I thought I would revive (no pun intended) this thread after reading this morning's paper:
http://www.reviewjournal.com/lvrj_home/2004/Jan-26-Mon-2004/living/22958446.html
Monday, January 26, 2004
Copyright © Las Vegas Review-Journal
SAVING LIVES: When Seconds Count
Proponents encourage widespread training and use of special defibrillators
By JOAN WHITELY
REVIEW-JOURNAL
Photos by Cariño Casas
Jack Barlich, 66, of Del Rey Oaks, Calif., was winning at pai gow poker at the MGM Grand one moment. The next, he had dropped his glass of sparkling water and slumped unconscious against his wife.
It was May 1. Barlich was in cardiac arrest. Irene Barlich tells what happened next.
"The dealer was already on the phone (summoning security officers and paramedics). Other bystanders, hotel guests, put him on the ground and started CPR right away."
Within minutes, security officers had jolted Jack's heart with electricity, restoring a heartbeat. Paramedics whisked him away to a local hospital, where he spent two weeks stabilizing enough to be transported to California, for two more weeks of hospitalization.
"They are definitely lifesavers," says Jack, who now knows defibrillators -- devices to electrically shock a heart -- from both ends: as patient and as administering technician. For 30 years he was a firefighter, sometimes responding to medical emergencies.
Retired from that career, he is now mayor of Del Rey Oaks. Several years ago he underwent a triple-bypass heart surgery. Today the Barlichs select their hotels carefully for good medical support services, including availability of AEDs.
AED is an acronym just entering the average American's vocabulary. It stands for automated external defibrillator, the kind of equipment that MGM security officers used on Jack. The electric shock can jump-start a quivering, nonfunctional heart back into a regular rhythm.
A "hug" is what YMCA of Southern Nevada spokesman John Denton likens AEDs to. At both YMCA branches, an AED hangs prominently behind the front desk. Denton says, "It's saying, 'We do care about you this much.' "
Compared to the defibrillators used in hospitals or by highly trained paramedics, AEDs are simplified. The device, not the operator, analyzes a victim's heart state. Then the AED gives instructions -- with voice and written prompts -- on whether to shock, and how to do it.
The devices are crucial because cardiac arrest kills more Americans each year "than cancer, AIDS or other disease state," according to Michael Gioffredi, vice president of Cardiac Science, an AED manufacturer based in California. According to the federal Occupational Safety & Health Administration, cardiac arrest causes 300,000-400,000 U.S. deaths yearly.
Yet few laws compel public places, except for certain types of medical facilities, to have defibrillators. Only about 5 percent of the nation's government buildings -- federal, state and local -- are equipped with AEDs, Gioffredi estimates.
Large Las Vegas gaming resorts are ahead of the national curve in having AEDs ready, say representatives of the Clark County fire department and Dr. David Slattery, education director of the emergency medicine department at University Medical Center.
Some of the landmark medical research proving the usefulness of AEDs was done in Las Vegas casinos. A study published in The New England Journal of Medicine in 2000 looked at AED use by casino security officers in Clark County, Lake Tahoe and Mississippi.
Of cardiac arrest patients who received a shock within three minutes of collapsing, 74 percent survived, the study reported. That compared to a national survival rate of 5 percent for all cardiac-arrest patients.
The amount of time lapse between "drop" and "shock" can make the difference between life and death, numerous experts say. For every minute that passes from drop to shock, one study says, the person's chance of survival drops 10 percent -- making survival a low possibility if 10 minutes pass before AED intervention. Administering CPR, however, can stretch the survivable time between drop and shock.
But nongaming Las Vegas venues are trailing at getting AEDs.
"It definitely saves lives, but it's still a `mystical thing' " to the average person, says Asa Marie Davis, a spokeswoman for the American Red Cross, Southern Nevada chapter. She says it gets comparatively few training requests for AEDs compared to CPR.
