Johnny Thomson 00:01
Defibrillators save lives and more and more village halls across the UK are recognising their importance, particularly in remote rural communities. Hi everyone, I’m Johnny Thomson and welcome to The Village Halls Podcast sponsored by Allied Westminster, the UK’s is largest specialist provider of village hall insurance and the home of VillageGuard. Now, whether you’re interested in football or not, it was difficult not to be aware of a dramatic story involving Christian Eriksen during Denmark’s Euro 2020 game against Finland last summer. The player collapsed towards the end of the second half suffering a cardiac arrest and thanks to the quick thinking of one of his colleagues, the presence of a fantastic medical team and a vital piece of equipment, he survived and is now returning to the game just eight months later. My guest today is Martin Fagan, who is Secretary of The Community Heartbeat Trust, a charity which aims to help communities provide defibrillators to save lives. Welcome to the show Martin and thanks for joining me today.

Martin Fagan 01:13
You’re very welcome Johnny and nice to be here and chat.

Johnny Thomson 01:17
Yeah, thanks for coming on. Now, as I just mentioned, defibrillators save lives, and they really do make a massive difference to survival rates in cases of cardiac arrest. But before we get on to talking about that in more detail Martin, tell me a little bit about you, your background, and also the fabulous organisation that you’re part of.

Martin Fagan 01:39
Right, well, if we talk about the organisation first because that’s more important than me. As an organisation as a national charity, what we try to do is to help give both advice and also provide the the right equipment to help people put defibrillator projects into their communities, but done to best practice, done in a way that addresses the issues of governance, sustainability and resilience. So we’re not a low cost by any means, we are a best practice and everything we do with the community is about trying to make sure these projects are done as well on day one, and they’re still going on day you know 10 years down the road. You know, they are life saving equipment, so let’s do it right first time. In terms of me, I’ve been with the the charity since its inception. My background is medical in one form or another. I trained as a biochemist and toxicologist originally. Came up through sales, marketing in healthcare, eventually into healthcare informatics. And then that took me out to places like the Far East working for many years with governments in various countries in the Far East. I came back to the UK, worked for a while for the Department of Health in the NHS Confederation before ending up where I am now as the National Secretary for the charity.

Johnny Thomson 02:55
Fantastic. Okay. And yeah, with your background and your knowledge in the organisation that you work for you the perfect guy answer the next question, which is in simple terms, what is a defibrillator Martin?

Martin Fagan 03:07
Well, I think the easiest way to to understand what a defibrillator is, because it’s a magic word a defibrillator, so it obviously de-something’s and that something is the fibrillation. So one what on earth does fibrillation mean. You know, if you say that to people they look at you with glassy eyes. Well, you got to understand how the heart works. So the heart is a muscle. And it’s a very special muscle, it’s the only muscle in your body that never gets tired. Every other muscle you use in your body, if you stretch out your arm and back again, or you run down the road, your muscles get tired and they get tired because a buildup of lactic acid. Now your heart is just sort of squeezing, contracting, relaxing, contracting, relaxing, contracting, relaxing, roughly once a second 24 hours a day, 365 days a year, 80 plus years, but it doesn’t get tired, it is the only muscle in the body that doesn’t get tired. You could imagine situation if it did get tired and it says okay, I’m just gonna take five minutes off and go and have a cup of tea. It would be a rather drastic thing to to happen. So, so your heart contracts, but the muscle cells there can’t get tired. So while it’s contracting normally, and it squeezes because it’s hollow, it pumps blood and oxygen around the body. And that’s fine as long as it’s actually squeezing in a nice regular way. But occasionally, it starts squeezing in a slightly different irregular way. So instead of actually a nice, consistent whoosh coming out of the heart, you’ve got it sort of shaking like a jelly and if it’s shaking like a jelly, it means you haven’t really got any blood and oxygen coming out of the heart and being passed around the body. Now that shaking like a jelly has a term called fibrillation. And if whilst the heart is in fibrillation and is not pumping blood and oxygen around the body, then obviously that’s not really a good position to be in because obviously the vital parts your body, like your brain and elsewhere, do not get that oxygen and if you don’t get that oxygen, you die. So from the time the heart goes from working normally, to the time it’s completely stopped, and it doesn’t move, it doesn’t shake doesn’t do anything, there is a period when that heart has gone from normal beating, to shaking like a jelly to doing nothing. So during that period of shaking like a jelly called fibrillation, you can do something to try and correct and bring the heart back to working normally and that’s where a defibrillator comes in. It stops fibrillation.

