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Saving lives at home

Once the tool of
professionals, defibrillators get a push for public use
Sunday, December 4, 2005 | 12:00 a.m. CST; updated 12:10 p.m. CDT, Sunday, July 20, 2008

As the leading cause of death in the country, sudden cardiac arrest claims 340,000 lives each year.

According to the American Heart Association, that’s 600 deaths a day, 25 deaths an hour. The American Heart Association is working to make it possible to save more lives. Along with manufacturers who have put portable defibrillators on the market, the Heart Association is providing the public with information so that defibrillators can be used with minimal training.

For the public, this means something that was previously only available for use by medical professionals is now available for use in homes, where 80 percent of sudden cardiac arrests occur.

The change was brought about by the advent of Automatic External Defibrillators, or AEDs. Unlike those used in hospitals, these devices do most of the work themselves. About all that’s required is placing patches on the victim’s chest, turning on the device and following instructions provided by the machine.

“It detects whether or not the heart is in a certain rhythm, and if it needs a shock, then it shocks,” said Jay Simons of University Hospital Ambulance Services.

The machines are not fully automatic. Users must push buttons as they go through the defibrillation process.

Outside of the hospital, defibrillation is the only treatment for ventricular fibrillation, or V-Fib, which occurs when the heart beats abnormally. During V-Fib, the most common cause of cardiac arrest, the heart may pulse or twitch rather than actually beat. Through patches placed on a patient’s chest, defibrillators deliver an electric shock to the heart in order to jump it back to a regular rhythm.

Under a state law passed in August, anyone who purchases an AED must receive training from the American Heart Association, the Red Cross or other recognized training program. The law also says users must have a doctor review and approve use of the device and must call 911 as soon as possible.

Other provisions require owners of defibrillators to notify “emergency communications districts or ambulance dispatch centers” in their area and explain that those who have obtained training and use an AED in an emergency situation cannot be held liable for any damages that occur as a result of the treatment.

Capt. George Miller of the Boone County Fire Protection District said that consumers who buy an over-the-counter AED need two things: training by a nationally known program and medical oversight, which means making a physician aware of potential use of an in-home AED.

In 2004, the Philips HeartStart Defibrillator became the first to gain FDA approval to be sold over the counter. According toPhilips, the defibrillator is considered safe and easy to use by virtually anyone with the materials provided in the package.

The HeartStart model comes with an owner’s manual, a reference guide, an explanatory poster and a training video. The manufacturer recommends those who purchase the device watch the video and read the accompanying material before using it. They also recommend training in CPR and defibrillator use.

While the HeartStart can be used on adults as well as children, the company offers separately sold infant and child SMART Pads, which are attached to a patient’s chest. The AED will recognize the child or infant pads and adjust accordingly, however SMART Pads for infants and children require a prescription. But the manufacturer advises, “If infant/child pads are not available, do not delay treatment.”

The adult pads can still be used but the procedure must be altered. Instead of placing both pads on the child’s chest, one is placed on the chest and one on the back.

The HeartStart model comes with a five-year warranty and is sold at some Sam’s Club locations and through online retailers including Walgreens.com, Staples.com, and Amazon.com. Medicare began covering AEDs in 2004 for certain at-risk patients.

In 2001, the American Heart Association introduced its public access defibrillator program to “reduce the time to defibrillation and improve the cardiac arrest survival rate,” according to its Web site. The program placed defibrillators in places that people gather such as schools, libraries, government buildings, offices and malls.

“The American Heart Association encourages business to create teams to work during an emergency,” said Brian Walsh, the association’s director of communications for Missouri.

Walsh recalls an emergency about four years ago at the MasterCard office in Chesterfield when an AED at the security desk was used to save someone’s life. In June, a Columbia power plant employee was saved by co-workers when they used an AED installed by city government to revive him after he collapsed. Doctors told the co-workers they had saved the man’s life.

The U.S. Office of Rural Health Policy provided the Missouri Department of Health and Senior Services with a number of AEDs to be distributed to first responders such as law enforcement, ambulance services and fire departments in eligible rural and suburban communities. The state health department works with the Missouri Emergency Medical Services Association, the University of Missouri and the American Heart Association to train workers in AED use.

Other AED models are available from manufacturers that include ZOLL Corp., Samaritan, Medtronic, and DefibTech. Each model offers various prices and designs. Defibrillators by these manufacturers require a prescription to purchase.

Consumers can compare the merits of each model by going online to AEDgrant.com, whose goal it is to have an AED in every home, business and public place. The Web site also offers a grant application to make purchasing defibrillators more affordable.

“Training is simple and AEDs are getting better and better at knowing what to do,” Simons said.

Training not only explains how to use a defibrillator but also goes through basic training for CPR, chest compressions and checking someone’s pulse.

Online retailers such as Walgreens.com or EqLife.com offer to work with patients seeking to purchase an AED by helping them obtain a prescription from physicians. Some Web sites also direct patients toward training programs.

Organizations offer programs along with training for CPR. Boone County Red Cross “demonstrates the use of an AED as well as safety precautions like where and where not to use them,” said Julie Wiecken, education and marketing director.

Miller, of the Boone County Fire Protection District, also provides training locally.

Aside from the training received and the fact that these machines work semi-automatically, they also walk users through the process, adjusting to fit the pace of the person operating them.

“We hope it’s the easiest it can be,” Walsh said. “There are pictures on the pads you stick to the chest, but the machine tells you what to do.”

After determining whether a patient needs to be shocked, the AED may tell rescuers to stand clear and push the shock button to administer a shock. It will then analyze again. If no shock is needed, the machine will give further instructions and remind users to call 911. If the patches are left on the patient’s chest, the AED can monitor whether they go into V-Fib at any point.

The American Heart Association reminds people not to rely on AEDs alone and so far has put more effort into getting these devices into public places than into people’s homes.

“The science isn’t there that it makes a bigger impact than calling 911 immediately,” Walsh said. “Follow the chain of survival where the first thing you do is not grab the AED but call 911.”


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