NHK reports 70% SCA events in school do not report AED use. Study of 1500 student deaths.

70% of children with "sudden death" using AED at school are not listed
June 4, 2022

Approximately 1,500 children die in 16 years due to accidents at school or kindergarten or sudden illness.

As a result of NHK's investigation based on public data, it became clear that about 30%, or nearly 500 people, were "sudden death."
Furthermore, in 70% of "sudden death", there was no mention of whether or not AED, which is considered to be effective for lifesaving, was used.

Experts point out that the data is "insufficient to verify the process by which lifesaving measures were taken."

I talked to one of her mothers.

Asuka, the daughter of Toshiko Kirita of Saitama City (at that time, a sixth grader), suddenly suffered a heart attack in the school playground while practicing a relay race and collapsed, and died the next day.

According to a survey by Saitama City, Asuka was in a state of needing treatment with an AED immediately after her fall.

However, at that time, the teachers in the field thought that they had breathing and pulse, and could not immediately determine that treatment with AED was necessary.

Toshiko said, "I was always frustrated at first as to why no one tried to use the AED. I learned of a case where I died in a similar situation in the past, and I wondered if the same thing would happen again. I had a strong sense of crisis. "

Even though it was an accident that left a big lesson
In 2012, after Asuka's death, the Saitama City Board of Education created an emergency response manual for teachers named "ASUKA Model" with Toshiko.

In addition, Toshiko herself continues to give lectures at schools all over the country so that she can learn the importance of AEDs by learning from her daughter.

Asuka's cases are also summarized in the "School Accident Case Search Database" published by the Japan Sports Promotion Center.

This database is used for grades and outbreaks submitted by schools and gardens to provide sympathy money for students and children who died in accidents or had serious disabilities while attending school or in kindergartens, nursery schools, elementary and junior high schools and high schools. It is a summary of the location, type and situation of the accident.

Asuka's case states, "In the school playground, during the extracurricular activities of the relay road race, I finished running 1000m, walked about 15m and then collapsed. I was immediately taken to the hospital and treated, but died the next day." ..

Toshiko feels sad that the accident left a big lesson about AED, but it didn't get through and ended with a very short sentence.

In addition, we believe that recurrence prevention will not be possible unless the details of the case are clarified as much as possible and the lessons learned are changed to a system that can be shared by everyone.

"I want you to describe the situation in detail so that the lessons of the accident can be conveyed."

Toshiko says, "By looking at the public database and knowing the accidents that are happening at other schools, you can be prepared for the accident that it may happen at your own school. I would like you to describe the situation in detail so that it can be communicated to the people who saw it. That may help prevent recurrence. "

Detailed analysis of school accidents
How many accidents have occurred in schools and kindergartens?

NHK has analyzed in detail more than 8400 data for the 16 years from 2005 to 2020, which are open to the public.

As a result, the number of children who died has risen to 1556, and the breakdown is as follows: ▽ High school students are the most 700, ▽ Junior high school students are 380, ▽ Elementary school students are 272, ▽ Kindergartens and nursery schools are 97, etc. increase.

Looking at the number of applications for condolence money by year, the number was the highest at 137 in 2011, and it has been declining gradually since then, but it has risen to more than 50 every year for the past few years.

Furthermore, when the cause of death was investigated in detail, it was found that 30% of the total, 490 people, were "sudden death" due to sudden cardiac arrest.

Since prompt AED treatment is effective in the event of cardiac arrest, the words "AED", "defibrillator", and "electric shock" in the description of the situation before and after the fall were extracted. , I investigated the frequency used in the data and the words used together.

70% of sudden deaths Whether or not AED is used No description

As a result, 70% (356 people) of sudden death did not have a description, and it was not clear from the data whether or not AED was used.

On the other hand, although the rest (134 people) had a description about AED, only about 10% (19 people) showed the passage of time until the device was used, such as "immediately" and "immediately". ..

It is said that the lifesaving rate decreases by 10% every minute when the electric shock caused by the AED is delayed, but the data of the Japan Sports Promotion Center has specific descriptions such as the time from collapse to use and the distance to the installation location. There wasn't.

Also, of the 134 people who had an AED, 28 (20%) were used after the emergency services arrived, and I do not know the details such as why they fell down and did not use the equipment immediately. did.

