I DIDN’T WANT
TO MAKE
IT WORSE

This week, St John Ambulance refreshed its brand. New complementary colours, an animated cross, and a line I liked: the power of first aid, in everybody’s hands.

It made me wonder what it would take for that line to be true.

I’ve done a first aid course twice. Once in my early twenties. Once a couple of years ago, at work.

I remember almost none of it.

What I remember is a room, a dummy on the floor, and a man with a slightly odd sense of humour who was trying quite hard to be cool. I remember kneeling in front of people I worked with, hoping I wouldn’t get picked. I remember being glad when it ended.

The actual first aid is mostly gone. Both times.

If somebody collapsed in front of me tomorrow, I think I’d be copying what I’ve seen in films. The picture in my head isn’t from either course. It’s from television. Somebody kneeling, counting, and then the person coughing back to life.

And I don’t think the picture is even right.

The thing I’m actually frightened of isn’t only that I’d forget. It’s that I’d remember enough to know I should do something, and not enough to be sure I was doing it right.

What if I hurt them. What if I break something. What if I’ve misread what’s happening. What if I start, and it turns out I shouldn’t have.

What if I make it worse.

For a long time I assumed the answer to that was more training. People like me forget, so teach more of them.

And training matters. I’m not arguing against courses. But you can practise on the dummy for an afternoon and still not be the person who can do it when it counts.

Because the dummy isn’t somebody you love.

It isn’t even somebody. It doesn’t have a face. It isn’t making a strange noise. Nobody around you is panicking. You’re not wondering whether the ambulance will get there in time.

And there’s something else I found. In one study, researchers went back to people who were trained in CPR, who were right there when somebody collapsed, and who still didn’t do it. The commonest reason wasn’t that they’d forgotten how.

It was that they panicked.

Which means the course can make you willing and still not reach the part of you that freezes. Willingness is what you feel before it happens. The freeze comes later, on the floor, and it doesn’t ask whether you did the course first.

I looked at the first aid guides too. Even inside the first aid apps, the ones you would actually open when somebody dropped, some of the videos opened with a presenter. Others with a little dramatised scene, the accident playing out first, as if naming what had happened wasn’t enough. Five to fifteen seconds of it before you got a single instruction. Or pages of steps to scroll through.

All of it made for somebody sitting down to learn, with time to spare. None of it made for the person it’s actually for. The one down on the floor beside somebody, right now, who can’t remember the course and needs the next thing and nothing else.

The advice always came in two parts. Do CPR. And get a defibrillator.

So I looked at the second one. I’d always filed them under serious medical equipment. Something a more qualified person would arrive and use.

They’re built for the opposite. You switch it on and it tells you what to do. It reads the heart itself. It decides whether a shock is needed. If it isn’t, it won’t give one.

You cannot accidentally shock somebody who doesn’t need it.

I genuinely didn’t know that. And once you know it, the way we keep them starts to look strange.

If I walked past one tomorrow and saw somebody drop, would I immediately think: take that? Or would there be a second where I thought, am I allowed. Is somebody else coming. Should I wait.

Nobody has stopped me. I’d be stopping myself.

So I looked at the map of defibrillators near me.

The nearest was three hundred metres away, in a primary school. It said not available. It was out of hours, and a school is a school, so it might as well not have been there.

Most of the others were the same. Schools. Shops. Places that close. A few converted phone boxes that stay open.

One that said available now was in a Tesco. That Tesco closes at midnight. And at five on a Sunday.

So that defibrillator keeps Tesco’s hours.

Which is a peculiar way to store the thing that can save you from something that doesn’t keep office hours. The way we hang defibrillators, you’d think a cardiac arrest was only allowed during school hours. Not in the holidays. And definitely not after five on a Sunday.

And the ones out in the open, on a wall or in a converted phone box, aren’t simply there to grab. Many are locked in a cabinet, and the code usually comes from the ambulance service during the 999 call. So even the box on the wall isn’t really open, not until you’ve made the call and got the code.

The people who run them know the locked ones are a problem. NHS England has put out a safety warning about it, after cases where the code couldn’t be found in time. The ambulance services now say the cabinets shouldn’t be locked at all.

And that’s better. But I don’t think unlocked is really the opposite of locked.

A defibrillator three hundred metres away, shut in a school for the night, is still no use to me. Nor is the one I don’t take, because I’m not sure I’m allowed.

The lock on the door was the least of it. Opening it changes none of the rest.

And here’s the part that bothered me most. When people do act, they do the compressions. Hardly anyone gets to the defibrillator. Fewer than one in ten.