Johnny Thomson 05:16
Okay. And yeah, I think most people will probably be aware of these from watching dramatic TV medical shows and seeing people grabbing two bits of metal and pumping someone on the chest and they fly in dramatically into the air as they’ve just been hit with a, you know, 1000 volts or whatever it is, of electricity to to stop that shaking jelly from happening. That’s pretty much how it is, but it isn’t, is it?

Martin Fagan 05:40
It’s not as dramatic as you see on Casualty and other programmes on telly. Those are done for drama, it’s to create entertainment, the reality unfortunately is a little bit less dramatic. So nowadays, you would use what’s called an automatic external defibrillator. So AED and that is different from something that is an implantable defibrillator called an ICD. So an AED an external defibrillator, which is what most people, you know, show as a concept for a defibrillator is a little box and has a couple of wires coming out of it and on the end of it too little electrodes.You stick those electrodes on the on the chest, either side of the heart, and it will fire a bolt of electricity between the electrodes and ideally through the heart. And it’s like sort of rebooting your computer. So you’re grabbing hold of this heart and slapping it around the chops and saying behave yourself, you’ve got to start working properly. And that’s really what what a defibrillator is doing. But they are actually fairly undramatic things in many respects. You stick these electrodes on and you stand back and press the button and somebody might shake a little bit and then hopefully, things go back to normal. It’s not quite the same as Casualty where they’re sort of hanging off the ceiling afterwards.

Johnny Thomson 06:49
Yeah, it still seems a little complicated and certainly a bit scary to operate, but I understand they’re actually not like that at all either.

Martin Fagan 07:00
Certainly not modern defibrillators. So so any of the modern ones, modern ones tend to have things like visual displays, television screens on them. And so they don’t just talk to you as the older ones do, but the the new ones will actually show you pictures. And so it’s really a matter of just follow the picture, do what it says on the screen. And the pictures are valuable, because it’s not only showing you what to do. But if you’re in a panicky situation, there’s stress going on, there’s lots of noise around you, because everybody else is panicking around you, you’re not listening, you want to focus on what’s what’s going on. So the screen really does help you focus. Plus, of course, if you’ve got a hard of hearing or you don’t speak English, or your a child helping the rescue, those pictures really help. So modern defibrillators with pictures on them, and animations on them really do make it a very simple process for people to follow through. And the other important thing to remember, which is really critical in this whole thing is you can never make the situation worse, you can only ever make the situation better. Now, you mentioned Christian Eriksen a little earlier on. And if you go through exactly what happened to him. Okay, so he was running along, and he fell flat on his face. What did his teammates do? The very first thing they did was to recognise that he had a problem. And they recognised that he was probably in cardiac arrest. So number one important thing is to make sure people recognise that somebody needs help. Number two, is you call for help. So if you’re out in the community, call 999 and ask the ambulance service. But if you’re on your own call for help get somebody to come and help you. That’s number two. Number three, you would start those chest compressions. Now if you think about what’s happening, fibrillation, the hearts quivering like a jelly, it’s not pumping anything out, you need to get this blood and oxygen moving around the body again to to keep that person alive. And not just to keep their person alive, but you also want to get oxygen coming to the heart muscles themselves. So you take over the beating of the heart by pressing the person’s chest. Number four is you use the defibrillator to try and get the heart working properly again, and then you get them off to hospital. So if you think about what happened in the Christian Eriksen incident, that’s exactly what happened, his colleagues recognised it, they called for help, his colleagues, his other players started those chest compressions and somebody brought a defibrillator onto the field of play to use on him. And that process, those five steps, the the recognition, the call for help, the chest compressions, the defibrillator, and then sending him off to hospital, those five steps are called the chain of survival. And it’s the chain of survival that saves people’s lives. The defibrillator is just one part of that. And that’s an important thing for people to remember. A defibrillator is a tool, okay? It’s nothing to be frightened off. It’s a tool. So all you do is you follow that process through and the defibrillator is there and design the modern one is designed to help you go through that stage four and help in the rescue and help save their life.

Johnny Thomson 09:45
Yeah. But I guess the simple fact is that if you take that defibrillator out of the equation, it becomes, if you look at the you know if you look at the odds, if you like of survival, they are significantly reduced aren’t they without without the presence of a defibrillator?

Martin Fagan 10:03
Absolutely, because you’re missing out an essential part of the jigsaw. You know, your sequence of steps are those chain of survival. If you take one of those links out of the chain, you haven’t got a chain anymore. So the defibrillator is absolutely critical in that, but it is one of the links in the chain.