Expert "How to record and verify lifesaving processes and issues"
Professor Taku Ishimi of the Graduate School of Medicine, Kyoto University, who is a doctor and familiar with sudden death at school, said that the data of the Japan Sports Promotion Center is very valuable big data to understand the situation of the accident. "It's not enough to verify how the lifesaving procedure was done, because it doesn't say how the AED was used or why it didn't work," he said.

After that, "To prevent recurrence, the distance from the fallen place to the place where the AED was placed, the time until the device was used, the judgment of the corresponding teacher, etc. were further enhanced and verified, and the school and society as a whole It is important to connect it to countermeasures. "

In some cases, there is an AED but it is not used
It is said that there have been cases of sudden death at school that were not used despite the presence of AEDs.

According to Professor Ishimi of Kyoto University, who is familiar with sudden death at school, there are two main cases.

<1. Is the AED installed in the wrong place? >
First of all, there are cases where the AED is located far away or there are times when it cannot be used.

In the case of a boy in the third year of junior high school who had a cardiac arrest while practicing baseball for club activities on the school ground, the AED was in a school building away from the ground and it took a long time to get it, so it could not be used.

Also, in the case of another high school boy who lost consciousness during club activities, the school building was locked and could not be taken out because it was night.

In this case, the school subsequently revised the location of the AED to a ground or the like.

According to Professor Ishimi, the best place to install an AED is based on the following conditions.

▽ Near a playground or gymnasium where there is a high risk of cardiac arrest ▽
Within 1 minute one way to a site that may be used ▽ A
place that anyone can access 24 hours a day

He also points out that in order to prevent recurrence, it is necessary to record more detailed processes and responses for each case and consider countermeasures.

<2. I didn't use it because I had breathing>
The other case is when a fallen child is breathing and decides that an AED is not needed.

When you suddenly have a cardiac arrest, you may have a cramp-like symptom called "agonal respiration," in which breathing is interrupted.

Such breathing that is clearly different from usual is a "sign of using AED", but there are actually cases where many people do not know and responded by recognizing that "you should not use AED because you are breathing". It means that there was.

"Don't hesitate when you get lost, get an AED right away."
Professor Ishimi said, "The AED automatically analyzes the movement of the heart and determines whether an electric shock is necessary. It is important not to hesitate when in doubt and to use the AED immediately." increase.

67% of AED users reintegrate into society without sequelae
Unfortunately, there are cases where using an AED does not help.

However, many cases have been reported in which appropriate lifesaving measures saved lives.

According to a survey conducted by the Japanese Society of School Health, the number of cases of AED cardiopulmonary resuscitation for children and students in elementary schools, junior high schools, high schools, etc. was 147 during the five years from 2012 to 2016, of which about 67% (about 67%). 99) means that they have returned to society without any aftereffects.

Professor Ishimi said, "The use of AEDs can save many lives even in sudden cardiac arrest. It is not uncommon for cardiac arrests to occur at school, and we learned how to use AEDs so that any teacher or student can use them. It's very important to keep it in mind. "

Data analysis details
It is an analysis result of "school accident case search database".

From 2005 to 2020, 8404 cases in which death or disability compensation was paid are listed.

The Japan Sports Promotion Center says that these data can be viewed by anyone as a material for studying measures to prevent the recurrence of accidents. I hope they will be used at school sites.

Cases of death are on the decline
The details of the data.

Of the 8404 cases, 1556 children died during the 16 years from 2005 to 2020.

Let's take a closer look.

<By year (application for condolence money)>

Among the published data, there is a tendency for the number to decrease to
134 in 2005,
119 in 2006,
125 in 2007,
123 in 2008,
114 in 2009, and 115 in 2010.

▽ Increased to 137 in 2011, but decreased again
▽ 81 in 2012 ▽
85 in 2013 ▽
76 in 2014 ▽
83 in 2015 ▽
78 in 2016
▽ 77 in 2017
▽ 82 people in 2018 ▽
69 people in 2019
▽ 58 people in 2020, which is less than half in the last 16 years.

<By school>

High school has the highest number of deaths, accounting for 700 people, nearly half (45.0%) of the total.

