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.

WhiteWidow

Because there seems to be a general idea that using a defib is a cure, it isn't. How many times has the phrase 'they save lives' been used in this thread? They CAN save lives but often they don't.

BTW Gasman, have read and completely agree with you.

You are being so unreasonable I could cry.

1. those five minutes you're talking about (and it will be longer than that because the 999 call has to be made, talk to the dispatcher, crew to truck (and then you're still assuming they're sitting around that particular station waiting for your call and not already on another shout and having to travel from that instead) are literally the difference between life and death. Every minute without shocking when needed increases the death rate substantially. By the time that ambulance arrives, the odds are seriously down. But don't take my word for it. www.chainofsurvival.com/cos/Timing_detail.asp. If you don't want your child defibrillated this way and want to wait for the professionals (who would obviously still be called in any case. This is about increasing the odds of them being still being able to be saved when they arrive) thn fine. But if so, you're a fool.

2. CPR can help keep them alive until the defib gets there, but early shocking is even more valuable.

3. they are idiot proof. Absolutely idiot proof. Even you could work one. They won't shock if one isn't advised, they talk you through it start to finish.

4. it isn't just for the kids. There are staff on site, parents, all kinds of people. And anything can happen. The more these machines are around generally, the more people's lives will be saved.

5. As far as I know, they don't damage any other internal organs. But when compared with death, I'd rather risk to damage internal organs than let someone die.

6. we are not talking about diagnosing hearts starting to fail. You seem to think people are going to need to be paediatric cardiology consultants. We are talking about situations where someone has stopped breathing. That's it. The protocol is not even to take a pulse anymore. - too tricky and wastes valuable time. If the patient isn't breathing, get someone to call 999, start CPR and get that defib in as fast as possible.

7. if it "goes wrong" the person administering the defibrillation would not be held responsible so long as they had followed the protocol. However, since the machine won't administer a shock if one is not advised, even if you push the button repeatedly after it announces "shock not advised" it is hard to envision a scenario where the protocol isn't followed.

8. you're assuming staff won't want to be trained. Fair enough they haven't been asked but I think it is a bigger error to assume they won't want to be trained than to assume they will.

I pray to all that is holy that you are never, ever in a situation where someone needs a defibrillator and there isn't one available due to the direct efforts of people like you. The facts in this situation are there and very, very easy to find. You're determined not to find them AND looking to a discussion board for back up, increasing the likelihood that you can encourage someone else to stick their head in the sand, meaning you increase the odds someone will die from these machines not being around. I'm glad you're not governor of my child's school. People in charge should not be deliberately encouraging ignorance in such a way.

Her hear Goannego!!
The OP is stubborn and ignorant!

Sorry but some of the above is misleading....

No. 2 for example. CPR isnt something you use 'until a defib gets there'. Early shocking would be of no value whatsoever in the majority of paediatric arrests (which will be respiratory rather than cardiac, and even if they are cardiac the majority wont have a shockable rhythm).

No 6 'get that defib in as fast as possible' - but it probably wont be of any use whatsoever for paediatric arrests (see above).

goaannego

I expect if AEDs were free this would be a very different thread. Have you read all the posts on cost-effectiveness?

In terms of cost-effectiveness, there may be other ways of spending the money that, long term, may "save" more lives than a defrib: eg first aid courses for everyone, including the kids or even something like dancing/drumming for the school, which encourages exercise.

Less dramatic but long term, just as important.

CPR is something you use until the defib gets there, if for no other reason than there's no better alternative to keep the blood (and thus the Oxygen in the blood) circulating.

Are you saying that you can just tell whether it is respiratory arrest and not cardiac arrest in a non clinical setting just by looking at the patient? That's truly impressive! All first aid until the professionals get there is about increasing the odds of survival until they do. You're in a school hallway or playing field, a child is collapsed and not breathing in front of you. What would you do if not call 999, administer CPR and hope for a defib before the ambulance gets there? Just say "oh, the odds are against you so I will do nothing?"

Survival is not guaranteed, not even with a defib. Not ever. But it certainly ups the odds.

Prettybird, you're right. I concede. And since the odds of fire are minimal, we can save even more money without fire and smoke alarms. And fire drills. Time better spent doing something else. And do away with the school nurse - she's not very cost effective as the kids seem to get sick anyway. And first aid training for staff. All that staff, away from school, and the course costs money. Nothing should ever be spent on easy things in places where the public spends lots of time that could save lives. Ever.

Meh.

Have you actually read this thread? Because you are coming across as if you are not aware of the content of it.

Based on your figures Voles, I would reckon that the cost associated with shocking an adult in the school would be around £80,000, which is presumably why they are only found in public places because the costs of keeping them in every workplace are too high.

CPR is not something you use until a defib gets there....sorry thats just wrong. If a child arrested, I wouldnt be hoping for a defib in the first instance, I'd be hoping for someone else trained in paediatric CPR to come along, because the likelihood of a defib being needed is small.

And if someone has an output but isnt breathing then I dont think I'd need to be in a clinical situation to work out that a respiratory arrest is likely.

A defib will only 'up the odds' if its a cardiac issue which can be treated by shocking. Most arrests in children will be respiratory, not cardiac and if they are cardiac, they most likely wont have a shockable rhythm.

Not all of it, but a fair amount. It started off with an OP of "everyone else wants this, but I don't, and my reasons for not are entirely based in I don't know anything about it and cannot be bothered to find out. But I'll complain on an online forum about it and hope for support."