Johnny Thomson 10:18
Yeah, yeah. Now rural communities, of course, well anywhere is a great place to locate a defibrillator. But in rural communities help is likely to be a little further away, I guess and I understand, you’ve pioneered the use of the good old red telephone boxes, for example, to hold many of them. And there’s been a lot of work with village, church and community halls as well.

Martin Fagan 10:48
Yes, I mean, if you think about phone boxes, so those lovely sort of square red, two metre high iconic structures that are recognisably British, if you think about it, you know, people think of Britain and they look at the guidebooks and it always has a nice red phone kiosk. If you go to airports and you buy a tin of toffees it’s in a toffee tin made up in the shape of a red phone box. So they are considered to be British icons. And going back to around 2009, British Telecom had announced they were actually going to close down lots of these phone kiosks. Nobody uses phone kiosks anymore, because everybody has mobiles. And so they started a programme where they were closing them down. And a colleague of mine actually went to British Telecom, one of the senior managers of BT lived in the same village. And he went to him and said, if you’re closing these down, could we take over some of them please, because they tend to be right in the middle of a community, they tend to be very easily recognised, they appear on satnavs and Ordnance Survey maps, could we take over some of these and put defibrillators in them? Because you’re supplying power anyway? And, you know, repurpose them? And the guy from BT said, Oh, that’s an interesting idea. Yeah, okay, we’ll do it. And so we did a couple, two or three initially, just to try it out. It worked. We had a bit of a learning curve because they are old. And they do have a little bit of creaky wiring in them. But nonetheless, we went through that. And since then, I think we’ve probably converted about 1000, or there abouts to defibrillator sites. And we’ve also helped communities turn them into libraries and fish tanks and all sorts of things that you can turn them into. But from our point of view, we’re repurposing them as as defibrillator locations. And of course, lots of other people have started doing that as well. And not just the iconic red ones. We also do some of the the steel and glass ones as well, they can be equally as useful. We’re doing them slightly differently, but they’re equally as useful. And again, they’re in the centre of communities. So if you think about it being time, time is of key of the essence. You know, having something which stores a defibrillator, that’s easily found means you can get to that defibrillator very quickly, you can find it very quickly and therefore, time is shortened. And if time is shortened, you get better response in the in the rescue. Other places, village halls are very good. Village halls have a tendency to be signposted. If you go into a village. Quite often you’ll see the the signpost saying village hall this way. Churches obviously because they’re very easily seen in the main. Or pubs. Everybody knows where the pub is. You know pubs are a good location. So we’ve installed I don’t know how many so far, over 7000. But most of those have been in in kiosks, village halls, pubs, churches, community centres, even on the side of people’s houses. Wherever is the best location in that community, where that location that defibrillator can be found extremely quickly, even for a stranger to that village.

Johnny Thomson 13:41
So if anyone out there is listening, and they’re interested in getting hold of a defibrillator for their community, whether they’re a I don’t know a committee member of a village hall or, or even just, you know, part of the activities of a sports club or something like that, where, where should they start?

Martin Fagan 13:57
Well the easy thing is to come and talk to us, which is an obvious thing to say. But everything we do is about, as I said at the beginning, it’s about doing it well is doing it to to a high degree of success. And it’s not just about the defibrillators it’s having the right defibrillator. It’s not just putting it in location is making sure that location is suitable. It’s also making sure that access to it is safe, you know, you’re not going to to cause a problem giving somebody an injury trying to get get to see the defibrillator. But also you have to take into account some degree that if you’re putting something like a defibrillator, in the public domain, you have certain responsibilities. You have a duty of care, safety and so on. But one of the things that people often forget about is that you also have to comply with disability legislation. So there was a wonderful example at a village not far from where I live here in the Midlands, where the committee put it in and you had to stand on a little stepladder to get to it. And we said to them, why have you done that? And they said I was to keep it out of reach of people.

Johnny Thomson 15:01
Yeah, which kind of makes sense, in some respects, you can understand people kind of making that, that mistake?

Martin Fagan 15:07
Well you can do, but but if you think about it, somebody who’s perhaps in a wheelchair, they have as as much right to have access to that equipment as somebody who’s able to stand on two legs and run a marathon. So it’s important that you when you when you position it, when you when you get the equipment, when you think about the placement, you do take into account that it’s not only you who may be fit and healthy and well, accessing it, it could be children accessing it on behalf of somebody else, it could be somebody who’s got a disability, it could be somebody who’s a foreign national, doesn’t speak English. So you’ve got to take into account a little bit more than just let’s stick a defibrillator on the wall.

Johnny Thomson 15:43
And I guess you’ve also got to understand how it works. And and when it’s appropriate for it to be used as well.

