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.

Ssash, once you've started that CPR, when do you stop? And do you leave the patient to call 999? Of course you don't. You're doing CPR.

No No No - you ALWAYS call for help BEFORE starting CPR, you never start CPR before calling for help.

But my point is that for safety and first aid equipment you can make the same sort of argument. I've participated in a lot of fire drills and heard smoke alarms go off,etc but I've never, thankfully been in a fire or even known anyone who was apart from my friend's husband.

Errrrrrrrrrrrrrrrrr you do realise that your chances of being in a fire are far higher than a child having a cardiac arrest don't you? Actually you probably don't.

Oh, and by the way, it's not just the children which could get heart problems. The staff too. It's well documented that they save lives, and you will have to stand by the decision not to have one. Couldn't you raise money charitably to buy it? I

But the OP is saying that they are considering one that can't be used on adults. It is NOT well documentd that they save children's lives. They don't, because it is incredibly rare for a child to have a cardiac arrest.

There are thousands of heart conditions, the only one an automated defib works for is VF.

Actually I've changed my mind. Having initially been persuaded by some of the comments on this thread that the OP should at least look into it further and not dismiss it out of hand, some of more obdurate contributors on here have made me go back to my initial instinct that the OP was right to have reservations.

Listen to gasman and follyfoot

Oh God, another fucking First-aider who thinks they now know it all enters the thread - great!
I did my ILS refresher last week, had to pass an assessment on the use of both an AED and manual defib.
Have my PILS update next week (that's Paediactric resuscitation), and there's no defib assessment. That's because the British Resusicitation Council do not see it as a clinical priority in the Resusicitation of children - obviously they're wrong because a few first aiders on MN say so.

It's interesting - I've changed my mind a couple of times since reading this thread, but gasman's post (if correct, which I'm assuming it is) seems pretty definitive.

I would like to ask all those saying "what price a child's life?" whether they all have defibrillators in their own homes, on the basis that you might one day need them.

Oh hack mum I have asked that exact thing a few times and been told I am being ridiculous!

Hooray!
Gasman's posts no longer seem to be invisible.

Any AED (external automated defibrillator) you get will be suitable for use from age 1 and over. If the school is willing you could make it available to the local community to use by making sure the ambulance service know where it is and where to send someone to get it.

Just fanning the flames. I'm a no vote personally, would rather see the money spent on good emergency aid training and practice, sports/games/activity equipment and nutritious school meals.

Where is Gasman's post? I can't be ar*ed to find it

mmmmm.....ive learned CPR on adults, children and babies, but i have not been told that defibs dont work on children - though not doubting those with more knowledge than me, i would be interested to find out when i next have training, that being the case.

I'm in one of the emergency services and i would use whatever was to hand regardless i suppose - anything being worth a try.

Having said that, i have only seen a defib used on adults, due to the circumstances.

warrants further investigation then.

(that said - how many adults are there at the school? but agreed that if that is the case then it may not be the PTAs place to buy it....)

I don't think anyone is saying defibs don't work on children, I think they are saying that the situations where defibs do work are less likely to occur in children.

Having followed this with interest (sitting on my hands trying not to post as I don't have the same level of patience as Stealth ) all I can say to the OP is good luck trying to have a rational discussion with your GB and PTA on this one.

I think in time it will become the norm for every public building to have a defib, and probably some private rersidences too.

also I think it is really up to the PTA to decide whether to prioritise a new reading scheme or a defib.

purple - gasman's post is on page 15.

stealth - sorry, hadn't read every post, so missed your point about people having them in their home.

I think the main case for having a defib is in case it is needed by an adult. So obviously it would have to be one that could be used with both adults and children. But the chances of it being needed at all seem remote.

So the person who thinks first aiders are useless and know nothing is the same one that thinks that if you don't have a phone with signal handy, you should walk off and go find one and call 999 and then come back rather than starting CPR? And emphasises how you should ALWAYS do this?

Great. you obviously trained in this a lot.

I love how first aiders and first responders, you know the people who voluntarily give up their time without pay To train how to do this, train others how to do it and spend shifts of time to voluntarily be first on the scene with the CPR and AED and O2 and are well aware of their limitations in training and in what their jobs are (keep em alive until you can get em to a clinical setting) are not only shouted down by arrogant asses who never leave theatre, and won't touch someone without pay, but by morons who don't know the protocols in the first place.

Oopsi, FYI it is certainly very commonplace in the US for almost every public place to have one. You used to be able to buy them on Amazon though I don't know if you still can. It is so commonplace and so accepted that I am in shock that the debate is even happening here.

Until, of course, the "I never leave theatre so I know what everyon else should do who hasnt been to medical school and doesnt have my drugs and gadgets to hand" crowd tell everyone that no one but doctors should touch nyone. Ever.

Hack man happy for it to be asked again, no one seems to be able to answer other than its ridiculous. Butvthen to some people logic is ridiculous. They couintr it with ill thought out emotive statements about saving xhildrens lives

Vicar, it's not that defibs don't work on children. Hope I am explaining this correctly. If a child is in a shockable rhythm then defibrillation may work. But children are much less likely to have a shockable rhythm than an adult if they are in cardiac arrest, and if they do they are much more likely to have other serious problems that caused the arrest in the first place so they are less likely to have a successful resuscitation.

