What is the competency level of your organisation’s first aiders?

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ST Photo

“Four in 10 cardiac arrest incidents went unnoticed by private ambulance crewmen when they responded to non-emergency calls…”

Do you think your organisation’s workplace first aiders can perform their duties above reproach?

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Monday, October 21st, 2013 Comment No Comments

One More Family Grieves

During my rounds, I attended to a patient by the name of Mr L.

He is 57 years old, a father of a 10 year old girl, with no prior medical condition.

According to his wife, he was working late till approximately 1am at home because he tends to stay up late as the next day is a Sunday.

Past 5am, his wife heard him gasping for air during his sleep. Because he was not responsive, the ambulance was called.

They arrived past 6am. 2 shocks were delivered before return of a pulse. However, by this time, he was already down for 45 minutes.

In the hospital after head scans, he was diagnosed with hypoxia-induced encephalopathy, aka brain damage from lack of oxygen.

He is now bed-bound with contractures, needs a tube for feeding, on adult diapers with a large sacral sore the size of a adult fist.

His wife was asking for my opinion on the Do-Not-Resuscitate orders for her husband, because she cannot bear to see him suffer any longer. He has been in this state for half a year already.

If only someone can reach him within the first few minutes with an automated external defibrillator (AED), it will surely give him a better fighting chance.

This someone WILL NOT have a duty-of-care to this father/husband in the capacity as a volunteer, unlike another victim of an incident whom I had attended to before.

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Tuesday, August 6th, 2013 Comment No Comments

More Facts to Save Lives

More facts, from the UK. Facts from the USA can be found in an earlier post.

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Tuesday, July 30th, 2013 Comment No Comments

Another Family Grieves

In my rounds recently, I attended to a patient who I will name Mr S.

He is 46 years old, a father of 2 school-going children.

3 months ago, he was playing street soccer with his colleague at a company-organised game, when after a second round of play, he collapsed by the court.

He was attended to immediately by the private ambulance paramedics on duty at that time.

According to his colleagues, the paramedics thought they felt a pulse, and they also thought he was breathing. But he was still unconscious.

On the way to hospital, the colleague who was accompanying him found the paramedics performing CPR on Mr S. No mention of any use of any AED or defibrillator of any kind.

Any now he is bed-bound, un-communicative, prone to contractures, and has to be fed via a tube through his nostrils.

So what went wrong here?

I have written a topic on this, and even had it published in our local press.

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Tuesday, October 9th, 2012 Comment No Comments

Misplaced AED Contributes to Family’s Loss

The daughter of a 55- year old man who suffered a fatal heart attack at an arena in the Abitibi just before Christmas says the family will not pursue the case.

Denis Letourneau collapsed during an old timers hockey game.

It turns out the defibrillator that normally hangs on a wall near the rink was missing.

It was only found much later in the office of the arena manager who apparently removed it because of renovation work.

Annie Letourneau says her father had just recently been given a clean bill of health by his doctor and there was no indication of heart disease.

My opinion : Just because your venue has installed an AED does not exclude you from any liability. Having a misplaced, missing or stolen AED is just as bad as not having any AED at all.

We provide consultancy for risk management in the view of the organisation installing AEDs on their premises. With better risk management comes better protection for both the rescuer and victim.

Contact us at

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Saturday, January 7th, 2012 Comment, Event No Comments

Deaths from AED Failures

A new study was just published, showing the number of deaths occurring because of failures in AEDs.

The top reasons were :

1. The AED failed to be switched on.
2. The AED failed to complete the heart analysis.
3. The AED failed to deliver the recommended shock.
4. The AED switched off automatically.

The full article can be viewed HERE.

This is why our company has been very meticulous in the deployment and use of the AEDs at our clients’ locations. Just ask Sentosa Island, our best client.

The evidence of the outstanding performance of our clients can be viewed HERE.


Friday, September 9th, 2011 Comment, News No Comments

Favourable Outcomes by Our Clients

We have been asked recently on how good our service to our clients is, in view of natural concerns of device failure.

This is something I am conscious of, since I am a medical practitioner and advocate for early CPR and early defibrillation in the community. This is the reason why I have been monitoring all the AED uses that I have helped my clients deployed in Singapore since we started, and I am now proud to say that our clients have passed with flying colours on all 3 possible scenerios that any public AED can encounter.

Scenerio 1
This is when the victim’s heart is in ventricular fibrillation (VF). This occurred in September 2008.

