The ‘Heart-Friendly Town’ and the Scourge of the Defibrillator

A community defibrillator? Surely that’s a no-brainer?

It’s an emotive issue and the received response is ‘Of course I’d want to see one in my high street or whatever’. Defibs save lives, and if money were no object (and we have to be realistic here) it would be great to have them everywhere.

At the risk of being completely shot down by the establishment, I’d say it needs a bit more thought. The question should not be ‘Do you want a defib on your High Street?’ but rather ‘Do you want more lives saved?’ And then following that, ‘How can we save the most lives with the resources we have available?’ Let’s not get distracted by the ‘Defib or no defib’ debate, it’s much more complex than that.

Buying a defib is emotive – surely it’s a good thing! But I’d encourage people to consider the opportunity cost – what other intervention could have been implemented, and would it have been more effective? As far as I know the BHF is still offering help to buy community defibs, and it is tempting to take the funding because it’s ‘free money’ – but if you donate to charity you hope it’s being used effectively, and there are other measures that would be good to implement and would benefit many more people. Yes, I’d like to see defibs but only as part of a wider health campaign.There’s a danger in installing a defib, ticking the box, and thinking that’s it, you’re done.

Heart attacks are frightening experiences for all involved. The likelihood of one happening in the first place should be of considerable concern, at least as much maximising survival rate when one actually does. Here’s a fact – most of them happen in the home. Not in the high street. Therefore there is more likelihood they could be successful if installed in a built up residential area rather than a shopping area. Why are they installed in high streets? Perhaps because the research on ideal placement is not done, or perhaps because decisions are made by those who have the budget but not the awareness (and pointing no fingers here), perhaps it is a political decision to make people feel cared for, or it’s an emotional decision – or perhaps for PR.

The defib only provides a return on investment when it is successfully used and a life is saved. It’s not enough to install one – it needs to be secure from thieves, but also accessible immediately to those who need it, with no wasted seconds. So I’d respectfully suggest that most of them are installed in the wrong place.

So what do we do if most heart attacks occur out of the range of where most defibs are installed? Of course look at relocating the defib (obviously!) But also look at other measures that could be implemented – is a defib the best solution? Naturally, if it’s a defib or nothing, I’d go for the defib every time. I want lives saved. However, I think the resources can be better deployed to greater effect in the same community by different interventions.

If defibs are going to be installed, I’d prefer to see them as part of a wider initiative. How about having a ‘heart-friendly town’ where organisations and individuals work together to tackle the root causes of heart disease? How about awareness evenings? More GP referrals to exercise outlets? Health buddies? A commitment to living healthier for longer rather than just longer? You might think that this is over-ambition – and maybe it is. But I’d argue although it’s more time-intensive than buying a defib, it stands to improve health in every generation in the community, for longer. It will prevent people needing the defib in the first place.

People need to take back control of their health. As a community we need a healthier outlook. There is a correlation between what life choices they make and what benefit or disbenefit this brings them.

I’m a nurse, and I can honestly say that the joy from seeing someone succeeding in reducing their cardiovascular or diabetes risk considerably is like no other. Seeing people take control, and get their lives back – seeing them excited by what they’ve achieved is indescribable. The change this brings to themselves and their families is amazing.

By making changes, you not only reduce the risk of needing a defib:

  • You decrease your future need of diabetic drugs
  • You increase your body image
  • You increase self-esteem
  • You increase confidence
  • You facilitate healthier relationships with those you love
  • You have a lighter mood.

I have seen all these outcomes and more. I would like to see health promotion – proper health promotion at the top of the community list. It’s all too easy to install a ‘just in case’ box on a wall and leave it at that – but do we not deserve better than that? In fact a project in Salford, Manchester was set up to address health inequalities and ended up achieving all sorts of unexpected outcomes as a result – and for every £1 invested it yielded £12 of social and health benefit for the participants and their communities – and this carried on as long as the project was running; even afterwards, much of the benefit remained as people maintained the changes they’d made and reaped the rewards.

Yes, a defib is great, but what if in 20 years it has saved no lives? In terms of return on investment, there are many other concepts that will be more effective for more people, for much longer (even permanently). Lives are complex; save a life, and you’ve saved a father, grandfather, cousin and uncle in one go; you save a family’s grief, you save hardship, pain, anxiety, fear, and uncertainty. Faced with the choice between possibly saving one life and definitely saving 50, I’d go with the 50 every time. Yes, in health as with in everything, it is a numbers game.

Whatever a defib costs, it’s likely more lives can be saved by using the investment another way. I applaud the sentiment with which people campaign for more defibs, but the people in our communities need, and deserve, more than just that. Let’s aim bigger. Let’s live better.