
Community Involvement Needed for Life-Saving Program
By Kathleen Donahue for the Tribune
Every minute, every second, every breath counts.
An individual experiencing sudden cardiac arrest typically gasps for air, his or her heart unable to make electrical connections essential to its every beat.
An electrical shock will restore heart rhythm and save a life. But defibrillation therapy must be administered within minutes of a cardiac arrest, and emergency medical personnel may not arrive in time.
Cardiologist John H. Windsor, D.O., and emergency medical technician Derek Hanson believe that most every adult North Dakotan can defibrillate a heart if given four hours of training and access to an automated external defibrillator (AED).
“The more people who have access to the AED machines, the more lives you can save,” said Windsor, a physician with the Heart & Lung Clinic and director of the Cardiac Catheterization Laboratory at St. Alexius Medical Center.
An AED, smaller than a laptop computer, guides a trained operator in determining the necessity for shock therapy and then administering it, if necessary. “It’s so simple almost anyone can operate the automated machine,” said Hanson, a board member of the National American Heart Association (AHA) and St. Alexius Safety and Disaster Director.
Hanson, Windsor and the AHA are looking for support from community organizations to start a Public Access Defibrillation (PAD) program. Others signifying interest in assisting community organizations include Brad Erickson, Medcenter One Emergency Medical Services Coordinator, and Kevin Stewart, Community Services and Training Director for the Burleigh-Morton Chapter of the American Red Cross.
While major employers in the Bismarck-Mandan area have installed AEDs at their worksites, “the AEDs are missing in the public arena… where you have masses of people gathered,” Erickson said.
Community groups will be encouraged to purchase AEDs so they can be placed in civic centers, shopping malls, golf courses, exercise facilities and sports arenas. The AHA, St. Alexius and Medcenter One provide support in terms of providing education, training and physician oversight for PADs, Hanson said. The Red Cross offers training in Bismarck-Mandan and throughout southwest North Dakota, Stewart said.
“If there are more AEDs in the community, the safer community we are going to have,” said Barb Sand, Director of Advocacy for the West Region of the Northland Affiliate of the AHA.
Windsor and Hanson believe PAD programs will increase survival rates among cardiac arrest victims. Consider these facts:
· The AHA estimates approximately 250,000 people die from sudden cardiac arrest each year, an estimated 700 a day.
· For every minute that passes without defibrillation, a victim’s chance of survival decreases seven to 10 percent.
· Very few resuscitation attempts are successful after 10 minutes.
· The statewide average of response time of emergency vehicles in North Dakota ranges from eight to 12 minutes.
“When you think that for every minute defibrillation is delayed your chance of survival is diminished by 10 percent, you realize the importance” of AEDs, Stewart said.
Time is truly of the essence when administering defibrillation therapy. As Windsor said, “There are a lot of things I can treat. But I can’t treat dead.”
AEDs: Easy to Use
The heart stops pumping blood and develops a very chaotic rhythm when an individual experiences ventricular fibrillation (VF), the most common arrhythmia to cause cardiac arrest. “With VF, the heart wiggles like a bowl of jelly. It’s just undulating. Normal activity has to be restored,” Windsor said.
The AHA notes in its “Case for PAD Programs” that defibrillation is the only known therapy for VF. An electrical shock can restore the heart’s normal rhythm if done within minutes of arrest. “Within a matter of seconds, the brain becomes deprived of oxygen,” Windsor explained. “As time passes, it is more difficult to resuscitate the individual.”
The AED helps to establish normal electrical activity. As Windsor said, “We are essentially resetting the switches.”
Not too many years ago, defibrillators required two individuals to carry. “They were heavier than those IBM typewriters.” Technology has advanced rapidly, and AEDs have evolved to the size of a laptop computer and even to pocket size.
Their evolution in size was only surpassed by the technology that makes them easy to use. The AED has embedded computer chips to analyze the rhythms instantly and accurately, making it possible for non-medical professionals to administer without risking an accidental shock. “The AED gives an accurate assessment of heart rhythm,” Windsor said. The AEDs also are not a risk for people with pacemakers – Automatic Implantable Cardiac Defibrillators (AICD). But Dr. Windsor cautioned, “AEDs can be safely used; however, if the AICD doesn’t convert the rhythm, the AED probably won’t either.”
Individuals who undergo a four-hour training program are told to ensure someone has called 911. They are then instructed to make sure victim is not breathing before applying the device. Voice prompts guide them in determining the need for defibrillation. If the AED indicates an abnormal rhythm, then the users push a button to administer a shock. “If the person is lying there and there is no sign of life, you can’t mess up,” Hanson said.
