The NSW Education Minister Prue Car MP, through her Department, has made several statements regarding the reasoning behind the refusal to consider the LifeVac™ airway clearance device in NSW schools after the tragic and preventable death of Decklan Hayward at Glenroi Heights Public School in Orange, NSW. The NSW DoE has relied on several assumptions and exaggerations of facts that will lead to further tragic deaths in NSW schools.

A.     Current first aid measures are sufficient and “should have worked”.

B.     Teachers when faced with a dying child from upper airway obstruction are  prohibited by policy and law to act to save their lives.

C.      An ambulance will arrive in a timely manner and save the child, regardless of first aid attempts by teachers (even in rural areas).

D.     NSW Health “advice” to the NSW DoE supposedly says that it is better for teachers to watch a child die who is unresponsive to existing unevidenced first aid measures than utilise a TGA-listed medical device that has never failed and saved over 1100 children after even the best first aid has failed.

E.      Australian law prevents teachers from using a TGA-regulated and proven medical device but rather demands the strict adherence to guidelines developed by a non-government, member representative group with no legislated authority.

None of these beliefs are based on facts or evidence and show a troubling nativity and ignorance from both the NSW DoE and Minister Car.

A.     Current Australian first aid measures are divergent from the worldwide scientific consensus and evidence. Australian-type “chest thrusts” have no scientific data, research, or clinical trials that prove efficacy; they are anecdotal. There is no relevant research that indicates that CPR has any role in the effective treatment of upper airway obstruction in living subjects. The promises made by advocates of these local measures are not supported by any documented evidence. Clinical trials or relevant scientific research. A claim that first aid measures “should” have worked in the case of Decklan Hayward and therefore “should’ work in future choking emergencies is a logical fallacy as the evidence contradicts the premise.

B.     There is no legal basis that prevents teachers from acting to save a child’s life in an emergency even if outside “policy” [see NSW Civil Liability Act 2002]. Common law establishes no precedent for this belief.  In fact, the DoE has been using a non-accredited policy for emergency training of teachers for decades (E-emergency care). There is no accreditation or proof that this policy provides “effective treatment and management” of students. Therefore, the established policy formation methodology by the DoE, in regard to emergency management, requires no more than a stroke of a pen (without any determination by an accredited body) to modify the current policy to include the LifeVac™.

“E-emergency care provides simple, effective treatment and management protocols to support staff in managing common emergencies. This online training closely reflects the types of illnesses, incidents, and accidents that most commonly occur in schools, school activities, and on excursions.”

C.     An ambulance will usually not arrive in a timely manner and save the child, regardless of first aid attempts by teachers (especially in rural areas).

As the decision by the DoE was made in reference to the recent choking death of Decklan Hayward in Orange NSW, let us examine this NSW Ambulance data to establish the validity of this claim.

As established internationally, severe (complete) upper airway obstruction is one a small list of incidents that require absolute and immediate intervention to prevent death/ serious injury i.e. absolutely time-critical.  

·        ​4 – 6 minutes of oxygen starvation means brain damage is possible.

·        6 – 10 minutes of oxygen starvation means brain damage is probable.

·        Over 10 minutes of oxygen starvation means the person is likely to die.

The NSW Ambulance data, despite the propaganda shows that the response time in the 50th percentile (Median) at 15.1 minutes (2021-22).

Significantly in this Orange data, emergencies only had an ambulance response time of under 15 minutes in <50% (45.8%) of cases. Other factors influence time to patient care in paramedic ambulance response data that are either not measured and/or are open to manipulation to improve the apparent compliance level with KPIs. These include the mobilisation time (that is interpreted to provide the best “appearance” of success) e.g. a rural response may involve the disturbance of a paramedic from their residence after hours and then the pick-up of another paramedic on call before the actual response in the direction of the incident. Additionally, the activation of the case onto a vehicle data terminal may not accurately include the total delay to active response. “Response time” can be (and is) fudged by responding to an out-of-area or “unavailable” ambulance to fudge mobilisation and response data.   

