Community First Responder Eamonn Brennan has shared coffee and swims at the Forty Foot in Co Dublin with a man he has helped to save after a cardiac arrest.
“There is no greater experience than this when it happens,” he says of being able to provide life-saving care to another member of his south Co Dublin community.
In this particular incident, four years ago to the week in which we meet, Brennan and a fellow Community First Responder (CFR) had got to the man’s house within five minutes of the cardiac arrest. They started cardiopulmonary resuscitation (CPR) and applied multiple shocks with their defibrillator before the ambulance crew arrived to continue the process. The patient got a second chance at life and now walks around with his own defibrillator – implanted in his chest.
Every minute counts after a cardiac arrest. For every 60 seconds that pass without CPR, your likelihood of surviving drops by about 10 per cent.
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“When you get to five minutes you are at the 50/50 mark,” says Ger O’Dea, community engagement manager for the National Ambulance Service (NAS). “There is not an EMS [emergency medical service] system in the world that can get to a cardiac arrest within five minutes, unless they are outside their front door when it happens.”
This is why he quotes the retired UK cardiologist Prof Douglas Chamberlain, a pioneer in the training of paramedics, that “cardiac arrest is a community problem”. It is the response by members of a community to the medical emergency of one of their own that plays a big part in determining whether or not there is going to be an empty chair in the local coffee shop, a gap on the sidelines at the GAA club, one customer fewer in the convenience store.
Frankly, the odds are stacked against anybody surviving a cardiac arrest outside a hospital. Of the 2,802 such incidents attended by the EMS around Ireland last year, 206 people “returned to their communities”, according to the NAS. But slowly and surely the chances of survival are rising.
What’s called “bystander” CPR was attempted in 84 per cent of these out-of-hospital cardiac arrest incidents recorded by the NAS in 2022, according to the annual register published in October. That’s risen from 60 per cent over the past 10 years, during which time the number of survivors after a cardiac arrest has more than doubled, says O’Dea, going from 93 to 206. “You would have to attribute that to public awareness, public training, willingness to do bystander CPR and the CFRs.”
Last year, in 10 per cent of these acute incidents, a defibrillator had also been used before the arrival of the EMS. When once onlookers might have stood back helplessly in fear, now they are more aware that they can’t actually do any harm, he suggests.
“We tell people it is better to do CPR on somebody who doesn’t need it than not do it on somebody who does. The other thing is that the defibrillator will not shock the patient unless the patient needs to be shocked, so you can’t actually make a mistake with the machine.” Brennan and his colleagues in Dalkey Community First Responders train to be the most capable “bystanders” possible. They are one of 252 CFR schemes in the country who are managed through the ambulance service. Their members are alerted after a 112/999 call is made relating to particular types of emergencies in their locality.
A text with the location, gender and age of the patient includes a code indicating the nature of the incident. CFRs are sent to reports of cardiac arrest, chest pains with risk of heart attack, choking and suspected stroke. They are not asked to attend trauma incidents such as road traffic accidents or any known violent or dangerous situation.
“To know we have volunteers training and willing to respond in CFR areas is tremendous for us as an ambulance service,” says O’Dea. “It means when we get there, everything that could possibly be done prior to arrival is being done and it gives the person the best possible chance.”
A lot of people get confused between a heart attack and a cardiac arrest, he says.
With a heart attack, generally the patient is conscious, suffering with chest pain “and in simple terms that is a plumbing problem, a blockage in one of the arteries cutting off blood to the heart, causing chest pain – if untreated that can develop into cardiac arrest.
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“Whereas a cardiac arrest is an electrical problem, where something has gone wrong with the electrical system in the heart and that is why we give them a shock to try to reset it. Effectively, you’re dead. Your heart has stopped. It is our fight and battle to start CPR, that will circulate blood around to the vital organs, particularly the brain. We don’t only want to get people back; we want them to be able to leave hospital intact.”
As well as community responders usually getting to an incident first, they are also an asset after the paramedics arrive, he says. “There might be six or eight people at a scene trying to resuscitate someone and every one of those people will have a job. Nobody will be standing there saying ‘pick me’.”
The CFRs do a handover to the ambulance crew of the patient’s condition, with details of any medical history and medication they have gathered, which again can save precious time in the chain of survival. Then they are available to help the paramedics as required, which could range from holding a drip to comforting a patient’s spouse.
In addition to treatment needed in a medical emergency, there is the human element, says O’Dea. “In the background you have another set of patients, which are the family.” Often the compliments the ambulance service gets about the CFRs are from people who are “blown away” by the level of care given to the family. “I have babysat dogs in kitchens, moved cars off driveways, made lots of tea, held lots of hands and sometimes just sat on the floor [with the patient],” says Celine Chamberlaine of Dalkey CFR. She signed up as a part-time administrator in 2017 with no real intention of going on calls. But after being involved as the “patient” in training, she was so moved by the help and comfort offered by two of the responders she “decided then and there that I wanted to do what they did”.