CPR skills are an essential component in reviving an individual. “CPR can save lives, but what saves the most lives is early defibrillation, like public access defibrillation,” Erickson said. While cardiopulmonary resuscitation (CPR) can help maintain circulation and oxygenation after sudden cardiac arrest, early defibrillation (or electric shock), if administered within a few minutes, is the only intervention that can convert ventricular fibrillation into a normal heart rhythm. “It’s much more effective than CPR alone or even CPR combined with medications,” Hanson said.
Good Samaritan Protection
During its 1998-1999 session, the North Dakota State Legislature passed a Good Samaritan law that protects individuals who use an AED in attempt to save another person’s life. Those exempted from the law include police officers, emergency medical services responders, nurses and other medical professionals.
The American Red Cross points to recent successful legislation on a national level to increase public access to defibrillation. In fall 2000, the Cardiac Arrest Survival Act was signed into law. The measure instructs the U.S. Secretary of Health and Human Services to make recommendations to promote public access to defibrillation programs in federal buildings and other public facilities. The act also extended Good Samaritan protection to other states that don’t provide such protection. “This protection will help encourage lay persons to respond in a cardiac emergency by using an AED,” Stewart said.
The Rural Access to Emergency Devices Act of 2000 authorizes $25 million for grants for community partnerships for purchase of the AEDs and training on their use. The partnerships must consist of local emergency responders, police and fire/rescue departments, hospitals and community organizations.
The N.D. Department of Health believes placement of additional defibrillators throughout the state could save lives. “Training in the use of automatic defibrillators is widely available but the equipment is not. That is why the N.D. Department of Health has been supportive of grant applications to acquire more AEDs in North Dakota,” said N.D. Tim Wiedrich, Director of the Division of Emergency Health Services for agency. The N.D. Department of Health is aware of two applications that have been filed, said Wiedrich. The Office of Rural Health, University of North Dakota, has submitted a grant application that would provide AEDs for many communities and emergency medical services units such as ambulance services throughout the state. Metro Area Ambulance of Bismarck/Mandan has also submitted an application requesting AEDs for the North Dakota Highway Patrol. Wiedrich is hopeful both applications will be funded.
Community Involvement
If you have walked through the airport in another state, you probably noticed AED machines located every 60 or so feet. You may have noticed them in shopping malls, at sports arenas or community centers. “In the future, you will see them as common place as fire extinguishers,” Hanson said.
AHA guidelines calls for strategically placing the AEDs to allow for a three-minute response time from the collapse of a cardiac arrest victim to the arrival of a trained lay rescuer with an AED. St. Alexius recently conducted an inspection of its own facility and placed additional AEDS to allow for a three-minute response within the hospital.
PAD programs are already in place in the Fargo-Moorhead area and have resulted in two “saves.” A Barnesville, Minn., woman was revived as was a Concordia College professor who collapsed at a basketball game. “One of the persons who was recently trained used the defibrillator and brought him back,” Sand said. The PAD has “very much proven its worth.” A steering committee of public and private health organizations and non-profit groups applied and received a grant for the program. The committee helped prioritize the sites, Sand said.
In Bismarck-Mandan, placement of AEDs in public places has yet to materialized. “We are looking for civic organizations to take charge,” Hanson said. The AHA would like support from community organizations for funding and for public education.
The machines cost approximately $2,000 to $3,000; the hospitals can provide assistance with selection of a machine, Erickson said. The AHA encourages medical oversight for the PAD program and involvement from the emergency medical services (EMS) system to help ensure safety and effectiveness. Also, PAD programs should include a regular scheduled maintenance to ensure the machines’ readiness in the event of an emergency. Hanson and Windsor are available to discuss the program with organizations that are interested in making the investment.
As Hanson indicated, the machines are well worth the investment by a community organization. “Without these machines, the success rate is lowered for people who suffer sudden cardiac arrest. Simply put, having public access to these machines will save lives.”
For additional information on starting a PAD program, contact Derek Hanson of St. Alexius at 530-8620, or Brad Erickson of Medcenter One at 255-6838.
The American Heart Association’s home page on the Internet contains information about PAD programs. The address is: http://www.cpr-ecc.com/cpr_aed/cpr_aed_menu.htm.
The American Red Cross also lists information about the PADs on its home page: http://www.redcross.org/news/hs/cpraed/020520aed.html.
The Burleigh-Morton Chapter web site at www.ndredcross.org lists upcoming AED training sessions.
For additional information, contact Kevin Stewart at 223-6700 or at [email protected].
© 2002 The Bismarck Tribune. Reprinted courtesy of The Bismarck Tribune
