Progress on recommendations of Sudden Cardiac Death (SCD) Report : October 2007 News Archive

3rd October 2007

The creation of a new risk assessment questionnaire for sportspeople, the devising of ‘First Responder’ schemes and the establishment of two family screening clinics for those deemed at high risk of Sudden Cardiac Death (SCD) are some of the progress points outlined by the HSE on the implementation of recommendations of the 2006 Sudden Cardiac Death Report ‘Reducing the Risk: A Strategic Approach’.

The Sudden Cardiac Death Report was launched in March 2006 by Mary Harney TD, Minister for Health and Children.  The HSE has the responsibility to lead on it’s implementation in conjunction with interested organizations, groups and individuals.

Sudden Cardiac Death (SCD) is defined as death due to natural causes within an hour of the onset of symptoms, in the absence of any other cause, and assumed to have a cardiac cause.  There are approximately 5,000 SCDs in Ireland annually.  The majority of SCDs occur from late middle age onwards as a result of coronary heart disease.  Over the past few years there has been increasing awareness of sudden death in young adults, including sudden deaths in high profile athletes. The majority of these younger SCD cases are due to a number of pre-existing cardiac abnormalities along with infection, blunt trauma and drug use.

The SCD Report has a total of 75 recommendations of which 48 are ‘immediate’, that is requiring to be commenced by the end of 2006.  The SCD implementation group is concentrating on ensuring implementation of the 48 ‘immediate’ recommendations in the following areas:

·         Reducing time to response (to a cardiac arrest)

·         Systematic assessment of those engaged in sports and exercise

·         Detection and assessment of those at high risk of Sudden Cardiac Death

·         Surveillance and audit

An SCD implementation steering group comprising the HSE, the Irish Heart Foundation (IHF) and the Pre-hospital Emergency Care Council (PHECC) has met on a number of occasions to progress the report recommendations under the chairmanship of Dr Siobhan Jennings, Consultant in Public Health Medicine.  In the first phase of work the areas targeted were:

1.      Responder development

2.      SCD risk assessment in sports and exercise

3.      work with coroners, pathologists and CSO and

4.      addressing communication of resulting work

Dr Siobhan Jennings emphasised the importance of inter-agency cooperation on this strategy and said: ‘While the HSE has overall responsibility for implementing the report’s recommendations, it is evident that other organisations ambulance and first, both statutory and non statutory, have an important role to play and these organisations and individuals have contributed immensely to the progress to date.’

.Progress in the four areas:

1. Reducing time to response (to a cardiac arrest)

·First Responder template
This guide has been prepared to give information and advice for those planning to set up First Responder programmes

·Co-ordinators and resuscitation training personnel
11 new HSE positions to assist in the development of priority First Responder programmes   (One national pre-hospital First Responder coordinator,  four HSE area pre-hospital First Responder coordinators, six pre-hospital resuscitation training officers)

·Funding for the MERIT project
(HSE, PHECC)  targeting training in immediate response to cardiac and trauma events for GPs and practice nurses  in conjunction with ambulance personnel. Programme through UCD Dept of General Practice. To date, over 300 Automated External Defibrillators (AEDs) have been supplied to attending GPs 

·Initiation of uniformed First Responder pilot projects
such as Gardai in Kilkenny and Blanchardstown, fire service in Sligo.

·Initial work on guidance for purchasing  AEDs
Carried out through MERIT and Pre-Hospital Emergency Care Council (PHECC)

·Education and training standards across six  levels of response from cardiac First Responder to advanced paramedic
These standards developed by PHECC with progressive implementation between 2007 - 2010 

·Development of Cardiac First Response Report (CFRR)
Developed by PHECC for documenting out-of-hospital cardiac arrests in conjunction with the establishment of an out-of-hospital cardiac arrest register

·Spatial analysis research
by PHECC using HSE ambulance response time data to analyse demand and guide deployment of ambulance resources, minimising response times and maximizing the effectiveness of response (completed in the north west)

