Saying “We’re going to do CPR,” instead of asking “Do you want to do CPR?” means a sharp rise in the number of bystanders agreeing to perform first aid while waiting for an ambulance. The dispatchers also know that when they ask a caller if someone is breathing, and the caller says, “yes, but...” and starts an explanation, that means “no.” “A second here and a second there matters,” director of clinical medicine Paul Bailey said. “It’s mindblowing what a difference these linguistics make. “It’s about attention to detail at every step.”

Cardiac arrest, he cautioned, was not the same as a heart attack. In crude terms, a heart attack was a plumbing problem in blood vessels around the heart. Cardiac arrest was an electrical problem that stopped the heart beating. It stopped blood reaching the brain, lungs and heart and death could follow in minutes. St John Ambulance Director of Clinical Medicine Paul Bailey. Credit:Emma Young. Each year, St John was called to 2000 cardiac arrests, Dr Bailey said. The victims were more commonly men, aged 40 to 80, but there was no typical patient.

Often they had no knowledge of any heart disease and no outward appearance of it. Sometimes they were fitness freaks. Sometimes they were children. The cardiac arrest was “routinely unexpected”. It mostly happened in the family home. The most fortunate was the group whose cardiac arrest was witnessed by a bystander, who had what medics term an “initial shockable rhythm” of the heart, with resuscitation started by St John paramedics. Of this group, 37 per cent survive the cardiac arrest in WA, St John figures show. The rate rose to 50 per cent if a bystander could use a defibrillator. But without these circumstances, the rate dropped to around 10 per cent. With a median ambulance response time of 9.2 minutes in Perth (in the middle of the pack for Australia and most comparable to rates in Victoria, New Zealand and London), Dr Bailey said what happened before ambulances arrived was pivotal.

For every minute post-arrest without either CPR or defibrillation, survival rates fell 10 per cent. This was why the service was overhauling every aspect of its approach to better emulate the acknowledged world leader in the field, Seattle. There, 56 per cent of the most fortunate group (witnessed, an “initial shockable rhythm”, resuscitation started by paramedics) survived. “They have a relentless focus on every aspect, shaving seconds off here and there,” Dr Bailey said. “They do all the simple things really well.”

Seattle had an impressive median response time of 4.5 minutes. Its call centres instructed people on how to do CPR, and it recorded and reviewed the activity taken in every single call-out. Some aspects of its service were not easily replicable by St John; for example, Seattle’s firefighters were trained in CPR and sent as first responders to out-of-hospital cardiac arrests from fire stations peppered thickly through the city. But more applicable was its system of CPR delivery called “pit crew” CPR, a highly structured approach to fine-tune the mechanics of a chaotic scene and decrease pauses in the action, with tightly defined roles for each crew member. “We know what works in CPR – it’s staying on the chest, compressing hard, fast and deep, and minimising interruptions,” Dr Bailey said.

“The ‘Seattle switch’ turns this into something highly choreographed, almost a dance.” St John representatives also attended “CPR University” in Phoenix, a city of closer size and layout to Perth in which researchers had managed to re-engineer the approach to cardiac arrests. In the meantime, St John has used a linguistic analysis of call centre recordings to train dispatchers to use the present perfect tense (what's happened) instead of simple past (what happened) and terms of futurity (we’re going to do CPR) instead of terms of desire (would you like to do CPR). The number of bystanders performing CPR has risen from an average of around 70 per cent to 91 per cent in just a couple of months. The other plan of attack is defibrillators – beginning to come down in price to around the $2000 mark, St John wants to get 10,000 more defibrillators into WA businesses, sports teams, schools, community groups and homes.

Walking the walk, Dr Bailey himself carries two defibrillators: one in his car, and one in his house. “I bring it to my son’s footy games,” he said. “It generates conversations. “Think of the ubiquity of pool fences and smoke alarms in our world; I want to see these in people’s homes.” Dr Bailey doesn't go anywhere in the car without taking a defibrillator. Credit:Emma Young

St John has also developed an app that allows anyone with medical training or a first aid certification opt in as a “first responder” so they can be alerted to an emergency unfolding near them. For the untrained, the app also provides first aid guides, a register and map of available nearby defibrillators, and a feature allowing St John dispatchers to find the phone’s geolocation. Those people who do recover from cardiac arrest had good prospects, said Dr Bailey. More than 90 per cent of them went on to live full, independent lives. One of his former patients, Tony, had an entirely unexpected cardiac arrest soon after the birth of his first grandchild. Dr Bailey had to defibrillate him nine times in order to save his life. Fast-forward 22 years and Tony has just turned 70. He has been present for the births of two more grandchildren. Recently he and his wife tracked Dr Bailey down and surprised him at work, thanking him for doing his job in their time of need.

Dr Bailey said his passion for improvement in the field was not uncommon among ambulance service medical directors. “It becomes an obsession for most of us,” he said. “The point is, when the community buys in, powerful things can happen.”