But the compressions aren’t the thing that restarts a heart. They keep the blood moving, so the brain survives the wait. And when the heart is in a rhythm a shock can fix, the defibrillator is the thing that can reset it.

So the thing that can reset the heart is the thing kept furthest away.

Behind the code, the school gate, the shop shutter, and the small lock in your own head.

The numbers I found were grim. Under one in ten survive a cardiac arrest outside a hospital, and a lot of that turns on whether a defibrillator reaches them in time.

999 helps. A call handler stays with you and talks you through it. But if you’re doing CPR on your own, with no one else there, you’re told to stay and keep going. You don’t leave to go looking. Which means a defibrillator could be close and still be no use, because you can’t get to it without stopping the compressions you’re being told to keep doing.

And the ambulance can’t be the whole answer. A cardiac arrest is the most urgent kind of 999 call, a seven-minute target. But the damage begins within a few minutes, before that. So the first minutes can never belong to the ambulance. Someone already there has to start, and keep the blood moving, until it comes.

So it was always going to be whoever was in the room.

Some countries decided that was the actual problem.

Denmark went from about one in five people doing CPR to most of the country. They didn’t rely on telling people to care more. They put CPR in schools and in the driving test. They wired the defibrillator map into the emergency system. They send volunteers towards the person and towards the defibrillator. And what they tell the volunteers is the plainest thing you could say.

You can’t make it worse. The only wrong thing is to do nothing.

The speed changes everything. Getting CPR and a shock in the first few minutes can make someone far more likely to survive. One study of witnessed cardiac arrests where the heart could be shocked found that close to three in four survived when the first shock came within three minutes. Before the ambulance.

They didn’t make first aid look better. They built the moment around the fact that people panic.

Which brings me back to St John Ambulance.

They arrived at that line after research involving more than six thousand people. One of the things it found was that the charity felt old-fashioned and inaccessible.

The power of first aid, in everybody’s hands.

I liked it, and I meant it. Which is why the rest of it frustrates me. The line is right. Hands are exactly where the problem is.

I know St John Ambulance hasn’t just tweaked a logo and added some new colours. It has a new strategy. It teaches enormous numbers of people. It runs ambulances. It covers events. It does real things every day.

That almost makes it more interesting. Because the line gets so close.

The new look is bright and friendly, the way a banking app is, the kind that launched a few years ago and needs you to trust it with your money. But St John Ambulance isn’t new. It’s almost 150 years old. Older than the NHS. It helped teach this country first aid. The trust was already there. It didn’t need earning. It needed using.

It changed how first aid looks. Not what happens in the moment those hands don’t know what to do. Maybe because how it looks is the part it can change on its own. Changing the moment would take everyone else. But if anyone could pull everyone else together, it’s them.

They walked right up to the real problem, and then reached for a font.

One of the words from that research was inaccessible. So I started imagining what accessible would actually look like. What that line would look like if it were true, not as a slogan, but in the moment, in my hands.

Say somebody collapses in front of me.

I open one app, and press the button that says someone has collapsed. In the same second, it calls 999, sends where I am, and reaches the people nearby who signed up. So I never have to choose between the phone and my hands. It stays in front of me the whole time.

It shows me the next thing. Not everything there is to know about CPR. Just the next thing.

Is he breathing normally? He isn’t. Put your hands here. Push. And it keeps showing me where, while the call handler asks their questions.

Nothing is waiting for anything else. The call is still happening, but I’m already doing something. The screen keeps the rhythm. I follow it.

And while I’m doing that, someone is already running for the nearest defibrillator. If it’s locked, the code goes to them, not to me. So I never have to leave him. It happens around me. I just keep pushing.

I don’t have to remember the course, because nobody is asking me to.

And when I hesitate, the person on the phone tells me the most useful thing I can imagine hearing.

I’m here. Keep going. Help is coming.
Stay with him. We’ll bring it.

None of it is science fiction. The 999 call handler already talks you through CPR. Phones already know where we are. Volunteer networks already exist. Some places already send one person to the casualty and another for the defibrillator. In Sweden, drones are already flying them to the scene.

The pieces are there. They’re just not joined up around the person on the floor, the one who wants to help but is too scared. Which is exactly the kind of thing St John Ambulance is in a position to bring together: 999, the defibrillator network, volunteers and the frightened person in the middle.

And maybe it all comes down to whether the person is left to face it alone.

Because if somebody I loved collapsed tomorrow, that’s exactly what I’d be. On the floor, trying desperately to remember what I was taught.

I can imagine looking at them and thinking I might hurt them. Thinking I should wait for someone who knows what they’re doing. And losing time because I’m scared of doing the wrong thing.

I didn’t want to make it worse, so I did nothing.

That is worse.