·Agreed national signage for AEDs

2. Systematic assessment of those engaged in sports and exercise

·Risk assessment (RA) questionnaire
being finalised for those contemplating participation in sports and exercise in the context of exercise being good for mental and physical wellbeing.  The RA group offered comment/advice during the development of the GAA’s risk assessment questionnaire

·Guidelines for GPs
To assist them deal with queries about risk assessment and its follow up

3. Detection and assessment of those at high risk of Sudden Cardiac Death

·Improved toxicology response to coroners request
Applying to the case of SCD in young people, resulting in reduced time to informing and testing families as appropriate    

·Ongoing analyses
of Central Statistics Office (CSO) data on prevalence of sudden death in young people in Ireland

·Study of post mortem data
Investigating the causes of SCDs in Ireland in people ages under-35 (2005)

· Development of protocols
Via the Coroners Society of Ireland,  for coroners on informing GPs and families of SCDs

· Establishment of two SCD family screening clinics
through voluntary funding: Family Heart Screening Clinic, Mater Heart House Dublin – launched February 2007; and Inherited Cardiovascular Diseases Unit, Tallaght  / St James’s Hospitals – launched June 2007.

4. Surveillance and audit

· National Out of Hospital Cardiac Arrest Register to start in November funded  by PHECC using PHECC CFFR  in association with NUI Galway

·Work on a national AED register and development (with Irish Medicines Board (IMB)) of best procedures for adverse event reporting

Members of the SCD implementation steering group have met with a number of stakeholders, including the voluntary ambulance services, a number of community first responder groups, a representative group of cardiologists, the Irish Medicines Board, the Irish Sports Council, CROI, the Department of Education and the Department of Health and Children, to progress the implementation of the recommendations.

A copy of the SCD Report is available on the HSE website at http://www.hse.ie/en/Publications/. A description of heart conditions that cause SCD can be found in the Heart Health Information section of the Irish Heart Foundation website http://www.irishheart.ie   and a list of the members of Steering and sub-groups making up the project team working in this area are below.

Members of the Project Team:

SCD Implementation Steering Group

Dr Siobhan Jennings (Chair) - HSE Population Health

Frank McClintock - HSE Ambulance Service

Dr Geoff King - PHECC                                  

Dr Brian Maurer - Irish Heart Foundation

Michael O'Shea - Irish Heart Foundation           

Dr Joe Galvin - Cardiologist, Irish Cardiac Society

Angela Fitzgerald - HSE National Hospitals Office          

Brendan Cavanagh - SCD Strategy Coordinator

SCD Ambulance and First Responder Sub Group

Frank McClintock (Chair)- HSE Ambulance

Dr Geoff King - PHECC

Sarah Cain - IHF

Dr Peter Wright - HSE West Public Health

Macartan Hughes - National Ambulance Training School

Brendan Cavanagh - SCD Project Coordinator

SCD Risk Assessment (Sports and Exercise) Sub Group

Dr Joe Galvin (Chair) - Cardiologist, Irish Cardiac Society

Marian Kiernan - HSE Dublin / North East

Brendan Cavanagh - SCD Strategy Project Coordinator

Dr Carl Vaughan - Cardiologist, Irish Sports Council

Dr Brian Maurer - Irish Heart Foundation

Dr Michael Griffin - ICGP

SCD Coroners, Pathologist and the CSO Sub Group

Dr Siobhan Jennings (Chair) - HSE Population Health

Dr Brian Maurer - Irish Heart Foundation

Dr Joe Galvin - Cardiologist, Irish Cardiac Society

Dr Denis Cussack - Coroners Society of Ireland

Dr Brian Farrell -Coroners Society of Ireland

Dr Conor Keane - Faculty of Pathology

Joseph Keating - Central Statistics Office

Brendan Cavanagh - SCD Strategy Coordinator

SCD Communications and the Media Sub Group

Dr Siobhan Jennings (Chair)  - HSE Population Health

Fidelma Browne -  HSE Communications

Caroline Curren - Irish Heart Foundation

Imelda O’Neill - HSE Health Promotion

Mary Morrissey - HSE Health Intelligence

Brendan Cavanagh - SCD Strategy Project Coordinator

Last updated on: 03 / 10 / 2007