I recently had the misfortune to have my brother, a 60-year-old Aboriginal man, have a heart attack and an out of hospital cardiac arrest. My brother had no history of heart disease and his blood pressure and cholesterol were normal when recently reviewed by his GP. He was at the park on a sunny Sunday around midday celebrating the birthday of his three year old granddaughter. He was surrounded by family when he began to feel himself blacking out. He reached out and grasped a nearby pole and slid slowly to the ground. His adult children rushed over to check if he was ok and found he had no heart beat and was not breathing.
The likelihood of death is high with 9 out of 10 people who have a cardiac arrest out of hospital dying. For those who are lucky enough to survive there is the added prospect of brain damage as a consequence of the cardiac arrest.
My brother was one of the lucky ones. He survived the cardiac arrest and reach hospital where he was intubated and taken to intensive care to be stabilised. I flew from Melbourne to Perth on an early morning the next day to be with my family.
To try to understand what had happened I spoke with my niece who was with her dad when he had the arrest. Although she had no formal first aid training she led the immediate response when she saw her dad collapse. Her story was so stunning that I asked if I could video record her retelling the story on my iphone. While her sister was on the phone calling 000 she began providing first aid to her dad.
She began her story by saying: "I knew what to do from watching one of my favourite TV shows Grey's Anatomy. I knew that I need to remain calm and begin compressing dad's chest." She called out to a man standing by and told him to blow into her dad's mouth and he did so at regular intervals. After a while her 22-year-old son, who also had no formal first aid training, took over chest compressions. When he tired, the man doing mouth to mouth took over chest compressions as well as mouth to mouth.
At this point my niece said a woman standing nearby told her "there is a defibrillator on the wall over there". My niece said she ran approximately 150 metres to get the defibrillator off the wall. She called 000 to get the code to open the box to retrieve the defibrillator and while the first two codes failed to open the box, the third code opened the box. She ran with the defibrillator in hand and began to have difficulties breathing – with an asthma attack while she ran. Her son ran to help her and she threw the defibrillator to him, he caught it and ran the remaining distance back to her father.
Neither my niece or her son knew how to use the defibrillator, but the bystanders assisted and used it twice on my brother. The first time she said "there was no response and I don't think it was charged enough because dad didn't move". The second time as the woman used it she yelled stand clear, stand clear and after she discharged it my niece and said her dad's arms, leg and whole body lifted off the ground and he took a deep breath of air.
"We knew the defibrillator had worked but his heart seemed to be beating weakly so we kept giving CPR… When the police arrived they took over giving CPR until the ambulance arrived about twenty minutes after dad first collapsed."
I asked her how much time she thought had passed before the successful second defibrillation of my brother and she said she thought it was five minutes and that they had commenced chest compressions and mouth to mouth immediately on witnessing his collapse.
When I arrived early the next day after a flight from Melbourne to Perth my brother was in the intensive care unit at Fiona Stanley Hospital. He was still intubated and sedated and during the day on Monday he was taken for an angiogram. We had an intensive care specialist come to speak with my brothers six adult children, my two sisters and me. She explained he had a moderate sized heart attack and widespread coronary artery disease requiring surgery. She also explained that when he awoke we would know if he had any brain damage. To our great surprise when he woke he had no sign of any brain damage. He remained in hospital and after 10 days he had bypass surgery with four coronary artery bypass grafts. Over recent moths he has been recovering from surgery and began a cardiac rehabilitation program.
In the days that followed as I visited him in hospital while he waited for surgery and in the few days after his surgery I thought more about his experience and my niece's incredible story. I knew that sadly most people don't beat the odds and survive.
As far as I could tell multiple factors contributed to his good outcome. First, he had a witnessed cardiac arrest. Second, he was in a public place with a defibrillator available for the public to use. Third, his daughter had some virtual training that helped her understand what to do if someone had a cardiac arrest from watching Grey's Anatomy. Fourth, her son was able to help her and her sister immediately made a triple 0 call to an ambulance. Fifth, strangers came to watch and presumably see if they could help and were willing to also provide assistance. Sixth, the WA police first responders were trained in first aid and took over providing CPR until the ambulance arrived. Seven, the ambulance arrived within twenty minutes and took over his care and transported him to a nearby (eighth) tertiary hospital that was well staffed and ready to respond to his situation.
Finally, my brother believes his survival was a miracle and I must accept that even with all those factors working in his favour there was a huge amount of luck that not everyone experiences. During his near-death experience, he describes seeing a light off to the side and knowing that he wasn't not meant to go near it. He is still coming to terms with his survival and rehabilitation from surgery. We are all enormously grateful.
I am chief medical advisor First Nations heart health for the National Heart Foundation. I have learned from this experience that CPR training for non-medical people is critical to helping improve survival. The widespread availability of defibrillators in public places is an essential public health measure that does save lives.
If you have not completed a first aid course in recent years, whatever your background it is important and you may never know when you might help save the life of a relative or a stranger. For all the statistics about Aboriginal people and police, this is a good news story showing the positive and life-saving impact of police emergency attendance in a time of crisis. It feels good to know that other Australians will step in and help provide life-saving help in an emergency.
Professor Sandra Eades is Deputy Dean (Indigenous) of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne, and Chief Medical Advisor, First Nations Health, for the Heart Foundation.
