HEART GUARD
A Call for Equality in Saving Lives
A community-based service that addresses cardiac arrest survival inequalities in deprived communities.
START POINT
The starting point is the Laerdal Challenge in SDCC 2024, which focuses on improving survival rates in time-critical emergencies like OHCA. The challenge calls for a locally tailored service to enhance first aid awareness and emergency response in Scotland, particularly Glasgow.
DESK RESEARCH
Key resource of desk research
7min 48s
Median time before
arrival of ambulance
8%
Bystander defibrillator
deployment before EMS
66%
Bystander CPR rates
in OHCA
It can happen to everyone, and is hard to prevent
It is estimated that over 5 million people die each year from cardiac arrest, which can happen to any seemingly healthy person at any time, in any place, and often without any warning.
Every year, over 3,000 people in Scotland experience an out-of-hospital cardiac arrest (OHCA), and only around 1 in 10 people survive to leave the hospital.
But as bystanders, we can make a difference
Evidence suggests that immediate use of CPR can double or quadruple survival from out-hospital cardiac arrest. In some cases, defibrillation within 3 minutes can increase the chance of survival to more than 70%. As a bystander, timely action - calling 999, providing CPR and defibrillation - is critical to helping people survive an OHCA.
After the desk research, expert interviews were chosen to validate findings, fill knowledge gaps, and gain practical insights into OHCA response. Experts provided a deeper understanding of survival disparities, barriers to CPR training, and real-life emergency challenges. This method was more effective than surveys or focus groups at this stage, as it allowed for targeted discussions with policymakers and first aid organizations. Their insights helped refine the research focus.
Combining information from expert interviews and key reports, we found that deprived communities face more severe challenges, which became our narrow focus.
EXPERT INTERVIEW
Interview Scotland’s OHCA report 2019-2022 writing group staff
CPR training & interview with St Andrew First Aid staff
Interview Save a Life for Scotland staff
Field interview with Glasgow Street Aid staff
Of all groups, people from more deprived areas of Scotland deserve extra attention, as they are almost twice as likely to have an OHCA and are 60% less likely to survive to leave the hospital than those from less deprived areas.
DEPRIVED COMMUNITY
When we talk about 'deprived', we are using the definition of the Scottish Government. An area is identified as 'deprived', this can relate to people in that geographical community having a low income, but it can also mean fewer resources or opportunities in domains such as income, employment, education, health, access to services, crime and housing.
RESEARCH PLAN
Research Objective
An in-depth exploration of the social, cultural and systemic factors that influence the incidence and management of cardiac arrest in the deprived community Easterhouse, Glasgow, using ethnographic research methodology.
System map based on analysis of desktop research data.
Why Ethnography
By analysing desktop research data from dozens of papers, we get a systems map. It roughly explains why residents of deprived communities are more disadvantaged in the OHCA. You can see that the factors in the diagram interact with each other in a complex way. So we decided to go deeper into real communities, and we decided to use ethnography to conduct primary research to understand the complex reasons.
At this stage, we used design ethnography to understand what it means to live in one of the most deprived areas of Scotland and analysed in depth what resources, support and opportunities deprived communities actually lack and how these factors affect their competence and confidence to act effectively as bystanders.
Cluster analysis of Top50 deprived communities in Glasgow.
Easterhouse location in Glasgow.
Why Easterhouse
By looking at data from the Scottish Index of Multiple Deprivation we targeted Easterhouse. Easterhouse is known as a Glasgow Top 5 deprived community, it has a long history of being described as deprived. There are also many organisations and campaigns that have tried to help Easterhouse out of deprivation. Therefore, due to its representativeness, we decided to carry out ethnographic research in this area.
METHODOLOGY - ETHNOGRAPHY
ONLINE OBSERVATION
Documentary from YouTube.
Purpose:
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Learn about poverty in Easterhouse and how it affects health.
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Review existing research and analyse the social, economic and medical factors that influence cardiac arrest in the area.
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Identify the impact of policies, social resources, and the healthcare system on the community.
Methold: -
Review academic papers and government/agency reports on platforms such as Google Scholar, PubMed, etc.
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Analyse data related to Scottish Government, NHS Scotland, Glasgow City Council.
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Track Twitter (X), Facebook groups, local news for community discussion and health promotion.
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Research whether there are health improvement programmes or first aid training taking place in the area.