Then a bunch of people told the OP she was wrong, and StealthPolarBear kept insisting if it wasn't so important that everyone had one in every room in their homes, it couldn't possibly be ever important enough to have one in a building for large groups. So it turned into a debate as to whether it was worth the cost (with a side detour in confidentiality, which you hadn't broken, but you wouldn't have won any points going into the governors (who want this anyway) waving a forum thread going "oooo, strangers on the Internet say maybe it is a good idea after all).

And in terms of cost effectiveness, you thought you had your way to fight it again.

Did I leave out much?

"CPR is something you use until the defib gets there, if for no other reason than there's no better alternative to keep the blood (and thus the Oxygen in the blood) circulating."

Have you read any of the answers already given on this subject?! Children tend to go into respiratory arrest which will then lead on to cardiac arrest if CPR is not given. And if they do go into cardiac arrest due to a respiratory cause the chance of them having a shockable rhythm is small. The chance of a defib being used is incredibly small (less than 7%) but if you faff around looking for a defib when a child needs CPR you lower their chances of survival further.

So you think that the posts about cost effectiveness are people just trying to help the OP shore up an irrational desire to not have an AED in the school?

What makes you think a desire to have a defib in a school is rational?

That's funny, because my training in paediatric CPR is to do it until the defib gets there. And then defib with the paediatric pads. Bearing in mind that the protocol for starting CPR is non-breathing, are you saying you'd just do nothing?

Survival is not guaranteed, not even with a defib. Not ever. But it certainly ups the odds.

ONLY if it is a cardiac arrest, which very few children, even those with congenital heart disease have.

Can I spot a respiratory arrest in a non clinical setting - yes - patient isn't breathing but does have a pulse - easy.

You have linked to a site giving adult stats - gasman gave pead stats - much more relevant.

You mentioned school hallways, if the school has a defib and a child arrests in a hallway, it is easy for a part of their body to be in touch with metal - a radiator, a wired bra, a watch strap.

It is also possible someone else will be in contact with something metal that is connected to the child, such as a radiator or hot water pipe. If you defib and there is a conducting conection you defib the child who has arrested but you also administer a shock to someone else - and you can stop their heart by doing it. So getting things 'wrong' isn't just about no one being to blame but to cause damage to another human being.

BTW you do realise you still need to use CPR even if you do have a defib? How many times will you shock someone before the ambulance arrives? Enough to 'cook' the heart? The paramedics arrive with a defib but with a number of drugs that can also restart the heart or can make defibrillation more effective.

I'm guessing goannego that you have paedeatric BLS rather then ILS or ALS? BLS doesn't tend to go into the complexities of heart rhythms etc because it is designed for lay people working outside of a clinical setting. Those experienced in paedeatric resuscitation have pointed out, more than once, why defibrillation is inappropriate for most paeds and you are making yourself look a bit foolish by trying to contradict them.

Read what gasman says on this thread - he/she is an anaesthetist and will of course be trained in paediatric advanced life support.

The general public often think that defibs are the answer to every arrest without understanding that there are different sorts of arrests (particularly paediatric ones) many of which will not be impacted at all by defibrillation.

Effective CPR is so important.

It isn't as though you leave the child to go find the defibrillator. Someone should be doing CPR while it is found, which is another reason for having them in public places. Someone does CPR, someone calls 999 and goes to wait for them and someone finds the defibrillator. If you are sole rescuer, then you're doing CPR until either a) someone else takes over b) you are too physically tired to continue or c) someone like a doctor or paramedic orders you to stop. Or d) the rarest occurrence, the person starts breathing again.

Have you actually ever done a first aid course? Or administered CPR? Or do you just read about it on the Internet?

Since you ask....

10 years working full time in a trained role in operating theatres in a teaching hospital. Followed by another 8 or so years working in a smaller setting with mainly children (and adults) undergoing general anaesthesia in a smaller setting.

Goannego you missed out the posts from an actual real paediatric anaesthetist. Gasman told us that it is very very rare that these machines can help most children in the very very rare event of a child having cardiac arrest. However, most people decided to ignore these actual factual posts. How incredibly depressing and just confirms my feeling that a great many women love to display their willingness to do everything for lovely little kiddies. Probably DM readers and people who watch Children in Need. What most people don't want to stop and think about is actual need and cost effectiveness.

As stealth was trying to point out, but most of you seem too dim to catch on, if you really truly do care about children and health it's not sexy machines that you should be getting. It's boring unsexy things like campaigning for people to be paid properly so that our society doesn't carry on becoming more and more unequal. But that wouldn't involve photogenic kiddies and mummies feeling good about themselves.

Sorry OP I've gone way off track here. I'll get my coat.

Just one more thing. READ THE THREAD BEFORE POSTING !

To answer your last question, no I havent done a first aid course - it would be unnecessary as I have been trained in adult and paediatric resuscitation and yes I have administered CPR. And no, I dont tend to read about it on the internet.

yabu
I think it is a good idea (our school has one).

I find it rather shocking though, that the school asks for help for essential teaching materials. should the school maybe budget better?

I didn't realise gasman was doing first aid in schools. The things you can do in a hospital setting are rather different to what you can do in a school hallway. You still haven't said what you'd do, just told me that I'm an idiot who can't read.

But yes, I do realise that I need to use CPR with the defib. In fact, once the shock has occurred, and you can touch the patient again, you re-start CPR. Which is what I did, and do, just as I was trained.

I have had cause to do this in real life, and while I hope to never do again, the first aid volunteering I do means that sooner or later I probably will have cause to do so again. I'm very aware of what a defib can and can't do but I'd rather have the odds with an AED than not.