Martin Fagan 15:51
Well, I think that’s, that’s actually quite an important point. So you often hear that statements like, oh, you don’t need to be trained to use a defibrillator. And and to some degree, that’s correct. What the guidance actually says is that if you are not trained, you should not be prevented from using it. The guidance doesn’t say you don’t need to be trained. So there’s a slight difference in subtlety there. But if you think about it, you need to be trained to recognise what is a cardiac arrest, as opposed to say somebody fainting, or diabetic, you need to be trained how the 999 service works, only 5% of people in the country have ever phoned 999. So how does 999 system works? What’s happening? What sort of questions they’re gonna ask you? How does that link in with your your defibrillator in the community, because understanding that can obviously help in the way you use it? You obviously need to be taught how to do chest compressions properly. Now, yes, you can watch telly and I had a wonderful discussion with the makers of Doctor Who a few years ago, because they showed doing chest compressions on one of the episodes and I wrote them and I said, you’ve got an audience there of millions watching this and people do copy off what they see on TV. Why don’t you show just compressions being done correctly? Rather than the sort of the the theatrical way of doing chest compressions? To which the the answer was nobody believes anything they see on telly, to which I would then say, well go and talk to ITV. Their entire basis is that people believe what they see on telly. It’s called advertising. But the point is that chest compressions are not difficult to do, but they are very tiring to do so. So you really need to learn how to do them properly in an energy efficient way to give them maximum output and maximum success in doing that, and some of the more modern defibrillators will help you there. Because when when eventually do put the defibrillator on, it will give you feedback on your chest compressions, they will say, go faster, go slower, push harder, push softer, and give that coaching. And that all adds to the rescue and adds to the successful outcome. So training is good. We tend to shy away from the word training because the word training, by definition, suggests that something is difficult. If it’s difficult, you must be trained. And it’s not. It’s actually very easy. But it’s bringing it all together. It’s about building confidence, it’s about creating awareness. So that’s really what you’re doing. You’re creating awareness, you’re having awareness sessions rather than training.

Johnny Thomson 18:05
And it’s awareness around that chain as well, that you mentioned earlier. Of course, it’s not just about the defibrillator. It’s about those other elements as you outlined. Fantastic. Let’s let’s touch on, on a big question as well, I’m sure many village halls and others out there will want to know, which is around the cost of a defibrillator. And with that, what are the various ways in your experience that communities have been able to, to fund the purchase and the awareness raising and maintenance of these vital pieces and really important pieces of equipment.

Martin Fagan 18:42
We often go to, whenever a community approaches us we say to the community you’ve got really five stages in this. You’ve got your your fundraising, you’ve got your initial equipment purchase, you’ve got your installation, you’ve got commissioning, and you’ve got your ongoing support. So those five elements. In terms of the cost of equipment, the actual defibrillators range from circa £800 to £1400, £1500 pounds for the actual defibrillator. Now, in very simple terms, the more expensive equipment you have generally the more features it has. So it’s bit like your car, if you’re going to buy a basic Fiesta or a Rolls Royce. Now the Rolls Royce will have a lot more features in it than your basic Fiesta. So it depends really about what budgets you’ve got. You’ve also got to consider the location and the sort of service you want to offer and how that individual equipment may be impact on that. You also, if it’s being placed externally, you’ll be putting it in some form of cabinet. And there are again, lots of different types of cabinets around. We tend to favour double skin cabinets, not single skinned. And that’s to avoid problems with condensation. Defibrillators don’t like condensation, so let’s try and avoid that if we can do. You’ll need to instal it. If it’s a heated cabinet that will need to be installed by an electrician, you don’t have to have a heated cabinet but vast majority are heated. And the reason for that is that the the cabinets are heated to try and keep the defibrillator above freezing. The electrodes on the defibrillators tend to be water gel, so if they do go below freezing, then they will go solid. So you want to try and avoid that situation. Simply batteries will degrade in cold weather. So if you can keep it above freezing, then that’s going to add longevity and functionality to the equipment. Commissioning includes the training. So by all means run a training programme within the community or an awareness programme in the community. And awareness sort of goes beyond just face to face there’s posters, there’s articles, videos, etc. You can put on village websites and so on. But the thing that most people forget about is there are running costs. These are medical devices, they have electrodes that run out, they have batteries that run out, you do need to budget for those replacements and it’s not just the batteries and pads, when when the time expires and after they’ve been used where where there’s a cost, it could be your defibrillators taken away by the ambulance service. And it may take some time to come back. We had an example last year in Nottingham where it disappeared and it took us three weeks to find it and whilst it disappeared in Nottingham, we found it in Guy’s Hospital in London. And that takes time and money and also you know get a courier to bring it back for you. So there are hidden costs as well. So all of that needs to be budgeted for. So most communities will think about the initial cost, but they forget about the the ongoing cost. And so in a very simple rule of thumb, whatever it costs you to install it, it’s gonna cost you another 50% on top of that over the next 10 years to support it in a very simple rule of thumb. How do people raise funds? Lottery are very good. They’re just coming back online again having been diverted in their interest because of COVID. So Lottery is beginning to to give funding. If it’s a sports club, Sports England is certainly giving funding at the moment under the Jubilee Fund. Your local Rotary Lions and similar organisations are often very generous and will help. You can do your own fundraising. And there’s all sorts of different things you do with fundraising. I used the example the other day of what we did in our own that is during during the lockdown. And I think my wife will probably correct me, but I think we raised about £4000 during lockdown for for various village activities. So it can be done even with people socially distanced and everything else. There are fundraising things you can do, there’s crowdfunding there is just raising events, you know, do a sponsored run or a10k or a you know, somebody did a sponsor shave of the head. So there are all sorts of things that can be done within a community to fundraise. But when you’re doing that fundraising, please remember that, you know, two thirds of it goes to your equipment and one third will go to your support for the next 10 years.