One of those inspiring two responders was Concepta Corbett, who has been involved with this group since it was founded by Andrew Patton in 2014. The country’s first CFR group had been set up nine years previously, in Dunlavin, Co Wicklow.
After completing the Irish Red Cross certified training, Corbett went on to do an instructor course and is now one of the Dalkey CFR trainers, in addition to being a responder. Members meet for monthly, two-hour sessions of ongoing training, after they have completed their basic training. While initially she saw becoming a responder as a “chance to give back to society and to the community”, Corbett has found the voluntary role to be personally very rewarding too.
“People regularly say to us that we are wonderful in doing what we do. However the personal satisfaction of being able to help someone when they are ill and feeling vulnerable means a lot. So the patient, their families and the responder all benefit from the work we do.”
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She recalls one occasion when she was in the middle of the handover of a defibrillator that the responders carry in their cars when a text alert came through from the ambulance service. They pulled on their red, high-vis jackets and the lanyards with their identity cards, which they have in their cars at all times, and grabbed the kit bag.
“It was 4.32pm and it happened to be just around the corner, so we arrived at the door at 4.34pm. The wife of the patient was still talking on the phone with ambulance control. She was amazed. She thought we were angels that had dropped out of the sky.”
The area any CFR scheme covers is determined by the ambulance service, based on geographical and population considerations, along with where the group members are working and living. One group, in Salthill, Co Galway, has only a 1km radius, says O’Dea, whereas a group in west Limerick is covering a 30km radius.
Dalkey CFR operates in a 3km radius, from a central point of Barnhill Stores, just up the road from the village. Chamberlaine lays out a map on the table in the meeting room of Dalkey library, on which their area for calls is shaded in. Covering Sallynoggin, Glasthule and Sandycove, Glenageary and Killiney, as well as Dalkey, they worry sometimes that their name is misleading, particularly when it comes to recruitment.
Recruiting new CFR volunteers is both a local and national challenge. Anybody from any walk of life is eligible and no previous medical training or experience is required. You must be over 18 and hold a full driving licence.
“We want people to join,” O’Dea says simply – whether that is to swell the ranks of an existing group or getting together with a few other people in your community to set one up. “The bottom line is we can never have too many.”
Unfortunately, it often takes a tragedy before members of a community start to ask themselves if they had people trained in their midst, could they have saved that person.
He is managing a growing team of community engagement officers. There are currently three and this is being doubled to six – one for each of the new Health Service Executive regions. This will enable them to support existing community groups better and to boost the development of new ones. There are areas of the country, such as Co Roscommon and Co Leitrim, which are lacking CFR groups, although he acknowledges there are some active community defibrillator groups there that are not directly connected to the ambulance call service.
“We estimate there could be up to 10,000 defibrillators in the country – at the moment there are only 3,500 registered with the ambulance service. When somebody makes a 999 call they are directed to the nearest [registered] defibrillator.” So wherever a defibrillator is available, he would encourage the people responsible to register it on nationalambulanceservice.ie.
The Dalkey CFRs take responsibility for checking that 19 publicly accessible defibrillators in their area are in working order and they organise the replacement of batteries and pads as necessary. Members also lead community and school demonstrations on the basics of CPR and how to use a defibrillator. Corbett is one of those trained in critical incident stress management and will follow up with responders after a stressful callout.
In March 2020, the NAS had to stand down all the CFR schemes due to the Covid-19 pandemic. It started to relaunch them from December, 2020, but the Dalkey group would be typical in finding that some members did not return and now it has just a dozen active responders. Between them, they covered 255 callouts in the designated Dalkey area last year, roughly five a week. The main reasons were chest pain (134), stroke (72) and cardiac arrest (35).
They always try to attend in pairs, with one responder as a lead and the other as a buddy. No newly trained responder will attend a call without a mentor until they have been to some in a secondary capacity. The text alert system enables any of them to signal, to both ambulance control and fellow responders, when they are on their way to a call. While some CFR groups run rosters for being on call, the NAS advocates that every member of a scheme receive every text alert for their area regardless. Otherwise, he points out, if they happen to be very close to an incident, they would be unaware.
Brennan has had family experience of sudden death and it was one of the reasons he joined the Dalkey group in 2016. “My dad died of cardiac arrest. Since becoming a member, my sister, aged only 55, passed away in her sleep. Who knows whether either or both could have been helped had someone seen them having a cardiac event?”
While he can only speculate about what might have been for those family members, he is playing his part now in trying to give some members of his community a happier outcome.
For more information, see becomeacfr.ie and crf.ie. Ger O’Dea can be contacted through email cfr@hse.ie and Dalkey CFR on info@dalkeyCFR.ie
