Improving odds of surviving cardiac arrest


Vital lesson for all: A trainer showing how to perform cardiopulmonary resuscitation using an automated external defibrillator (AED). — CHAN TAK KONG/The Star

Long Soo Keat collapsed on the field from a sudden cardiac arrest (SCA) during a football match in Ayer Itam, Penang, in September 2018.

He could not be more thankful that there were people around trained in cardiopulmonary resuscitation (CPR).

Thanks to the quick response of five teenagers who knew how to perform CPR and use an automated external defibrillator (AED), the real estate agent, who was 49 then, survived to see another day.Long, who suffered a cardiac arrest on a football field in 2018, says CPR and the use of AED saved his life.Long, who suffered a cardiac arrest on a football field in 2018, says CPR and the use of AED saved his life.

Long was six minutes into the game with his fellow Chung Ling High School alumni when the incident occurred.

Amid frantic calls for help, St John Ambulance Malaysia (SJAM) Penang cadet Ansley Tan Zhong, 14, sprang into action with help from his team.

SJAM Foundation Penang honorary secretary Ricky Chan Kok Soon, 58, said time was of the essence in this kind of situation.

“All five teenagers, at that time – SJAM L/Cpl Gabriel Soon Chai Long, SJAM Pvt Liong Jun Yong, both 16, and cadets S. Shaman and Tang Yi Ze, both 14, as well as Ansley – saved the man’s life through teamwork,” said Chan.

In this case, the availability of a public AED at the school played a big part in keeping Long, who had irregular pulse and was gasping for breath, alive.

“I do believe Long was in the right place with the right people at the right time. It saved his life,” Chan told StarMetro.

Long, now 54 and a father of three, is a firm believer in the importance of having AEDs installed in public areas.

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“I am grateful that the teenagers have been trained to save lives.

“Having an AED made such a vital difference for me.

“I hope AEDs will be placed in public areas where hundreds of people pass by every day,” he said.

Every minute counts

In Malaysia, cardiac arrest is the number one cause of death.

Based on 2021 data from the Statistics Department, 18,515 people died of coronary artery disease.

This means about 50 Malaysians die every day from cardiac arrest.Subang Jaya City Council security guard Wan Amirul Ammar, trained in the use of AEDs, explaining to (from left) MBSJ employees Siti Hasmah Shamsudin, Norsalasiah Salbani and Nur Shuhaida Abdullah the function of the device placed at the lobby of the city council’s headquarters. — SS KANESAN/The StarSubang Jaya City Council security guard Wan Amirul Ammar, trained in the use of AEDs, explaining to (from left) MBSJ employees Siti Hasmah Shamsudin, Norsalasiah Salbani and Nur Shuhaida Abdullah the function of the device placed at the lobby of the city council’s headquarters. — SS KANESAN/The Star

According to the American Heart Association, a person’s chance of surviving SCA drops by 7% to 10% every minute a normal heartbeat isn’t restored.

Immediate CPR is imperative because the body can suffer irreversible brain damage within minutes.

There will be brain and tissue damage from a lack of oxygen if a normal heartbeat is not restored rapidly.

According to research from the US National Institute of Health, the combination of CPR and early defibrillation can save lives.

The institute further states that applying CPR alone gives a person a 5% survival rate but when combined with an AED, the survival rate jumps to 75%.

As such, Malaysia has started looking into introducing AEDs in public places.

In March 2022, then Health minister Khairy Jamaluddin announced that starting 2025, it would be compulsory for government buildings and public facilities to have AEDs in their premises.

He added that RM3mil would be allocated for the project, which was launched on June 1, 2022.

So far, the MyAED Community project (the ministry’s joint initiative with SJAM and Malaysian Red Crescent Society) has installed 100 AEDs around the country, but there has been no further progress reported.

The good news is that some states, such as Penang, have pushed for AEDs.

As of September 2022, 163 AEDs have been installed throughout the northern state, thanks to local authorities working with non-governmental organisations (NGOs).

As for Klang Valley, efforts to instal AEDs in public spaces are gaining pace via partnership between NGOs and private entities.

Yeo showing an AED and placement of pads on a patient’s chest to deliver electrical shocks. — CHAN TAK KONG/The StarYeo showing an AED and placement of pads on a patient’s chest to deliver electrical shocks. — CHAN TAK KONG/The Star

SJAM Foundation Selangor Coastal Area chief operating officer Datuk Yeo Kim Thong said they had begun installation of AED kiosk stands at public places in Klang Valley, including malls, office buildings, sports fields and government office lobbies.

“Our partnership is with the local authorities and malls.

“Our target is 111 AEDs for Klang Valley and so far, we have installed 40 stand- alone AED kiosks.

“We plan to equip 71 more areas.

“Each kiosk costs RM8,000 to RM12,000, and has full instructions for bystanders on how to use the AED,” he said.

Easy to use

Yeo said the AED was easy to use even for someone with no training, as the device was voice-automated and gave instructions.

“It is a portable device that can analyse the heart’s rhythm and if necessary, deliver an electrical shock or defibrillation to help the heart re-establish an effective rhythm,” he said.

“Minutes count when reviving someone in SCA, as each minute’s delay in resuscitation causes the survival chances to fall,” said Yeo who has been with SJAM since 1978.

He said it was important to keep in mind the crucial “chain of survival” link.

“It starts with a 999 call. Carry out CPR, the second link, before defibrillation with an AED.”

He said the foundation provided two-hour guidance on how to use the device, to employees in public buildings and malls where the AED had been set up.

“We also provide CPR training for the security guards and workers at the information counter so they can immediately respond if there is a case of SCA,” he said.

Yeo pointed out that since most SCAs occurred away from hospitals, these stands provided an essential tool.

“Our efforts to place AED units in the busiest public places were set in motion in July 2020.

“We receive calls and our ambulance team does respond but at times, it is too late because of traffic congestion.

“This is why we need to increase the AED presence in public areas and create awareness of CPR knowledge,” he said.

Yeo said SJAM Foundation did annual audits on AEDs in every location to ensure the machines were functioning properly.

So what should you do if someone near you collapses and is unconscious?Fernandez says if a person has collapsed and is unconscious, check to seeif they have a pulse and are breathing.Fernandez says if a person has collapsed and is unconscious, check to seeif they have a pulse and are breathing.

SJAM Foundation Federal Territories regional officer Kenneth Charles Fernandez, 33, suggests checking to see if the person is breathing and has a pulse.

“If there is no pulse and the person is not breathing, call for emergency help to ensure help is on the way.

“Then use an AED if available. The AED gives you step-by-step voice instructions.

“It will tell you how to check for breathing and a pulse and how to position electrode pads on the person’s bare chest,” he said.

Fernandez said that once the pads were in place, the AED automatically measured the person’s heart rhythm and determined if a shock was needed.

“If it is needed, the machine will tell the user to stand back and push a button to deliver the shock.

“The AED is programmed not to deliver a shock if a shock is not needed.

“Start CPR after the shock is delivered if CPR is still needed.

“The AED will also guide a person through CPR.

“The process can be repeated as needed, until the ambulance personnel arrive,” he said.

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