Community Streetscape.
Purpose:
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Understand the environment, distribution of healthcare resources and health behaviours of residents in the deprived community of Easterhouse.
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Document AED accessibility and community awareness of first aid.
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Observe residents' social interactions, lifestyles and potential health risk factors.
Methold:
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Field visit the community to document medical resources, AED equipment, public health facilities.
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Observe residents' health behaviours (smoking, exercise, social
interactions). -
Check to see if the community offers first aid training or promotional information.
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Record residents' social patterns, e.g., presence of strong neighbourhood relationships, community support systems.
OFFLINE OBSERVATION
Bulletin boards in shopping malls.
Purpose:
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Learn about the residents' knowledge of cardiac arrest, first aid training, and AED use in the community.
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Learn if residents have had first aid training and what their attitudes are toward learning CPR.
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Learn if there are misconceptions to first aid, such as ‘being afraid to do CPR’ and ‘believing that first aid is the responsibility of the paramedics’.
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Learn about residents' perceptions of health issues and first aid support they would like to receive.
Methold:
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Chat with people of different ages and occupations in places such as supermarkets, cafés, parks and community events.
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Use open-ended questions such as:
‘Do you know where I can find an AED in my neighbourhood?’
‘Have you learnt first aid? Do you think CPR is important?’
‘What would you do in an emergency?’ -
Observe residents' responses and attitudes to identify any interest or concerns they may have about first aid.
CASUAL TALK WITH LOCALS
Neighbours were talking in their yards.
Participants:
The interviewee is a first aid trainer who used to live in Easterhouse for a number of years and is familiar with the local healthcare resources, first aid training and is able to provide a true picture of the current situation and challenges in the community in terms of cardiac arrest response.
Purpose:
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Learn about the coverage, audience characteristics, and participation in community-based CPR and AED training.
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Explore the willingness of local residents to learn CPR, as well as their motivations, barriers, and misconceptions.
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Analyse whether there is a lack of AED equipment or training opportunities in the community and the impact of these shortages on emergencies.
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Explore how poverty factors affect the acquisition and implementation of first aid skills.
DEEP INTERVIEW - LOCAL COMMUNITY CPR TRAINER
Online interview with local community CPR trainer.
Participants:
PHOENIX sport club was repeatedly mentioned in the previous research as an important community organisation in Easterhouse, working to improve youth health, reduce community violence and have a profound impact on the local community. The club's staff have been in touch with the residents for a long time, and have an in-depth understanding of their members' health status and awareness of first aid in the community.
Purpose:
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Learn how PHOENIX is impacting health, community support.
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Does PHOENIX have partnerships with first aid organisations, government health programs to promote first aid knowledge?
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Analyse how poverty affects health awareness, accessibility of first aid training.
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Understand the organisational structure of the club, look for possibilities to help improve community response to emergencies, and possible challenges.
FOCUS GROUP INTERVIEW - LOCAL COMMUNITY CLUB PHOENIX
Chatting with PHOENIX staff after interview.
SYNTHESIS:
TRANSLATING FINDINGS
INTO THEMES
HEALTH
PROBLEMS
BARRIERS
& CONCERNS
LONELINESS
& UNSUPPORTED
FEWER
OPPORTUNITIES
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unhealthy lifestyles
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high-stress environments
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more long-term health conditions
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limited access to healthcare
HEALTH
PROBLEMS
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public spaces were shut down
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communities lack key structures such as community centres
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nowhere to socialise and lack of social ties with neighbours
LONELINESS
& UNSUPPORTED
BARRIERS
& CONCERNS
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little knowledge of cardiac arrest or how to perform CPR
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unaware of the benefits of CPR training
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concerns about legal risks or being misunderstood
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believe there was nothing they could do as a bystander but wait for professionals
FEWER
OPPORTUNITIES
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lower levels of education
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difficult to find full-time work, only have temporary jobs, meaning employers will not pay for their first-aid training
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more lone parents with exhausting and time-consuming caring responsibilities
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no place to receive free CPR training
ANALYSIS & SENSE-MAKING: ICEBERG MODEL
EVENTS
PATTERNS & TRENDS
MENTAL MODEL
UNDERLYING STRUCTURES
People from deprived communities are almost twice as likely to have an OHCA
What just happened?
What trends have there been over time?
What assumptions, beliefs and values do people hold about the system?
