My remarks in the House of Commons on M-124, re: putting AEDs in RCMP vehicles
November 10, 2017
On November 9, I spoke in the House during debate on M-124, a motion by my Conservative colleague Alain Rayes to put AEDs (automated external defibrillators) in RCMP vehicles across the country, and for a committee study on how widespread AEDs are in first-responder vehicles across Canada.
Mr. Rayes’ motion is as follow:
That, in the opinion of the House, within twelve months of the adoption of this motion: (a) the government should follow the example of other Canadian police services and act to save hundreds of lives each year by equipping all RCMP vehicles with automated external defibrillators (AEDs); and (b) the Standing Committee on Public Safety and National Security should undertake a study to determine the availability of AEDs in first responder vehicles across Canada and make recommendations to the House in that regard while respecting the jurisdiction of other levels of government.
The full debate can be read HERE
. If you type “AED” into the search bar on my website, you can read about my past work on the subject. My remarks are below.
Mr. Speaker, I want to start by thanking my colleague for introducing this very important motion. I want to thank the member for who just spoke in favour of the motion. I particularly want to thank the parliamentary secretary, the member for , who I think is indicating that the government side is likely to support the motion. I think he was speaking in his capacity as the parliamentary secretary and therefore on behalf of the government rather than in his capacity as a private member. In either capacity, his support is very much welcome.
I want to talk about how effective defibrillators can be in saving lives and in particular about a numerical demonstration, a statistical demonstration of just how effective installed automatic external defibrillators, AEDs, can be when placed in the trunks of police cars.
First, let us step back a bit. The purpose of an AED is to reduce fatalities from heart attacks, but specifically to reduce fatalities from the kind of heart attack we refer to as a sudden cardiac arrest, which normally starts as what is known as a pulseless ventricular tachycardia and ventricular fibrillation. This is a huge issue in terms of the number of lives that are involved in this kind of cardiac crisis.
Cardiovascular disease is the number one cause of death in Canada and in the United States. Out of hospital, sudden cardiac arrest accounts for 50% of cardiovascular disease deaths, so half of the largest cause of mortality in our country. Ventricular tachycardia and ventricular fibrillation are, according to one study I was looking at, the source of 85% of all sudden cardiac arrest deaths. The rest of them are caused by trauma, poisoning, pulmonary embolism, drowning, hypothermia, drug overdose, cerebral haemorrhage, and a grab bag of other causes. However, 85% of that 50% of the biggest killer is caused by events that, in principle, could be stopped if a defibrillator were available and applied quickly, along with some other interventions.
In principle, AEDs can be used to save many lives. Let us be clear. It is all about how fast one gets to the person. I want to cite an academic paper published in 2009, in which the author states:
||…every patient with a witnessed ventricular fibrillation cardiac arrest should survive. If the patient does not survive, the goal is to determine why.
The paper said “every patient”. In principle, there should be a 100% save rate. As I say, it is all about the speed with which one is able to intervene, and to make that point, I want to call upon and describe the American Heart Association’s chain of survival metaphor. The member for who was involved in the Canadian heart association would be very familiar with this indeed.
The American Heart Association’s chain of survival metaphor lists the key ingredients for success: one, rapid access, calling 911 immediately; two, rapid cardiopulmonary resuscitation or CPR; three, rapid defibrillation. A fourth step follows defibrillation: rapid advanced care. Usually that takes place after an ambulance has arrived and continues on in the hospital.
In principle it is 100%. In practice, the highest survival rate we have seen for witnessed cardiac arrests, where someone actually sees when it happens, is 74%. That is the survival rate that takes place in casinos. In casinos, it is a high-stress environment, often with people who are in bad health who are doing a high-stress activity, but they are also always on camera. Casinos typically have defibrillators and trained staff close at hand. In that ideal environment, a 74% success rate has been achieved.
However, as I said, time is of the essence. To make this point, it is worth noting that after 10 minutes, the rate of success drops to less than 10%. Within three minutes, the success rate can be as high as 74%. If someone gets there and starts applying an AED after 10 minutes, there is about a 2% success rate.
This is why the public policy response both here and in the United States is focused intensely on putting AEDs into emergency response vehicles, such as ambulances and fire trucks, of course, to speed up response times when someone witnesses a cardiac arrest and contacts 911. We would like to see these put into police vehicles, in particular RCMP police vehicles.
The difference in survival rates in various American cities is based almost entirely on response times. To make this point, I just want to read the different response rates, from a few years ago, in a series of American cities. Detroit was 0%. It could not be literally 0%, but it must be below a 1% survival rate. Chicago is 3%; New York City, 5%; Los Angeles, 7%; the state of Alabama, 8%; Salt Lake City, 8%; Dallas, 10%; Rochester, New York, 10%; Memphis, Tennessee, 12%; Tucson, Arizona, 12%; San Francisco, 15%; Fresno, California, 15%; Houston, 15%; Minneapolis, 20%; Pittsburgh, 22%; Portland, Oregon, 23%; state of Iowa, 23%; Miami 24%; and Milwaukee, 26%. Seattle, Washington, is 46%, based on a combination of good CPR training and the availability of defibrillators where they are needed. In Seattle, they do not regard this as the final destination. I think they are, quite rightly, after 74%, if not the 100% that is available, in principle. We should be too.
Let me tell the House about how faster response times, due to police cruisers having defibrillators, can save lives. I turn here to another study, which tells us that in one case, in Miami, “Response by police averaged about 1.5 minutes faster than that of [emergency medical services] (6.16 versus 7.56 minutes), and the dual-response system”, in which both were notified, “reduced overall first-responder time to 4.9 minutes (compared with 7.6 minutes from historical control). This translated to a statistically significant improvement in the percentage of those who survived…ventricular arrhythmias (17.2 percent survival rate…).”
I will skip the other example I was going to give, except to point out that in the other example, the rate in Pittsburgh went from 6% to 14% after police vehicles installed defibrillators.
Now let us talk about Canada. In Canada there are 40,000 sudden cardiac arrests annually, and there are AEDs in police vehicles in many places. They are in Vancouver, Kingston, Laval, Fredericton, Medicine Hat, and even in Smiths Falls, in my riding. Those are defibrillators that were put into police cars, with my assistance, about 12 years ago.
The city of Ottawa has had them longer than almost anywhere else and has excellent statistics, which I want to quote to make the point about how significant the life-saving can be. Every cruiser in the Ottawa Police Service, 145 in total, has a defibrillator in its trunk. In 2012, this resulted in 22 interventions and nine successful saves of heart attack victims. That means they survived for at least two years. In 2013, there were 23 interventions, and eight lives were saved, which is, on average, one life saved for every 17 AEDs annually. That is a 17% save rate, compared to 5% nationally in Canada. It is not as good as Seattle, but it is three times as good as the national average.
AEDs that are purchased in bulk cost about $1,000 apiece. Training costs are essentially zero, because the cops are already trained. The cost factor of the time to arrive is not a consideration, as they are already first responders.
This means that at one life saved for every 17 AEDs, the 5,600 RCMP cruisers in which these could be installed could result in 300 lives being saved every year. Since AEDs last 10 years, we could save 3,000 lives over the next decade at a cost of $2,000 per life.
At one point I wanted to promote this by saying, “Life is cheap so let us start saving now.” My staff said that might not be the best slogan, but I believe that. Saving lives really is cheap. It has never been cheaper. At $2,000 a life, we could literally repopulate the House of Commons with people whose lives are saved every year from next year forward, if the motion is passed and we begin to work to fulfill the goals it seeks to promote.
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