Helpful Guides for General Practice
RACGP 5th Edition Standards for General Practice
GP5.2E - Our practice has a defibrillator
The new 5th Edition General Practice standards now have a criterion for defibrillators (AED). although this is listed as a "recommendation" rather than a "requirement", this is long overdue in the RACGP Standards. It is hoped that this inclusion will lead to a greater uptake of AED's in practices as it is the most significant improvement practices can make to patient survival, following sudden cardiac arrest (SCA).
At the moment, statistically speaking, you are much more likely to find an AED in an emergency at a RSL club in Australia than in a general practice. This means according to the survival statistics, the RSL club is a better place to have a cardiac arrest as you are much more likely to survive with early defibrillation i.e. prior to Ambulance arrival.
Hopefully this situation will be remedied by the RACGP in later revisions and practices will in the meantime decide for themselves that an AED is an important piece of live-saving equipment that they should have. Practices who have made the decision to purchase a defibrillator are reassured that they are able to provide the best chance for their patients, should they arrest.
What does the RACGP Standards say now about an Automated External Defibrillator (AED) ? The criterion sets out some advice to practice on deciding to purchase an AED and other general advice on installation. It suggests practices use a risk assessment process when making this decision, whoever the drawback with this advice is that it provides an unrealistic evaluation of the practical implications of a cardiac arrest occurring and thus enables practices to "opt-out" of purchasing a defibrillator, based on misconceptions when assessing risk and benefit. The criterion states:
"You must decide whether your practice needs to install an AED, based on the risks of harm from cardiac arrest, by considering:
[The difficulty with this statement is that an AED purchase is not a cost vs. benefit analysis like other medical equipment. The "risk of harm from cardiac arrest" is clearly documented; as is the improvement in survival that comes from early defibrillation (<3 mins), that can only be achieved in the pre-ambulance period.]
1. The location of the nearest AED, hospital and other emergency services;
[Practically the only circumstance where risk may be mitigated would be if the general practice is located inside an existing health facility e.g. hospital, where medical emergency teams are established. Proximity to an ED for instance will not change risk of harm as these facilities do not make AED's available for off-site emergencies. Additionally, proximity to Ambulance facilities does not mean that resources are always available to be able to deliver defibrillation within the target time of < 3mins. Mitigation may exist if the practice had common access to a Public Access Defibrillator (PAD) if they were located within a shopping centre or collection of medical suites for instance.]
2. The number and composition of practice staff members, patients and other people who visit your practice (an AED is useful in workplaces that are visited by many members of the public;
[As there is no guidance as to what constitutes a "large number" means, this assessment is rather subjective. One could logically argue that all traffic to a practice is from the general public of a sub-set that a "ill" and therefore any patient in a general practice by definition is at risk of cardiac arrest and harm.]
3. Records of injuries, illnesses and near misses."
[The current profile of Sudden Cardiac Arrest (SCA) in Australia does not rely on the traditional risk factors i.e. an obese male smoker with hypertension and a history of cardio-vascular disease. On the contrary many more SCA's are occurring in patients that do not fit this profile and are much younger. Additionally, "near misses" of cardiac arrest are difficult, if not impossible to determine are are not a measure of future risk nor reflect the level of safety and care provided to patients by the availability of an AED.]
The 5th Edition Standard also has general installation and training advice...
If you have an AED:
• it must be maintained according to the manufacturer’s specifications
• the practice team must be properly trained to use and maintain it [Medics for Life provide free training to staff after purchasing one of our defibrillators]
• it must be placed where it is clearly visible and accessible, and not exposed to extreme temperatures
• there must be clear signs to indicate where it is located.
GP5.2E - Our practice has a defibrillator
The new 5th Edition General Practice standards now have a criterion for defibrillators (AED). although this is listed as a "recommendation" rather than a "requirement", this is long overdue in the RACGP Standards. It is hoped that this inclusion will lead to a greater uptake of AED's in practices as it is the most significant improvement practices can make to patient survival, following sudden cardiac arrest (SCA).
At the moment, statistically speaking, you are much more likely to find an AED in an emergency at a RSL club in Australia than in a general practice. This means according to the survival statistics, the RSL club is a better place to have a cardiac arrest as you are much more likely to survive with early defibrillation i.e. prior to Ambulance arrival.
