Health and wellness

The Singapore app for heart attack victims that Hong Kong isn’t ready for: why myResponder would flounder in city lacking CPR knowledge

A lack of training, data and civic-mindedness would have to be overcome for such an app to be effective, says a Hong Kong heart specialist about a city in which fewer than one in 44 heart attack victims survive

PUBLISHED : Sunday, 26 August, 2018, 6:18pm
UPDATED : Sunday, 26 August, 2018, 6:36pm

Heart attack victims’ chances of survival depend on how quickly their heart can be restarted.

Just ask the family of Dickson Yu Tak-shing, whose life, sports officials say, was probably saved by a teammate, a nurse who knew how to use a heart defibrillator, when the former Hong Kong swimmer suffered a heart attack while playing soccer in the city two weeks ago. A defibrillator delivers an electric shock to restart the heart.

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“The worst is over,” the mother of the 28-year-old said after Yu regained consciousness two days after collapsing.

If a victim’s heart is not restarted within three to five minutes, a lack of blood flow to the brain condemns them to almost certain death; those who survive will likely suffer irreversible brain damage. To increase survival rates, Singapore launched a mobile phone app in 2015 that alerts citizens with training in resuscitation to help heart attack victims nearby.

Could a similar app increase survival rates in Hong Kong, where more than 97 per cent of people who have heart attacks die if they are not already in hospital?

A lack of training, data and civic-mindedness would first have to be overcome, says Andy Chan Wai-kwong, a heart specialist and honorary secretary of the Hong Kong College of Cardiology to which all heart doctors belong. He spoke in a personal capacity.

The Singapore app, called myResponder, has been downloaded more than 92,000 times since mid-2015. In that time, more than 13,000 citizen rescuers have responded to alerts that someone within 400 metres of them has had a suspected heart attack and needs resuscitating.

In July, three passers-by resuscitated a woman suffering from a heart attack in Singapore’s Woodlands district; one of the rescuers was notified through myResponder.

The app, which is free, requires people with training in cardiopulmonary resuscitation (CPR) to register; in Singapore more than 28,500 have done so. It is used in conjunction with a database the Singapore government has built which maps the locations of defibrillators that the public can use.

How the myResponder app works:

When an emergency services operator receives a phone call that someone has had a suspected heart attack, they activate myResponder, which sends pop-up alerts to subscribers near the victim, who will be able to reach them faster than the paramedics sent to the scene by the operator.

A spokesman for the Singapore Civil Defence Force said the proportion of bystanders performing CPR in emergency situations has risen from 22 per cent in 2011 to more than 50 per cent today.

“I think the app is a very good initiative,” Chan says. “It is widely used by citizens in Singapore but in Hong Kong, there are a few issues we should address before launching an app of this form.”

The prognosis for people who suffer heart attacks in Hong Kong is poor, according to a study published in 2017 by the Hong Kong Medical Journal. Fewer than one in 44 victims survive.

There were local studies about the [Hong Kong public’s] knowledge of CPR and automated external defibrillators. The results were far from good
Leung Ling-pong, heart attack study co-author

Last year the Fire Services Department, which operates the city’s public ambulance service, received 8,634 calls reporting suspected heart attacks, of which 5,795 – or nearly 16 per day – were confirmed cases.

Ambulances are supposed to reach a patient within 12 minutes of receiving a call. The 2017 study in the Hong Kong Medical Journal found half of ambulances responded within nine minutes, while the other half took longer.

There is no official database in Hong Kong of the location of defibrillators available for public use, although unofficial maps exist. A number of shopping malls, offices and housing estates have recently installed the life-saving machines, and the government’s Leisure and Cultural Services Department says automated external defibrillators (AEDs) are available at 371 public recreational venues, including swimming pools, stadiums and beaches.

Chan says Hongkongers may be hesitant about using a defibrillator because they assume, wrongly, that it requires training. “You don’t need to be trained. AEDs were designed for people to use even if they are not trained.”

Leung Ling-pong, clinical associate professor in emergency medicine at the University of Hong Kong and co-author of the Hong Kong Medical Journal study, says: “There were local studies about the [public’s] knowledge of CPR and AEDs. The results were far from good.”

I think we should discuss implementing a Good Samaritan act in Hong Kong
Andy Chan Wai-kwong

The Fire Services Department does not rule out exploring the use of new technologies to help save heart attack victims, but says its priority is to teach people resuscitation and encourage them to volunteer their help to victims of heart attacks. To that end it operates a number of awareness programmes.

More than 6,000 students have attended its on-campus CPR training workshops; more than 3,000 members of the public have received training in resuscitation under its “Press to Shock, Save a Life” programme; and it has partnered with the Philippine consulate to train domestic helpers in what to do if someone in the household where they work has a heart attack.

In 2007, the department launched the “Heart Saver Scheme” to encourage people trained in resuscitation to render assistance if they encounter anyone having a heart attack. More than 8,600 people have signed up as “heart savers”.

A spokeswoman for the department said it would “continue to explore new measures to encourage the community to provide [a] helping hand to … cardiac arrest patients, including … technologies to enhance the emergency preparedness of the community”.

Chan says another factor that might make Hongkongers hesitant in trying to save a heart attack victim’s life was fear of being held legally liable for anything that went wrong.

Unlike countries such as China and the United States, Hong Kong lacks a Good Samaritan law absolving anyone who goes to the aid of another in an emergency from civil or criminal legal liability.

“I think we should discuss implementing a Good Samaritan act in Hong Kong,” Chan says. “I think this is very important. Some people may be afraid of legal consequences and I think we should protect people; they should not be afraid of resuscitating people or using an AED.”

Another study reported in the Hong Kong Medical Journal supports this view and calls for Hong Kong to pass a Good Samaritan law, while pointing out that no one has been prosecuted over anything that happened when they tried to rescue someone in danger.

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The lack of a Good Samaritan law in Singapore has not stopped civic-minded people there going to the rescue of heart attack victims. The country’s government has made clear no major liabilities will arise for people who render assistance to others in need. They are only expected to comply with a standard of care that can be “reasonably expected of [their] skills and experience”, it has decreed.