'It does give you an uplifting feeling to hear these stories' - How one tragedy helped save the life of nine-year-old boy
Cormac McAnallen's sudden death has made us much more prepared for cardiac emergencies
In the first week of September, two unrelated events occurred in Dublin which had a traceable connection in one fundamental respect. One was the launch on the Thursday night of The Pursuit of Perfection by Donal McAnallen, charting his relationship with his brother Cormac, the Tyrone All-Ireland winner who died suddenly from an undetected heart condition in 2004, aged 24.
The other event preceded the book launch by just three days: in a school yard in Rush in north County Dublin a nine-year-old boy almost lost his life when he collapsed during the lunchtime break.
The pivotal moment in Donal McAnallen's beautifully told account of his relationship with his brother comes that March morning 13 years ago when tragedy befell their family. There had been no prior warning; Cormac appeared in rude health, captain of his county, a supreme athlete who looked after himself conscientiously. His death had a cataclysmic impact in terms of increased awareness of sudden death in the young, leading to a proliferation of automatic external defibrillators (AEDs) in clubs and communities throughout Ireland, and more widespread screening.
Three days before the book launch, Gaelscoil Ros Eo in Rush was open for its first Monday back after the summer holidays. Around 8.30am a mother dropped her children off to school, including her nine-year-old boy, before she carried on her regular journey to work in Swords 10 miles away. A few hours later she got the shocking news that her boy had suffered a cardiac arrest.
"And there was absolutely nothing beforehand, ever . . . I don't think he had ever even been to a GP; a very healthy boy," she explains.
That he survived is due to a number of fortunate coincidences and the intervention of people in the school and nearby. It is also due, in a way, to the legacy and consequences of Cormac McAnallen's death. Increased awareness and improved access to AEDs have saved lives. With a wait of at least 20 minutes for the arrival of emergency services and medical personnel, this boy's life was saved by a combination of CPR and the convenient proximity of an AED located in the GAA club, St Maur's, which is situated next door to the school.
"It does give you an uplifting feeling to hear these stories," Donal McAnallen says. "You do feel a little more emotionally involved. It is particularly strong where people have been saved by (Cormac) Trust defibrillators (the Trust set up after his death), not least Kevin McCloy, who has become an ambassador of the Trust." McCloy, the former Derry footballer, suffered cardiac arrest during a club match in 2014. Doctors at the game and an AED in the ground helped save him.
The school in Rush did not have its own AED, and the incident has prompted impassioned calls by its principal Tim O Tuachaigh that the State provide every school in the country with one. He estimates it would cost €6m, a pittance, he argues, if it can help save even one life.
But the episode also raises issues for those who already have AEDs. On certain days St Maur's GAA club closes early, leaving the AED used in this instance inaccessible. On this particular day a woman was cleaning the bar upstairs, working later than usual, when she was alerted to the emergency. Fortunately, she had been trained in first aid and CPR.
There are two fixed-point AEDs in the St Maur's club. The one used in this case is located in the foyer. Another is located in a referee's room next to the dressing rooms, but that room is often locked. A third is used as a mobile device that is brought to matches that teams are involved in away from home. The incident has made the club reconsider the issue of access and the pressing need to move one of the AEDs to an outside location where it is always available if needed.
The main concern about outside locations is the risk of vandalism, but it is a risk they will have to take. This is the second time in a few years the club used an AED, although the first time was not as serious and did not require shocks to be administered. The AED can monitor the heart's rhythm, and based on its findings inform whether shocks are required or not along with compressions.
Stacey Brady was the person working in the bar at the time the boy collapsed. "It was a very traumatic experience," she recalls. "When I got there some of the teachers were crying, the boy was on the ground and Tim (principal) was there. They were standing over him. I applied the pads. At that stage Tim was doing the compressions and they were on the phone to a paramedic. I was grand till a half an hour after it. I think it was just adrenaline."
When the boy collapsed the principal, who contacted the emergency services and soon began CPR, dispatched a staff member to the club knowing it had a defibrillator in the building. There is a side entrance through a gym, Evolution Fitness, which occupies part of the club property only a few metres away from the school.
The personal trainer in attendance was not trained as a first responder but she took the staff member to the AED in the reception area, removed it from its box and then went upstairs where they found Stacey Brady. "Stacey reacted in a non-panicked way," says the personal trainer, who preferred not to be named. "We went out and she was able to check the boy's condition and basically did what she had to do. She was fantastic I have to say." Together with Tim O Tuachaigh, she worked on the boy until the paramedics arrived.
