use of 'mummies' is patronising in the extreme.

Is like saying:If people want a burglar alarm why not get a full time policeman.

No it's not. Because a burglar alarm is useful whereas a paeds-only defibrillator will be completely and utterly useless. Amazing how some people on this thread are unwilling to believe what those of us with relevant expertise are telling them. I know you'd like to believe that your DC could be saved by a defibrillator in the incredibly unlikely event of them having a cardiac arrest but they wouldn't be. Sorry, but that's the truth.

This really is my last posting.

This whole thread is reminding me of the last time I stopped to help at a medical emergency on the street.

I got barged out of the way (having made it clear that I was a doctor) by someone crying "I've just done my first aid course".

If you all want to believe the people who have the first aid qualification then please do so but my considered medical opinion is that a paediatric only defibrillator in a primary school is not going to be of much use.

Gasman/turps - what is the difference between a paeds only defib and an adult one? Is it the strength of the shock, pad size or something else?

If a paeds only defi is the only one available is it worth trying on a young adult (or any adult) with a shockable rhythm?