The victim’s heart was shocked back to normal sinus rhythm eventually, and he was discharged from the hospital after a heart bypass surgery with no neurological deficit. The story can be read HERE.

Scenerio 2
This is when the victim’s heart is in normal sinus rhythm, but he is unconscious for any reason other than VF. This occurred this month in July 2011.

The AED correctly announced ‘No Shock Advised”. The victim started regaining consciousness while being stretchered into the waiting ambulance, and was informed by doctors that he did not have neurological deficit. The story can be read HERE.

Scenerio 3
This is when the victim’s heart is already in asystole (flatline) or in pulseless electrical activity (PEA). This occurred in September 2010.

The AED correctly announced ‘No Shock Advised”. The victim apparently had a preexisting medical condition, and was found near the toilet with blood in his mouth. The story can be read HERE.

So ultimately, the outcomes of rescue attempts by any organisation which is considering deploying AEDs are dependent on their medical emergency response plan.

For our clients, as you can see, are very satisfied with our services.

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Friday, July 29th, 2011 Comment No Comments

2 Minutes of CPR after Every AED Shock

It is important that rescuers of cardiac arrest victims provide 2 minutes of CPR after every shock delivered by the AED, according to guidelines provided by the International Liasion Committee on Resuscitation (ILCOR), the European Resuscitation Council (ERC) and American Heart Association (AHA).

The extracted documents with the highlighted statements (3rd page) from the ERC can be found HERE. The flow chart is as follows :

The extracted documents with the highlighted statements (2nd page) from the AHA can be found HERE.

The reasons for this is because pauses to provide shocks is detrimental to the overall outcome, provided the victim is not revived by the first shock.

According to Dr Kramer-Johansen J et al in his paper “Pauses in chest compression and inappropriate shocks: a comparison of manual and semi-automatic defibrillation attempts” published in the journal Resuscitation 2007 May;73(2):212-20, the amount of time chest compression is not done is 22 seconds (median) pre-shock and 20 seconds (median) post-shock.

What this means that in a 5 minute window period of rescue time ( starting with the first shock ) , if rescuers performs chest compression of 2 minutes in between shocks, the total time without compression is 84 seconds, compared to 168 seconds if the interval between shocks is 1 minute.

What this means is that if someone performs 1 minute of CPR in between shocks, the total time of not performing chest compressions, ie not perfusing the vital organs like the brain and the heart itself, is 2.8 minutes out of 5 minutes (56%), compared to 1.4 minute (28%) when the interval is 2 minutes of CPR in between shocks.

Local evidence that 2 minute CPR in between shocks is the right protocol is seen by the experience of one of our clients, who saved a life recently. The story can be found HERE.

However, there is clinical evidence that rescuer fatigue can set in easily, as shown below.

This is the reason why we encourage our clients to pre-plan deployment of teams to all corners of their area of coverage, and to rotate among the rescuers in providing chest compressions, if need be every minute. 5 cycles of 30:2 compressions:ventilation will last approximately 2 minutes.

Only with teamwork will we be able to achieve the best outcomes.

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Friday, July 15th, 2011 Comment No Comments

Why Using an AED on Any Unconscious Person Makes Sense

It was recently reported that the family who lost their husband and father on a country club grounds is suing the club owners for his death.

One of the reasons is that the club staff did not use their automated external defibrillator (AED), thinking that the victim had a “weak pulse”.

I had an article published in a local newspaper on this matter some time back, about the difficulty of healthcare workers not able to judge well the presence of a pulse in a cardiac arrest victim, let alone a layperson rescuer.

It seems that the public does not really understand the usefulness of using an AED on an unconscious person ( regardless on the rescuer’s perception of whether the victim has a pulse or not ).

The real value of an AED in your workplace or home, is that it is a heart monitor first, life-saving device second.

It does not matter what the reason is for the person to become unconscious. If the heart is in ventricular fibrillation ( the only proven time when the person can be saved ), the AED will tell you to press the button to give a shock. Otherwise, the the victim is already clinically dead or is still alive, in which situations the AED will disable the shock button and will not allow you to shock the victim.

We already have 2 events experience by our clients.

In this event, the victim was saved successfully and went back to his normal life and work ( as described by his sister about a year later ).

In this event, the victim was already clinically dead when the AED was applied.

Any comments on this?

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Tuesday, June 7th, 2011 Comment No Comments