Stephanie Northen reports
Where is the best place in the world for your heart to stop beating? Don't panic, you've got 10 minutes to answer that question - the same time you've got to save the life of someone who's suffered a cardiac arrest.
While you're thinking about it, you might like to know that the safest city to keel over in is Seattle. No one there is ever more than four minutes from a fire station with a defibrillator, the machines that restart your heart with an electric shock. It also helps that the city's schoolchildren have been taught life-saving skills for the past 30 years. In Seattle, 43 per cent of cardiac arrest victims struck down outside hospital survive. In the UK the figure is 2.5 per cent according to two Norfolk medics for whom the statistic has profound meaning.
Jeanne Reynolds and Peter Simpson, who work for the East Anglian Ambulance Trust, became frustrated that most of the people they hurtled across the county to help were dead before they ran up their driveway. It takes, on average, 12 minutes for an ambulance to reach its patient, which is two minutes too many. If they are lucky, and most of them aren't, they will be with someone who knows how to do cardio-pulmonary resuscitation (CPR).
Pumping up and down on a victim's chest doubles their chances of survival.
So Jeanne and Peter decided to act, and to do it through children. Peter cajoled pound;5,500 out of defibrillator and drugs companies, and the team visited Seattle and other US cities. Then they contacted the British Heart Foundation, which now sponsors their work. They are the BHF's 1,000th Heartstart project, though one of only three to focus on children in schools. In May last year they visited their first school. Last month they spent the day at their 30th, Nightingale first school, near Norwich.
They've now reached more than 200 teachers, and they've done it all in their own time.
Resuscitation, says Jeanne, should be the fourth R. "Children are enthusiastic and have such good memories. They can go home and tell their parents and spread the word." The extent of ignorance and reluctance to help depresses her. "Even staff in old people's homes don't do CPR. Even people who've already had heart attacks don't know how to do it." By the end of the day Nightingale's 16 classroom assistants and support staff will know. The teachers have already been on the course and know not only how to do it, but why.
"How many people have heart attacks in the UK every year?" Peter asks the assistants, for the third time that morning. "270,000," comes the reply.
"How many go on to suffer cardiac arrest?" "130,000," they reply. "And how long have they got if you don't do CPR?" "Ten minutes!" they chorus.
Peter, a paramedic for 12 years, is a humorous and candid teacher. He explains the difference between a heart attack, when a clot blocks an artery and the muscle starts to die, and cardiac arrest, when the heart goes into a crazy rhythm and, crucially, stops pumping blood round the body. Of course he's seen and done it all for real. "Try closing the person's eyes to do mouth-to-mouth," he suggests. "That sometimes makes it easier."
But he admits: "You probably won't feel like giving the kiss of life to a guy with a beard who's just been sick. Look at me. I don't want to snog a bloke. I've only had to do it three times and I didn't enjoy it. If you can't face it, just do CPR. That keeps the blood flowing. Don't worry about doing it badly. Don't worry about breaking ribs. Remember, if you don't do anything the person is dead. And you can't hurt a dead person."
Jeanne, an ambulance technician for six years, says the vital message is for people to act. "CPR buys us time. We don't expect people to do everything, just to do something." Once the assistants are trained, the staff then teach the children. They can use lesson plans provided by the BHF, in a programme which takes four hours over a school year and is broken down into 15, 20 and 40-minute chunks. The course also covers medical emergencies such as choking and bleeding. The plans and the resuscitation manikins to practise on are provided free to affiliated schools.
Jeanne and Peter come along to the first session with the children to pass on their tips. "Forget finding breast bones and tips of sternums. Just tell them to find the middle of the chest... how hard is that? And remember the rhythm of Nellie the Elephant is about right for the rate of chest compressions - 100 per minute," says Peter.
Adults and children are also taught how to use a defibrillator. (A heart that's gone crazy will not start beating properly again without an electric shock.) Like CPR, the message is that it's easy; just do it. The pound;1,000 machine that Jeanne and Peter have brought with them is about the size of a big paperback. An electronic voice talks the Nightingale classroom assistant through the procedure as she kneels by a manikin. She learns how to save a life in about two minutes.
The BHF recommends the full Heartstart course for 10-year-olds and up, but Jeanne and Peter have found that much younger children can grasp the basics. "The kids just soak it up," says Peter. "And even if they can't do CPR, they can tell someone else how to."
Sue Travis, head of North Repps primary, has seen the human sponges in action. Her 36 pupils were the first in the county to be trained by their teachers in Heartstart. They need to know how to do CPR because their village is 25 minutes from Norwich; after 5pm, it's also 25 minutes from an ambulance. "The children are pleased to be able to do something to help their community," she says. They absolutely loved it when Jeanne and Peter came back for their training session. It gave them a boost to see paramedics standing there saying, 'you can save a life'. That's pretty heady stuff for a kid."
The school and the village, which is also behind the project, are now fundraising for a defibrillator. Sue Travis knows where she wants it to go.
"It sounds awful," she says, "but there's a turkey factory in North Repps with an office that is open 24 hours. It's the perfect place for a defibrillator. Everyone knows where it is, and it is always open."
Jeanne says that four schools in Norfolk have now bought defibrillators for community use. Nightingale is one of them. "Forget fundraising for a trim trail," says Jackie Loughlin, the head. "What more can you do for your community than save a life?" Their machine was bought the week after Jeanne and Peter's visit. Some of the money was raised through a non-uniform day when the children came dressed as nurses, doctors and paramedics. The rest was donated by women who had run holiday activities for the children last summer.
Jackie Loughlin says her pupils, whatever their age, will do as much of the Heartstart course as possible. "Why isn't this a government initiative?"
she asks. "So much else is. We're going to do it year on year and start as soon as possible. We'll build it into our PSHE curriculum." Jeanne and Peter are pressing on. They've won over Norman Lamb, their local MP, and buttonholed the DfES civil servant in charge of PSHE to help them get life-saving on the curriculum.
In the meantime they aim to cover all Norfolk's schools, teaching the staff to teach the children. "We'll teach three staff, we'll teach 80. We don't care, we're flexible," says Jeanne. Heartstart takes a lot of her time, she admits, "but it's my way of making a difference. It does give me a buzz."
OK, the 10 minutes are up. The safest place in the world to have a cardiac arrest, safer even than a hospital, is a Las Vegas casino. There 53 per cent of victims survive the shock of losing - or winning - a fortune, thanks to security guards trained with defibrillators.
Schools can find out about Heartstart through the British Heart Foundation: www.bhf.org.ukindex. asp. Telephone 020 7487 7115 (London) or 0131 554 6953 (Edinburgh). Norfolk schools can contact Jeanne Reynolds on 07796 031299 or email firstname.lastname@example.org