Goannego, you should ALWAYS get help BEFORE starting CPR. Getting help is the first step in the chain of survival; cpr is the second.

oh hang on....gasman said

" but my considered medical opinion is that a paediatric only defibrillator in a primary school is not going to be of much use"

note that she/he says paediatric only - in that instance i revise again.

i dont think that a defib for general use is a bad thing to have in any public setting - does it have to be a paediatric one? is that what the PTA are considering buying OP?

i am now confused - has the OP said it was going to be a paediatric one?

I haven't seen arrogant arses who never leave theatre shouting down anyone who is a volunteer.

Volunteer first aiders know how to respond in an emergency. But the last FA course I went in certainly did not cover the medical evidence for particular courses of action, whereas I would expect an anaesthetist to have that knowledge.

I would also caution against assuming that just because defibrillators are commonly available in the US that we must have them here. There are many good reasons not to follow the American approach to anything to do with healthcare.

Anne your insults are starting to get beyond tiresome and move towards offensive.

You've stated that I would let a child die. And now you are suggesting that theatre staff would never touch someone without being paid. Pack it in please. I have reported your post about me by the way.

Vicar - the OP wrote "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."

But presumably a defib that worked with both children and adults wouldn't be much more expensive, if at all, and would be a more sensible purchase.

Oh god. I'm back. goannego some of your statements up thread are 1) rude and insulting - do you know how many anaesthetists teach voluntarily in their own time on life support courses? and 2) factually incorrect as I have said many many times before - because of the aetiology of paediatric cardiac arrests a defib will mostly be useless. The 2010 australian paper I found said only 7% of not v. many children had a shockable rhythm. That means that 9 times out of 10 it will be a pointless bit of kit which will distract those present from providing good quality CPR.

1. The school were apparently considering buying a paediatric only model unsuitable for use on adults. Having a joint model might make sense. I've never been involved in buying an AED and have only used them in the adult sector (some adult hospitals have them on their wards as standard with the more expensive hospital grade ones in a few places only). I am therefore unsure exactly what is available. I agree having a model which could defib adults (and older children too) might make it a more sensible purchase. As I said before many children's hospitals find they use their defib most often for adult visitors than for their own patients.

2. Paediatric BLS
   The algorithm in the UK is to shout for help, do airway manoeuvres, rescue breaths, assess for a pulse and then start CPR.
   www.resus.org.uk/pages/pbls.pdf
   If you are on your own with no phone signal the recommendation is to do all of the above + 1 minute of CPR then go for help unless it was a witnessed sudden collapse (i.e. likely cardiac cause) in which case the recommendation is to go directly to phone for help as this is the one situation in which prompt arrival of a defib may help.

3)Defib efficacy
As others have said defibrillators do work in children when they are indicated it is just that mostly commonly they don't often go into the kind of cardiac arrest where one is needed. This is different to adults. Because of this the availability of a defibrillator in the community for a young paediatric population is much less necessary and is the crux of my argument.

4. Defib safety An AED is set up to analyse the heart rhythm and to audibly prompt the users to shock if it is indicated. They rely on the users not touching the patient during shocking. The shock is delivered via self adhesive pads stuck onto the chest. If someone touches the patient as a shock is delivered they will get an electric shock. This can cause minor skin damage/ burns and worse case cause that person to have a cardiac arrest too (although they would ironically most likely respond to a further shock!)

We also use these pads in hospital (it is called 'hands free shocking') and while it has minimised the risks of people waving around charged paddles (fucking scary if it happens) nursing staff (mostly) have been injured when enthusiastic defibbers (mostly doctors, I'm sad to say) have pressed the button before everyone let go of the patient. There are some case reports of really nasty burns. So yes they are mostly safe but there is the potential for an accident. I wouldn't however use this as an argument to prevent the installation of a defib where it is likely to be of benefit but people do need to be aware there is a risk.

4. Clinicians in the community I would do exactly the same in the community as I would in hospital. Call for help, airway manoeuvres and start CPR. The thing I use most often in paediatric resuscitation is not a defibrillator but drugs, fluids and airway adjuncts. No one is suggesting the school provide these which is sensible as they all need training and skills to be used safely.

If you were advocating the installation of a defib in somewhere used heavily by adults then I would be fully supporting the campaign I just think it is a waste of money for a primary school.

Oh and goanne I don't think first aiders are useless and haven't said so but I do think they should accept the limitations to their skills and knowledge.

In actual fact - good CPR in the community (often delivered by first aid trained family and friends) has contributed enormously to the increased survival after cardiac arrest that we now enjoy. This is great. I have been at out of hospital cardiac arrests (including for someone I knew) and it is scary not to have my comfort blanket of equipment , monitoring etc and even worse if you know the person you are having to resuscitate. I take my hat off to first aiders who do this regularly.

However there are a grave number of misconceptions surrounding paediatric cardiac arrest on this thread which I have been trying to correct. The reason I am able to do this is because I have been to medical school, work in an acute specialty and participate in advanced paediatric life support training (yes, I too give up my time voluntarily to teach on these courses....but maybe I'm elitist because APLS is doctor/ senior nurse only? ).

I've been following this thread and have now started to get quite pissed off at people spitting in the face of pure facts and statistics in favour of emotional outbursts and anecdotes. Life is about calculated risks and we take them all the time.