Hopefully this situation will be remedied by the RACGP in later revisions and practices will in the meantime decide for themselves that an AED is an important piece of live-saving equipment that they should have. Practices who have made the decision to purchase a defibrillator are reassured that they are able to provide the best chance for their patients, should they arrest.
What does the RACGP Standards say now about an Automated External Defibrillator (AED) ? The criterion sets out some advice to practice on deciding to purchase an AED and other general advice on installation. It suggests practices use a risk assessment process when making this decision, whoever the drawback with this advice is that it provides an unrealistic evaluation of the practical implications of a cardiac arrest occurring and thus enables practices to "opt-out" of purchasing a defibrillator, based on misconceptions when assessing risk and benefit. The criterion states:
"You must decide whether your practice needs to install an AED, based on the risks of harm from cardiac arrest, by considering:
[The difficulty with this statement is that an AED purchase is not a cost vs. benefit analysis like other medical equipment. The "risk of harm from cardiac arrest" is clearly documented; as is the improvement in survival that comes from early defibrillation (<3 mins), that can only be achieved in the pre-ambulance period.]
1. The location of the nearest AED, hospital and other emergency services;
[Practically the only circumstance where risk may be mitigated would be if the general practice is located inside an existing health facility e.g. hospital, where medical emergency teams are established. Proximity to an ED for instance will not change risk of harm as these facilities do not make AED's available for off-site emergencies. Additionally, proximity to Ambulance facilities does not mean that resources are always available to be able to deliver defibrillation within the target time of < 3mins. Mitigation may exist if the practice had common access to a Public Access Defibrillator (PAD) if they were located within a shopping centre or collection of medical suites for instance.]
2. The number and composition of practice staff members, patients and other people who visit your practice (an AED is useful in workplaces that are visited by many members of the public;
[As there is no guidance as to what constitutes a "large number" means, this assessment is rather subjective. One could logically argue that all traffic to a practice is from the general public of a sub-set that a "ill" and therefore any patient in a general practice by definition is at risk of cardiac arrest and harm.]
3. Records of injuries, illnesses and near misses."
[The current profile of Sudden Cardiac Arrest (SCA) in Australia does not rely on the traditional risk factors i.e. an obese male smoker with hypertension and a history of cardio-vascular disease. On the contrary many more SCA's are occurring in patients that do not fit this profile and are much younger. Additionally, "near misses" of cardiac arrest are difficult, if not impossible to determine are are not a measure of future risk nor reflect the level of safety and care provided to patients by the availability of an AED.]
The 5th Edition Standard also has general installation and training advice...
If you have an AED:
• it must be maintained according to the manufacturer’s specifications
• the practice team must be properly trained to use and maintain it [Medics for Life provide free training to staff after purchasing one of our defibrillators]
• it must be placed where it is clearly visible and accessible, and not exposed to extreme temperatures
• there must be clear signs to indicate where it is located.
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Choosing a defibrillator for your general practice
Sorting out the various features and specifications of AED defibrillators currently available.
General Practice Emergency GuidelinesA flip chart style guideline, setting out the 10 most common and challenging emergencies in primary care and how to manage them. The guide shows step by step instructions using the equipment and drugs available in general practice.
Contact Medics for Life for details Please note a postage and handling charge will apply. |
General Practice Triage System
Medics fro Life has released a web-based triage system for general practice.
you can find it at www.gptriage.info | ||
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CPR Guide for New Parents.
Given the current situation, where in NSW no public hospital antenatal courses include training for new parents in resuscitation; Medics for Life has produced a short guide for parents. This guide has practical and common-sense advice for parents faced with the reality of having to do CPR on their baby. The advice is based on years of experience and the best methods from around the world.
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A Universal Collapse Protocol for General Practice
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Statistically, the most likely type of cardiac arrest that will occur in a general practice setting is the Sudden Cardiac Arrest just as it is in the community (= 85%). In A general practice This will most probably a witnessed event i.e. patient collapses, staff member notices and responds to help. Sudden Cardiac Arrest is an electrical problem that needs to be corrected quickly to increases the chances of long-term survival.
Unfortunately the survival rate from cardiac arrest in the community and in general practice are identical. This is despite the availability of clinical staff and emergency resuscitation equipment. There are several contributing factors to this anomaly in outcomes, these include:
Medics for Life with over 18 years experience in clinical training for general practice, (after a 15 year career in pre-hospital paramedicine), has developed a new protocol to assist practices in the initial management and identification of the cause of a collapse in a general practice setting.
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