Next, 380 junior high schools (24.4%), 272 elementary schools (17.5%), and 97 nursery schools and kindergartens (6.2%) show that the number of fatal accidents increases as the grade goes up.

<By location>

Looking at the places where the accident occurred,
▽ Roads are the most 575 people (37.0%)
▽ Classrooms and nursery rooms are 179 people (11.5%)
▽ Playgrounds, school playgrounds and gardens are 150 people (9.6%)
▽ Gymnasiums and 95 people (6.1%) in the indoor playground
▽ 49 people (3.1%) in the playground and stadium outside the school
▽ 36 people (2.3%) in the corridor
▽ 25 people (1.6%) in the pool ▽ 25 people (1.6%)
in the river )
▽ Toilet 23 people (1.6%)
▽ Sea and lake, swamp and pond 17 people (1.1%)
▽ Mountains and forests including ski resorts 16 people (1.0%)
▽ Gymnasiums outside the school 14 people (0.9%)
▽ Stairs 14 people (0.9%)
▽ Parks and amusement parks 14 people (0.9%)
▽ Veranda Is 12 people (0.8%).

The tendency to have the most roads does not change in elementary and junior high schools, high schools, etc., but in high schools, the second is the playground and school playground, and the third is the gymnasium and indoor playground, so there are opportunities for club activities compared to elementary and junior high schools. It seems that the increase is in the background.

On the other hand, nursery schools and kindergartens are often accompanied by parents to pick them up, and while the proportion of roads is decreasing, nursery rooms and classrooms account for 45 people, accounting for 46% of the total, which is the largest number.

<The cause of death>
The causes of death were
▽ "head trauma" in 472 (30.3%)
▽ "sudden cardiac death" in 267 (17.2%)
▽ "whole body bruise" in 177 (11.4%)
▽ "suffocation" 149 (9.6%)
▽ "Visceral injury" 119 (7.6%)
▽ "Large vascular sudden death" 118 (7.6%)
▽ "Central nervous system sudden death" 105 (6.7%)
▽ " 62 people (4.0%) had "drowning"
▽ 27 people (1.7%) had "heat stroke"
▽ 25 people (1.6%) had "cervical spinal cord injury"
▽ Others ・ The number of unknowns is 30 (1.9%).

<Sudden death by year>

Sudden death due to sudden changes in physical condition accounts for 30% of the cases of death, and there is a tendency for it to decrease.

▽ 45 in 2005 ▽
35 in 2006 ▽
41 in 2007 ▽
35 in 2008 ▽
39 in 2009
▽ 39 in 2010 ▽
38 in 2011 ▽
27 in 2012
▽ 2013 23 people in
2014 ▽ 25 people in 2014 ▽
30 people in 2015
▽ 19 people in 2016
▽ 25 people in 2017 ▽ 25 people
in 2018 ▽ 25 people
in 2019
▽ 19 people in 2020.

<By school>
By school, 178 (36.3%) were in high school, 126 (25.7%) were in junior high school, and 89 (18.2%) were in elementary school, and the rate of sudden death was particularly high in high school and junior high school.

<Occurrence status>
Looking at sudden death by situation, 140 people accounted for about 30% of the "extracurricular instruction" such as club activities such as baseball and athletics, followed by 96 people in "subjects" such as physical education classes.

<Sudden death by place>
In the data of sudden death, there are many cases where the physical condition suddenly changes when the body is moved.

▽ Playgrounds, school yard, and gardens in the school are the most 103 people (21%)
▽ Classrooms and nursery rooms are 95 people (19.4%)
▽ Gymnasiums and indoor playgrounds are 68 people (13.9%)
▽ Roads are 62 people (12.7 %) %)
▽ There were 29 people (5.9%) in the playground and stadium outside the school
▽ 12 people (2.4%) in the pool.

Status of AED usage
Prompt AED treatment is effective in the event of cardiac arrest.

When the words "AED", "defibrillator", and "electric shock" were extracted from the description of the situation before and after the fall, 134 out of 490 people had the description.

Looking at "who" used it,
▽ 102 people (76.1%) seemed to have used AEDs by faculty members and students
▽ 28 people (20.8%) used by paramedics
▽ 1 also used in hospitals There were people.

* For details, please refer to the Japan Sports Promotion Center "School Accident Case Search Database".

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