The expectations of citizens ‘in an emergency’ are changing. Both at home in the UK and internationally, there is a growing realisation that the actions of normal everyday citizens in the first few moments of a health-related emergency are key.

The evidence for public access Automated External Defibrillators (AEDs) is strong and compelling. Sited in prominent locations in community spaces, these devices can be used by anyone – even without training – to save the life of someone who has collapsed in cardiac arrest. They are designed to be used in the critical few moments before professional ambulance help arrives, where seconds really do count for survival. More recently, in the wake of tragic high-profile terror events and serious accidents, ‘major bleeding’ kits are appearing in public places, designed to be used by ordinary members of the pubic to treat trauma victims in those precious life-preserving moments before emergency services are on scene.

The connection between communities, people and these pieces of equipment is fundamental. There is little use in having AEDs and major bleeding kits if people do not know where they are located, or would not think to look for them. These situations are extremely daunting. Being faced with the reality of having to use these devices is psychologically overwhelming for some. Existing research informs us that the correct siting of AEDs is vital, and that training people improves the chances of equipment being used. But it is individual humans that will actually make the difference on the day, and how they think and feel about these devices is as crucial as where they find them.

Just as throwing a life-ring to someone in difficulty in the water would be a reflex action for many, there is a need to embed the same automatic reflexes in society when it comes to being a bystander witnessing a collapse or serious injury. We firmly believe that – by thinking a little differently – the creative arts can help us understand how to get there.

What did the project involve? 

A previous Ideas Exchange project ‘‘Designing in’ defibrillators: combining art and urban planning to increase the visibility of public access defibrillators in civic spaces’ allowed researchers to demonstrate that there are creative concepts in this space, and that uniting the expertise of artists, town planners, the pubic and healthcare professions results in visions that challenge the established ways of working. There is an appetite to understand how cultural and expressive ways of using urban spaces can augment community resilience to emergencies. The researcher’s initial workshops sparked a range of exciting ideas: Street art and sculpture to ‘location mark’ embed this equipment prominently in civic spaces; performance art to de-sensitise social groups to their anxieties about acting in an emergency; poems and public audio that gently remind people how they are empowered to help. The workshops also yielded important insights about accessibility and enablement – textured pavements to highlight locations of emergency equipment, tactile and sensory elements to calm potential users in emergencies.

This previous project focussed on initial blue-sky concepts across Bristol campus spaces. Shortly after our project, the University launched the roll-out of new AEDs installed in accessible locations across the precinct. The team now seek to build partnerships and look outwards to develop and energise a meaningful programme of research that can provide the best possible evidence to inform these creative ideas.

As a result of engagement with the AED roll-out, the research team have established strong links with St John Ambulance nationally. St John are just about to launch (Spring 2023) an exciting and ambitious strategy to become a research active organisation, and contribute to knowledge generation and the evidence base. St John Ambulance (SJA) is an international charity, with a core mission to work with communities to preserve and protect life. The timings of this project and SJA’s launching a research agenda presents a very contemporary yet time-sensitive opportunity to be one of the first academic institutions to form a collaboration with this far-reaching organisation, and promises the real potential of impact and innovation at scale.

The research team want to go beyond asking ‘where should we put defibrillators?’. They want to ask how the space itself invites people to step forward and act in an emergency. However, before they can apply, as a collaboration, to targeted research calls and national funding streams, they intend to cement the basis of this collaboration. They seek to transition the ‘bright ideas’ into answerable research questions, and to plan how the new collaboration can work together practically to explore and deliver these research projects.

The project has the four following objectives:

1. To inspire and curate ideas from St John’s diverse range of volunteers and staff, centring around improving the connection between citizens and the emergency equipment in their spaces (and, where possible, pilot the exploration of existing datasets to inform this).
2. To explore how the creative arts can interface with the existing activities of the organisation (emergency skills training, public awareness, public access AED programmes etc).
3. To build new relationships with individuals and organisations that work with SJA in the social action space, particularly with respect to accessibility and enablement in the delivery of citizen aid.
4. To mobilise knowledge across our already identified creative approaches (street/urban art and design, performance art, aural and written expression) to co-produce a set of candidate projects to take forward to competitive calls as an established collaboration.

Specifically, the project seeks to secure some time for a project officer in St John Ambulance to dedicate resources to leading a research collaboration group. The team will scope the use of the service’s routinely-collected data and existing activities, to understand how this might help them answer questions in this space. They will support this to be led by the volunteers themselves. They will use the far-reaching social connections that SJA has to hold workshops with volunteers of a range of backgrounds operating in a variety of sectors that SJA has a presence, particular with respect to accessibility and enablement. They will then secure time from creative experts (visual & performance artists) to work with the existing projects within SJA to see how best to design answerable questions.  

Who are the team and what do they bring?

• Matthew Booker (Bristol Medical School) is a researcher specialising in primary care and advanced emergency care. They are a member of the University of Bristol AED provision working group which seeks  to review and implement new strategy for automated external defibrillator (AED) provision across the University campuses.
• Helen Baxter (Bristol Medical School) is a researcher specialising in knowledge mobilisation techniques and mechanisms. She works to enhance the existing practice in knowledge mobilisation and implementation. Helen has a particular focus on mental health research, as well as her ongoing interest and collaborations in the field of urgent care. She is also a member of the AED provision working group.
• Sarah Allsop (Bristol Medical School) is a medical academic, with 12 years’ teaching and leadership experience in medical and anatomy education, and a background as an NHS doctor. She is a specialist in curriculum review leadership, development and design.
• Associate Clinical Director (Research, St John Ambulance)
• Partners from the Resuscitation for Medical Disciplines (RMD) collaboration at Bristol
• Research in Urgent Care, Avon Collaborative Hub (REACH)

What is to come?

One outcome will be the curation of a research group dedicated to the topic of creatively exploring emergency response. The team will collaborate locally with researchers already established at Bristol, including those who came together for the intial Ideas Exchange workshops. A Knowledge Mobilisation practitioner will oversee the curation of growth in this group and provide a channel for co-creation with a group of energised public contributors.  

In keeping with the creative arts theme, the team will look to summarise the work of the project using one of these media, as a tangible example of how creativity can catalyse the evidence base in this field.  Just as people have an innate emotional reaction to the prospect needing to act in an emergency, they have an intrinsic response to the expressive arts. The team want to understand what expressive art can help us understand about the science of ergonomics and human factors in these situations, and what the future can be.