Donal McAnallen's book isn't totally consumed with what happened after his brother died. Not until page 286 of the 332 pages do we read of the 'aftermath' and what follows. Much of the book is about their lives growing up together and the brotherly rapport that forged a close bond between two siblings divided by little over a year in age.
But there is no escaping how much Cormac's death has taken over family life since. "Back in February 2004," as Donal writes, "did I even know what a defibrillator was?" By the end of 2006 the Cormac Trust, set up to increase awareness of sudden death in the young and campaigning for better screening facilities, had supplied 80 free AEDs to a variety of GAA, soccer, rugby and golf clubs, as well as community centres, fire brigades and leisure facilities in Tyrone.
"So public and so mysterious had Cormac's tragedy been, and so many people would be potentially affected by similar issues, that we had to act," Donal writes. "We had to learn quickly about Sudden Adult Death Syndrome. One of the first things we learned was that lots of young people had died suddenly before but with much less publicity afforded to their cases."
He says that within days of Cormac's death they were contacted by many parents who had suddenly lost a son or daughter to heart conditions, mostly undiagnosed.
In 2007 the GAA set up a programme to provide discounted AEDs to clubs and become active in promoting ongoing awareness and training. Donal McAnallen is a dyed-in-the-wool GAA man but he hasn't always seen eye to eye with the GAA during the years since his brother's death. He cites many examples of overwhelming support and decency but also cases of bureaucracy and procrastination which proved frustrating.
"The GAA proved to he a harder nut to crack than you might think," he writes. For several years the Trust advocated a mobile screening unit that would travel the country and screen teams and individuals for a small fee. Commercial sponsorship and Trust contributions would have covered most of the cost. He submitted a detailed proposal on this to the GAA, with input from cardiologists and a campaign group in Britain detailing how it would operate. He received no response.
According to Donal, somewhere between 500 and 1,000 young people have died of sudden death-type illnesses on the island of Ireland since 2004.
Much has been achieved. "The medical profession and the public are so much better informed and prepared than they were a decade ago," he writes. "Provision of cardiac screening has increased hugely. Attitudes have changed too. The change was driven from ground level. So many county and club teams and individuals were getting screened of their own accord, not wanting to be hostages to fortune. In 2011, Croke Park announced that all senior teams would be screened as a matter of course. After six years, it had arrived at the destination we had been pointing it towards, only it had taken the scenic route."
He points out that wherever you work, learn, play or shop the chances are that you are within "shouting distance" of an AED. But not all is right. "Public awareness isn't yet where it should be. Ireland has one of the highest densities of community-based defibs in the world - roughly one for every 500 people - but many people don't know where their nearest defib is."
Gearoid McDevitt, player welfare officer with the GAA, described the incident in Rush as a "positive example of the awareness/association that people have with GAA clubs and the provision of these AED units. We have a scheme in partnership with Heartsafety Solutions where they provide AED units at a discounted price to GAA clubs."
According to McDevitt, the number of AEDs purchased by clubs is just under 1,500 during the scheme, although how many of these actually went to clubs he isn't sure. "At the time some clubs bought several devices and distributed to the community, schools etc. In addition, organisations like the Cormac Trust provide units directly to clubs which wouldn't necessarily be purchased via the scheme."
He says that GAA clubs who do not have an AED at their main grounds are in the minority. However, testing and maintenance of the units can prove challenging for clubs. "Larger clubs may not have a unit at each venue they use which we encourage them to address, as if an event occurs away from the clubhouse/main pitch it may not be possible to get the defib in time. We advise club executives to assign responsibility for maintenance of the defibrillator to a club officer. It is now recommended that clubs also place a sticker with the Eircode address on the unit/carrier bag so to easily notify the emergency services of its location in the event it has been used."
A defibrillator exchange programme is in operation with Heartsafety Solutions, whereby a further €100 reduction off the already discounted GAA club prices is available when the club 'trades in' an old defibrillator. The club, in exchange for their old unit, gets a new defibrillator with a 10-year warranty. This has been in place since October 2015.
In the case of St Maur's, the AEDs were donated by Apache Pizza, which has a business presence in the region, but the onus is on the club, as it is in all clubs, to ensure that they remain in working order and are accessible if needed in an emergency.
As Donal McAnallen writes, there is a risk of failing to follow maintenance procedures. His book is about a lot more than what happened after Cormac died, yet the wider educational impact of that tragedy is still being felt in incredibly positive ways. In the week he launched his book on his brother's life and death, that legacy helped save a young boy in Dublin. The link is undeniable.
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