The” mobilisation” data shows that 61.6% took under 3 minutes (i.e. 38.4% took longer than 3 minutes) and the median was 2.5 minutes but assumes immediate response of the paramedic ambulance to the emergency.

Secondly, there is no measurement of the time from arrival on scene to patient contact in the response data, which in cases of severe choking can be the difference between death/permanent brain injury and survival. NSW Ambulance does measure/report this statistic as it adds to the actual response time i.e. theoretical vs actual.  In one study, the median time interval to access the patients for all calls was 1.3 minutes (interquartile range, 0.8 to 2.6 minutes). Twenty-five percent of calls had intervals of more than 2.5 minutes, and 10% had an interval of more than 5 minutes. [Longer patient access times were experienced in non-residential settings e.g. business or building complexes]. Jack P Campbell, Matthew C Gratton, Jeffrey P Girkin, William A Watson, Vehicle-at-Scene-to-Patient-Access Interval Measured With Computer-Aided Dispatch, Annals of Emergency Medicine, Volume 25, Issue 2, 1995, Pages 182-186, ISSN 0196-0644.

NSW Ambulance data (whichever way it is read and interested in providing even a best-case scenario) shows that in the case of Decklan Hayward in Orange, the critical time interval for definitive management of a severe upper airway obstruction could not have been met by Ambulance response and treatment i.e. permanent brain, injury from hypoxia and/or death was likely. The prompt action by staff at Glenroi Heights Public School was not effective in the relief of severe upper airway obstruction, especially when relying on non-evidenced measures without clinical testing.  

There is a distinct difference between a likely terminal event, such as a cardiac arrest in a school child (usually resulting from an undiagnosed congenital heart defect/arrhythmia), where bystander CPR is unlikely to prevent death (and will not result in “revival”) without early defibrillation (also not recommended by NSW Education Department in NSW Schools); and a preventable and definitively treatable event such as a severe (complete) upper airway obstruction. The latter can and must be resolved in the pre-ambulance period to provide any chance at survival/ cerebral survival.

D.                 NSW Health “advice” to the NSW DoE supposedly says that teachers should watch a child die who is unresponsive to existing unevidenced first aid measures than utilise a TGA-listed medical device that has never failed and saved over 1100 children after even the best first aid has failed.

                     It is extremely doubtful that NSW Health made any such specific advice to the NSW Education Department. A separate FOI request has been made to the DoE and NSW Health to determine the veracity of the claim of “strong” advice. The DoE also claimed several years ago that NSW Health had also advised them that “defibrillators in NSW Schools were unnecessary”, but this proved to be a disingenuous claim that was created by the DoE solely to suit a policy agenda rather than the safety of students and staff.  The DoE has no evidence that the first aid measures recommended to teachers have any proof of efficacy or are supported by scientific research and even less that the contents of the E-Emergency unit have any rigor. Any advice from NSW Health regarding the use of the LifeVac™ was general and would not undermine the status of the determinations of its own TGA as the only regulator of medical devices in Australia. Nor would NSW Health place the recommendations of a non-government, voluntary group with no regulatory role in Australia over the DoHA. 

E.                 Australian law does not prevent teachers from using a TGA-regulated and proven medical device nor demands the strict adherence to guidelines developed by a non-government, member representative group with no legislated authority.

                    The DoE position is not supported in law by either the (Civil Liabilities Act 2002) or the Therapeutic Goods Act. The TGA is a legislated authority, that is under the Department of Health and Aging. There is also no grounds in common law for teachers or the NSW DoE to be held liable for using a clinically and evidence-reviewed and listed medical device. There is also no support in the WHS Act or Regulation that prohibits the use of a medical device in an emergency. In fact, the WHS Act and Regulation only provides guidance as to the minimum acceptable standards for workplaces.