One of the things I love about medicine is the cross-fertilisation of ideas and techniques from one discipline to another. I worry that as more subspecialisation occurs, cross-fertilisation will be lost. Emergency medicine and critical care, spanning so many areas, are unique in that they may be the last places of true open-minded generalists. It’s in these environments that innovation can flourish.
Being involved in pre-hospital care allows you privileged access to the few moments immediately after an injury has occurred. Physiology is very different at this time. One thing that occurs in animals who sustain head injuries, and we believe also occurs in humans is a phenomenon called Impact Brain Apnoea. There are many historical articles reporting it but it seems to have been largely forgotten in modern literature. A bang on the head, even with minimal or no parenchymal brain injury, can result in a period of apnoea – with obvious consequences if sustained and untreated. We wanted to find a way to minimise this phenomenon. Suggestions included training paramedics better airway skills, but they already have great skills – its just they are not there…
It dawned on us that, like you are never more than 10 feet away from a spider, you are probably never more than a couple of hundred metres away from a doctor, nurse, paramedic or first aider… Harnessing this community would not just be beneficial in traumatic brain injury, but more importantly in cardiac arrest.
And hence the GoodSAM App (www.goodsamapp.org) was born. Consider the scenario. Someone collapses in a bookshop. If a bystander opens the App, it automatically dials 999 (or the appropriate number for whichever country you are in). It simultaneously alerts a trained and registered responder, who may just be in the coffee shop next door. It is the equivalent of shouting for help, but being able to shout through walls. The ambulance will still arrive (in London about 70% arrive within 8 minutes for category A calls); but with a trained responder arriving earlier, they should be less hypoxic have had high quality CPR and may even have been defibrillated if appropriate.
Now if reading this you may be thinking, but I don’t want to be called when out shopping! And that’s fine! If you are a registered responder you can switch the App off and if you can’t go when alerted, that’s fine, the next nearest responder is alerted. When responder densities are high (nearly 1000 in London) the chances of you being alerted are actually very small.
We also built a defibrilocator into the App – it now has nearly 2000 defibrillators across the UK in it. If a responder sees an Automatic External Defibrilatior (AED) attached to something fixed (e.g. in a tube station), they simply use the App to take a picture of it and state the opening times of the location. Using the Geotags of the photo it is then put on the GoodSAM map.
You may have some concerns about this App – that’s ok – we had too. Questions such as “how will you stop abuse”, “how do you check people who register”, “what about indemnity” are common and we have addressed them as best we can here.
This is something of a social experiment! But the Good Samaritan community seems to be building rapidly both in the UK and internationally. If it works, it might really make a difference, not just in maintaining airways in trauma, but by providing high quality CPR and early defibrillation in out of hospital cardiac arrest.
Guest Blogs at St.Emlyn’s
This week’s guest blog comes from Mark Wilson. Here he talks about the GoodSam app which we think is marvellous. Mark is a super chap who is an inspiration to all of us in #FOAMed, Meducation, PHEM and Neurosurgery. I met him at SMACCGold where he did an amazing sessions on Neurosurgery for everyone (you have to watch this) and ICP monitoring. You should also check out the links below to see examples of his contributions in the past.
However, he is not guest blogging on the past, but on the present. He has developed the GoodSamApp with help from the #FOAMed community and it’s just an amazing idea and one that really deserves widespread dissemination and adoption.
Please read Mark’s thoughts above and please, please, please consider joining in on this amazing idea.
- Mark at SMACC on Neurosugery for everyone
- Mark at SMACC on ICP monitoring
- Mark’s personal page – warning this may make you feel inadequate.
Mark asked us not to be so gushing. He’s much more devoted to the project and to making the world a better place than to any self promotion. He is rather modest, but to be honest we couldn’t resist. He’ll be at SMACC in Chicago next year so why not book your flights now and come meet him in person.