Johnny Thomson 22:53
Yeah, yeah, that’s a really important point Martin to understand those ongoing costs as as part of that. Okay, so Community Heartbeat Trust, where should people go to get access to information online? Presumably website? Yeah?

Martin Fagan 23:10
We’ve certainly got a website. It’s www.communityheartbeat, that’s one word communityheartbeat.org.uk. There is a contact us page on that, but if you want to write to us directly you write to enquiries@communityheartbeat.org.uk. We have a telephone number too, if people want to call that’s 0330 1243067. We actually slightly missed out, we wanted a really easy number like 1234567. And we didn’t quite get it. We were pretty close. Yeah so 0330 1243067, nice, easy number and we’ll get back to you. We don’t advertise costs of defibrillators on our website, because it depends entirely on the circumstances, what people want to do, what their budgets are, how they want to use it. Is it solely for in an elderly population, do you want to include younger population, etc? So come to us tell us what it is you you want to do. We’ll we’ll give you a project guide will give a copious amounts of information, we’ll try and help guide you. And if you want us to, at the end of the day, we’ll help you acquire the equipment.

Johnny Thomson 24:19
Yeah, fantastic. And don’t worry if you if you didn’t manage to scribble all of that down. We’ll, we’ll put a few links on our website to go with this episode so people can can find their way there. I know there’s a great page on your website about getting a project started, as well Martin. I looked at that, and it’s fantastic, so I’d recommend people go and have a look at that. And other than that, wow, thank you for providing so much information in less than a half an hour. Wonderful, wonderful stuff. And so other than that hanks for coming on the show and more than that thank you for the work that you and The Community Heartbeat Trust do, you must have saved many, many lives already I’m sure.

Martin Fagan 25:06
I would like to say yes to that. But it’s one of these things that, when somebody’s life is saved, people talk about it, but if they don’t get saved, then of course, they don’t want to talk about it. But the important thing to remember here is you cannot do anything wrong. Okay. If you actually save somebody’s life, you feel on cloud 99. If you don’t save somebody’s life, the thing to remember is you’ve given them a chance, you’ve given them a chance, and that not only obviously doesn’t help the patient, but it really helps their relatives to know that everything possible was done.

Johnny Thomson 25:37
Yeah. And better for you to feel that you at least tried. Yeah, rather than you were left standing there and not knowing what to do. Yeah. Yeah, I understand that completely. Well, thanks again Martin. Really appreciate you being on and thanks for the insight.

Martin Fagan 25:53
No, you’re very welcome. And it’s been a great pleasure. Thank you, Johnny.

Johnny Thomson 25:56
Yeah, thanks, Martin. And that’s all folks for this episode. Big thanks to our headline sponsor and specialist insurance provider Allied Westminster for making our podcast possible, and whose services you can discover more about at villageguard.com. And to online booking system provider Hallmaster, who also sponsor our podcast and can be found at hallmaster.co.uk You’ve been listening to The Village Halls Podcast, a unique listening community for Britain’s village church and community halls, and anyone interested in the vital community services they provide. We’ll be back again soon with another episode. So if you haven’t already, visit thevillagehalls podcast.com to subscribe, sign up for updates, link through to our social media pages and to find out more. Until the next time, goodbye for now.