Chrissy Hamilton |

More than 1600 people die of a cardiac arrest that occurs out of hospital in New Zealand every year.

Over the last 2017/18 year, St John has treated more than 2000 people who have suffered a cardiac arrest. This equates to five people per day. In this, the fifth St John Out-of-Hospital Cardiac Arrest Registry report (OHCA), five years of data now casts fresh light on who these people are, who is most at risk and why, as well as those most likely to survive. Where you live also plays a role with the upper North Island having the greatest number of cardiac arrests as well as the biggest population base.

Survival rates are a key benchmark of the clinical quality of an Emergency Ambulance Service (EAS) and worldwide, rates of survival are low. OHCA data is used to identify and improve clinical care and survival outcomes. It is encouraging that St John NZ’s cardiac arrest survival rate of 13% compares well against other emergency ambulance services: Ambulance Victoria (11%); London Ambulance Service (10%); St John Western Australia (11%); and the King County EMS, USA (20%).

We know that people in the least deprived areas have a higher survival rate than those in the most deprived areas. Using a measure* that is believed to be the first of its kind to correlate New Zealand’s cardiac arrest rates with deprivation and ethnicity, this year’s OHCA reports that people from the poorest communities are over-represented in this number. Māori have both the highest rates of cardiac arrest and the lowest survival rates. Pacific Peoples’ also have higher cardiac arrest rates and lower survival than Europeans.

When a heart stops beating, every minute counts. New Zealanders are far more likely to step up and try to help people in cardiac arrest than people in other countries. A considerable number of those experiencing a cardiac arrest received help from a bystander (74% received CPR and 5.1% received defibrillation). This is critical because for every minute without CPR or defibrillation, the survival rate drops by 10%.

“The biggest inroad we can make to NZ’s cardiac arrest survival rate is to dramatically increase the public’s use of AEDs (Automated External Defibrillators) along with CPR,” says St John Medical Director Dr Tony Smith. “Over the last five years, bystander use of AEDs has grown from 3.9% in 2013 to 5.1%. With public awareness campaigns and the introduction of the GoodSAM app we want to see this number grow further.

“If you can use a mobile phone, you can use an AED.”

Dr Smith attributes this year’s positive result to the introduction of the GoodSAM app (April 2018) along with the implementation of double crewed ambulances and participation in the global Restart a Heart Day (October 2018).

On average in urban areas, it took six minutes for an emergency vehicle to reach a patient and nine minutes to reach those living in rural and remote communities. We are grateful to Fire and Emergency New Zealand (FENZ) who co-responded to 84% of all cardiac events with St John. Critical response times have improved since the first Out-of-Hospital Cardiac Arrest report was collated in 2013/14 when the average for urban areas was eight minutes, while in rural and remote areas the average fell from 11 minutes.

St John continues to use OHCA findings to look at how we work to improve survival rates including how we address the equity and access issues highlighted by the report data.

In 2015, in response to the over-representation of Māori in the cardiac arrest rates, St John introduced the Out-of-Hospital Cardiac Arrest AED in Marae programme supplying training and AEDs to several marae. This programme has grown with St John gifting 50 additional AEDs year on year since then to selected marae and appropriate community facilities across the country. Since launching the initiative, 69 marae have received AEDs and more than 600 whānau members have completed the training.

The free 3 Steps for Life programme, a course that teaches people how to perform CPR and use AEDs supports this and is aimed at improving the survival rates of patients who suffer out of hospital cardiac arrest, most of which occur in the home.

Read the full report: St John Out-of-Hospital Cardiac Arrest Report 2017/18

* This report uses the NZDep2013 as a measure of socioeconomic deprivation calculated using census data. This includes factors like no access to the internet or a car, receiving a means-tested benefit, household income below an income threshold, being 18-64 and unemployed, being 18-64 years old with no qualifications, a single parent family, and not living in own home (seep15 of the report for full definition).

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