What beliefs keep the system in place?
Unhealthy diet and more concerns about life lead to higher risk of physical and mental problems
What has influenced the patterns?
What are the relationships between them?
Pursuing the basic needs of survival rather than healthy lifestyles, as they are expensive
Fewer employment opportunities result in a lack of access to CPR training provided for full-time employment, coupled with difficulties in receiving training in other ways
Bystanders have no emotional connection to other residents because they lack opportunities to meet up and socialise to form a sense of belonging
Insecurities about basic needs. Social class is solidified
People from deprived communities are less likely to have CPR training
People have neither accessible training nor motivation to learn CPR
In addition to caring responsibilities and financial pressures, cardiac arrest is just one of the many things to worry about
Bystanders hesitate whether to call 999 and don't take decisive action to help
The risk that bystanders need to take to actively help outweighs the care for the victim
Neighbourhood ties are not valued
EVENTS
PATTERNS & TRENDS
MENTAL MODEL
UNDERLYING STRUCTURES
What will happen?
What are the trends over time?
What assumptions, beliefs and values do people hold about the system? What beliefs renew the system?
What influences these patterns?
What are the relationships between them?
The incidence of cardiac arrest is reduced in deprived communities. When a resident collapses, bystanders respond immediately to perform CPR and collaborate to help
With enough support, residents of the community care more about having a healthy lifestyle, understand the first-aid process and are more than willing to engage in the rescue
Neighbourhood ties are build through community-led activities, which strengthened social networks, mutual aid and provide a sense of purpose and meaning
Learning about cardiac arrest is a way to support each other in the community, and I am proud of that
ENVISION, SPECULATE AND ‘HMW’ QUESTIONS
WHAT IF
QUESTIONS
‘HMW’ QUESTIONS
How might we create a localised system in deprived communities that engages residents in building neighbourhood ties through community activities, leveraging new technologies to raise awareness of healthy lifestyles and learning about cardiac arrest to create a supportive environment that can respond to emergencies more efficiently?
What if people can care more about preventing health problems than fixing what could have been prevented?
What if residents in deprived communities who don’t have full-time jobs can be seen as a strength in their community and feel motivated to engage in or provide CPR training to support their community and get to know their neighbours?
What if learning about cardiac arrest can be not only vital and valuable to themselves and their loved ones but also something fun to do?
INITIAL SERVICE CONCEPT
Transforming the unemployed residents into the first aid force of the community
Unemployed Residents
First Aid Force
STEP 1
Promotion
STEP 2
Transformation
Embedding promotion to raise awareness of heart health and CPR skills in daily community life.
Engaging residents with CPR training activities, and encouraging unemployed residents to be professional trainers.
Building a connection between First Aid training charity and community centre to deliver CPR trainers courses.
Enabling them to become community centre employees who provide First Aid training.
Currently, first aid training provided by First Aid charity is held at phoenix community centre from time to time, but due to time and resource constraints, these trainings cannot be held frequently and the number of participants is limited.
VOLUNTEERING: AN OPPORTUNITY TO REBUILD CONFIDENCE AND ENHANCE EMPLOYABILITY
Volunteering offers unemployed individuals a chance to gain achievement, rebuild confidence, and showcase active engagement on their CV through teamwork experiences.
OFFERING PAID POSITIONS AS INCENTIVES IN THE DEPRIVED COMMUNITY IS HARD TO SUSTAIN
Although providing community positions for unemployed residents is a good idea, the community centre currently faces a lack of funding and is actually operated by 20 volunteers at the moment.
TRAINING FOR THE PUBLIC COULD BE INFORMAL AND PLAYFUL
There is no need to worry that making the training process fun will compromise its effectiveness; in fact, it can enhance participant engagement. It is also helpful to include more interactive sessions in the training.
WILLING TO UPGRADE THEIR FIRST AID CAPACITY BUT LACK RESOURCES
Training volunteers involves significant time and financial investment. Therefore, after training, they are expected to serve in the organisation for years. It is important to let them know what to expect before joining.
VOLUNTEERING IS A FORMAL COMMITMENT THAT REQUIRES TIME AND EFFORT
TAKEAWAYS FROM PHOENIX COMMUNITY CENTRE
TAKEAWAYS FROM ST. ANDREW’S FIRST AID
With our initial service concepts in mind, we visited Phoenix community centre and St. Andrew’s First Aid to seek feedback.