Clark County public high schools will soon get on board, because a new state law requires them to have the devices by July 1. Lobbying for the law were families in two well-publicized recent local cases, in which young athletes suffered cardiac arrest during sports, due to previously undetected heart conditions.
One survived, one died. The survivor, 13 at the time, had received CPR by teachers until paramedics arrived, in about five minutes, to defibrillate. Paramedics did not reach the other until about 10 minutes after cardiac arrest.
McCarran International Airport has seven AEDs, for use by airport personnel, who sometimes get to the site of a "sick person" call before paramedics, even though Clark County Fire Department has a station at the airport, according to spokeswoman Hilarie Grey.
"Both of the times I was involved (in using an AED) the individual was already gone. I saw the machine as a tool of comfort for the family," who knew that all measures had been tried to save the deceased person's life, says Sam Torrence, 41, who has worked at McCarran International for two years. As a passenger service rep, Torrence answers emergency calls. In a prior security job at the Bellagio, he also operated an AED and had some "saves."
Shopping malls here have a mixed record. The Boulevard Mall has two AEDs with personnel trained to operate them, according to its marketing director. The Galleria at Sunset mall has no AEDs, a representative said.
Health and fitness centers are largely lagging, too. The three largest local chains -- Gold's Gyms, Las Vegas Athletic Clubs and 24-Hour Fitness -- do not have AEDs, according to spokesmen. The YMCA deployed AEDs a year ago. Club Sport Green Valley, 2100 Olympic Ave. in Henderson, has had a device for two years.
Gold's Gyms do not have AEDs but, spokesman Marcel Kuerzi pointed out, many fire department crews work out at the gyms, which provides an informal level of coverage for medical emergencies.
The Las Vegas Athletic Clubs do not have AEDs, but spokesman Bret FitzGerald questioned the need.
"The average person who works out at our club is already healthier than the average person who goes to a grocery store. If grocery stores don't have them, why should we?" He said his company is awaiting more definitive data on the benefits.
Dale Branks, a paramedic for American Medical Response, is also a board member of Project Heartbeat, which promotes the spread of public-access defibrillators. A former personal fitness trainer who holds a master's degree in exercise physiology, Branks has approached local health clubs on behalf of Project Heartbeat.
Most clubs resist adopting AEDs, but Branks calls it short-sighted. The American College of Sports Medicine and the American Heart Association issued a joint statement in 2002 urging health clubs to get an AED if they: have a membership of 2,500 or more; offer programs for special populations such as the elderly or those with medical conditions; or the paramedic response time will be longer than five minutes.
Health clubs, the statement adds, are finding high growth in new members older than 35. "It is reasonable to presume that the number of members with cardiovascular disease is rising as well," according to the position statement. As more people who are over 55 start working out, Branks calls it the "mainstreaming of senior adults" into gyms.
Health clubs personnel need to know that vigorous exercise is a known potential trigger of sudden cardiac arrest in adults with coronary artery disease, according to Branks. Illinois requires physical-fitness facilities to have AEDs, he points out.
It's hard to predict where sudden cardiac arrests will occur, but the National Center for Early Defibrillation at the University of Pittsburgh says research has identified locations that "seem to have a higher incidence," including: airports, businesses, county jails, golf courses, large industrial sites, homeless shelters, nursing homes, doctors' offices, shopping malls, sports centers and urgent-care centers.
AEDs should be as commonplace in public venues as fire alarms and fire extinguishers, says Luis Rodriguez, a county firefighter-paramedic who is stationed at McCarran.
But he recognizes inhibiting factors, such as cost of the equipment -- $2,000 or more, if only one is purchased -- and the cost of employee training. In cases where an AED is deployed without trained personnel, for any bystander to use, theft and misuse are also risks.
"Just putting the AED out there (without trained operators), may or may not help," Slattery says. "One of the most difficult things is deciding where to put these. . . . But the take-home message is early defibrillation."
