Where people gather, help in a heartbeat

Maryland among 44 to have eased access to defibrillators

March 04, 2000|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Rushing to his gate at Chicago's Midway Airport one day in October, Jim Rives, 57, collapsed in cardiac arrest. A nearby nurse started CPR.

Then Justin Hudson, a passer-by, remembered that the airport had recently installed automated external defibrillators, laptop-sized devices that can shock the heart back into a normal rhythm. He grabbed one, hooked the machine's two pads onto Rives' chest and delivered the shock. Rives' heart restarted.

"He would be dead if it wasn't for that machine," Hudson said.

In a step that could save thousands of lives, 44 states, including Maryland, have passed laws in the past two years that allow trained lay people to use these medical devices and that give them immunity from lawsuits. Similar legislation requiring defibrillators in federal buildings has passed the U.S. Senate.

Since Maryland's law went into effect in January, dozens of organizations, including athletic clubs, large companies and community colleges, have begun setting up programs. Baltimore-Washington International Airport plans to install 41 defibrillators throughout its terminals this summer. In Annapolis, 54 building guards and police officers in the State House complex finished training last week, and the machines will be installed by Monday.

The idea is simple: to get more of these machines closer to the people suffering cardiac arrests. One thousand people a day go into sudden cardiac arrest, and 95 percent die, often because it takes too long to get them to a defibril lator.

Across the country, the devices are turning up in casinos, malls and golf courses.

"It's tremendous. There is a whole group of people now who have cardiac arrests who before would have either been dead, on a ventilator or in a nursing home. Now, they walk out of the hospital two or three days later basically normal," said Dr. Seth Worley, a cardiologist in Lancaster County, Pa., who pushed successfully for defibrillators in the county's police cars.

The next fire extinguishers

For health advocates, the automated defibrillators -- which were developed during the past several years and are simpler than manual ones used in hospitals and on some ambulances -- are the next fire extinguishers. The great hope is that, eventually, anyone would be able to yank these machines off the wall and operate them. The American Heart Association estimates that up to 50,000 lives could be saved a year.

But with few scientific studies demonstrating that kind of impact, others aren't convinced. Success on that scale depends on many factors, including where the devices are placed, who uses them, how quickly they get to them and how well they operate them in a crisis.

"I think people are making a lot of assumptions about these devices that we can't substantiate yet," said Dr. Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, which runs the state's new program. He serves on a few national committees on public access to defibrillators. "We need to study this."

In Seattle, for instance, where widespread availability of the devices shortened the time to shock by three to four minutes, the overall survival rate remained unchanged, according to a 1999 study. Researchers theorized that providing cardiopulmonary resuscitation might improve those numbers.

Roots of medical condition

A sudden cardiac arrest is usually caused by underlying heart disease. A person's heart goes into a chaotic rhythm called ventricular fibrillation. The heart quivers uncontrollably and can't effectively pump blood. (This is different from a heart attack, in which an obstructed artery blocks blood flow to the heart. But about 70 percent of sudden cardiac arrest victims had a previous heart attack.)

CPR will help circulate blood and oxygen to the vital organs, but it's only a stopgap. The heart's rhythm must be restored to normal using a defibrillator. For every minute that passes without defibrillation, the person's chances of survival drop by 10 percent.

In Maryland and many other places, it usually takes 8 to 10 minutes for an ambulance to respond. For various reasons, about half of the country's ambulances don't carry defibrillators, according to the American Heart Association. (Maryland's ambulances are all equipped with either manual or automated defibrillators.)

All this contributes to a delay in defibrillation and low survival rates. In New York City, for instance, because of traffic, getting up stairs to apartments and other factors, resuscitation rates are only 1 percent, Bass noted.

Chicago program

Sherry Caffrey, a Chicago paramedic, said she has never seen anyone saved by the manual devices used on ambulances, because of the response time.

"If we got there and we actually got a pulse back, it was like, `Yeah, it's a save!' But they're neurologically dead. They would end up like a vegetable," said Caffrey. "I knew that it had to be applied in the first couple of minutes."

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