DEVELOPMENT
TESTING & ITERATION
We took the initial proposal and tested it with St Andrew staff. He walked us through the possible costs and human resources in this scenario, which helped us refine the gaps, and then we iterated on the proposal.
OUR SERVICE
COMMUNITY
FIRST AID
CHARITY
NHS
Despite the common goal of saving lives, communities, first aid charities and the NHS are currently in isolation, lacking the sharing of resources and information. There is a need to create a service that builds bridges between organisations and unites their strengths.
INTEGRATED SERVICE PROCESS
Expanding the service to cover the whole process from raising awareness to real-time response during cardiac arrest and addressing the aftermath, as well as establishing mutual help networks among the communities.
BRIDGING THE GAP
Staff show possible props in the proposal.
COMMON WAYS OF PROMOTION AND TRAINING
To provide a engaging and social environment for deprived communities to raise health awareness and learn how to go on CPR in a fun way.
ENGAGING AND PLAYFUL
PART-TIME CPR TRAINERS IN THE COMMUNITY
Creating long-term roles in the community dedicated to heart safety, responsible for the whole process of CPR training and first aid in emergencies.
LONG-TERM GUARDIAN
TRADITIONAL FIRST AID
Enhanced AI support to improve training accessibility and help with dispatch in emergencies, reducing pressure on NHS staff and community first responders.
AI POWERED FIRST AID
Staff's advice about proposals.
KEY TOUCHPOINTS
HEARTBEAT FESTIVAL
Engaging and educational
The Heartbeat Festival leverages the concept of a festival to bring residents together for activities such as: CPR Beats and AED Treasure Hunt.
From residents to heart guardian
In addition, the festivals and heart guardian recruitment events will be able to attract unemployed residents to learn about the training and work process and prepare them for further work as a heart guardian.
HEART GUARDIAN
AI-POWERED PLATFORM
AI-based virtual call handler
Current first aid training emphasises CPR but often overlooks calling 999. Our AI virtual call handler can address this gap, preparing residents for real-life scenarios by practicing emergency calls.
AI-based smart dispatcher
Integrated into NHS emergency medical services to assist call handlers in maximising the use of community first aid resources and better coordinating rescue during emergencies.
Empowering community First Aid
Establish a long-term volunteer role in the community dedicated to heart safety, responsible for providing regular First Aid training and responding to emergencies.
Unite a heart-safe & caring community
The Heart Guardian's goal is to transform the community into a heart-safe community where residents are aware of heart health and skilled in first aid. This role also aims to foster a sense of belonging and mutual support among neighbours.
SCENARIOS
Community First Aid training
Step 1: The NHS emergency call handler receives the emergency call and asks for the address.
Emergency response coordination
Step 1: The Heart Guardian introduces the emergency procedures for cardiac arrest.
Step 2: Residents are invited to call a training number.
Step 2: After the call handler confirms the emergency situation with the AI-based smart dispatcher, it assigns different tasks to Heart Guardians in that area.
Step 3: Residents interact with the AI-based virtual call handler to familiarise themselves with calling 999 and perform CPR while listening to the guidance.
Step 4: After the call, the AI provides feedback on the residents' performance.
Step 3: Heart Guardians share on-site information back to the AI smart dispatcher, which then sync it with the ambulance service.
SYSTEM MAP
IMPACT
Performance criteria
- NHS cost savings from decreased hospital admissions and shorter recovery times
- Number of community first aid resources successfully deployed during emergencies
- Feedback from NHS emergency services on AI dispatcher performance
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Reduced medical burden and saving cost for NHS
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Better allocation and coordination of resources during emergencies
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Performance criteria
- Resident satisfaction with community support
- Number of unemployed residents trained and recruited as guardians.
- Retention rate of Heart Guardians over 2-3 years
- Increases in residents’ confidence and community involvement
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Increased engagement and support for deprived community
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Empowerment and reducing inequalities
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Long-term community development, cohesion and resilience
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Increased heart health and First Aid awareness
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More efficient emergency response in the community
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Improved cardiac arrest rescue
Performance criteria
- Pre- and post-training feedback surveys on heart health knowledge
- Average response time to emergencies in the community
- Successful interventions by Heart Guardians
- Number of residents trained in CPR and first aid
BUSINESS MODEL CANVAS
SERVICE BLUEPRINT
