SUDDEN CARDIAC ARRRESTS STRIKE 350,000 PEOPLE EACH YEAR -Partnership with EMS and expanded access to defibrillators provide the key
By John FitzGerald When the Medley, Fla., Police Department bought three automated external defibrillators (AEDs) last year, Officer William Echols was impressed with how easy they were to use. Less than three weeks after he was trained to use the device, Echols was even more impressed when he responded to a medical emergency call – an 83-year-old man had collapsed on the street from sudden cardiac arrest (SCA). With the push of a few buttons, Echols administered an electrical shock that restarted the man’s heart and kept him alive until the paramedics arrived with advanced cardiac life support equipment and medications.
SCA strikes nearly 1,000 times each day in the United States alone. The number of victims of sudden cardiac arrest (SCA) each year – 350,000 – is comparable to the population of Minneapolis or Miami. Tragically, 95 percent of them will die.
But the overall survival rate doesn’t tell the whole story. Studies have shown that SCA survival is much lower in traffic-congested cities and remote rural locales – where EMS response times are longer – and increases dramatically in area with well-equipped response squads who can be on the scene almost instantly. In Seattle, where Medic One response has been in place since the 1960’s, the survival rate is above 30 percent. In Rochester, MN, quick response was made a community objective in 1990 – and the SCA survival rate rose to 49 percent by 1995.
Based on these statistics, a number of forward-thinking cities across the country and around the world are developing innovative partnerships between their emergency medical services (EMS) and the “first responders” – including police – who typically reach the scene of a cardiac arrest before the ambulance.
PLAYING A CRITICAL ROLE
Because police cars are already out on the street, their response time to medical emergencies is often faster than that of ambulances or fire trucks dispatched from the station. In most jurisdictions where they have been designated first responders, however, police officers haven’t been able to provide much more than reassurance or, at most, first aid and CPR. AEDs allow officers to take advantage of those few critical minutes that can make the difference between life and death for someone in cardiac arrest.
In some jurisdictions, such as Suffolk County, N.Y. and Greenwich, CT., police officers certified as emergency before last year. Then the department equipped squad cars in one of its two largest police districts with AEDs, with the goal of raising the cardiac arrest survival rate from 15 percent to as high as 30 percent.
And in London, England, police officers are participating in a three-year study to test the first responder concept. London Police will be the first in the United Kingdom to carry AEDs.
All these officers, regardless of their prior experience or level of medical knowledge, are able to use the devices because the expertise needed to analyze the hearts’ electrical function is part of the AED’s programming. Developed by manufacturers such as Physio-Control to meet a compelling community need, the latest generation of AEDs is lightweight, cost-effective and user-friendly.
WHY EVERY MINUTE COUNTS
As medical emergencies go, cardiac arrest is perhaps the most time-sensitive. SCA is usually caused by an electrical malfunction of the heart called ventricular fibrillation (VF) – an ineffective quivering of the heart muscle, making it unable to pump blood through the body. Once the blood stops circulating, a person quickly loses consciousness and the ability to breathe, and without effective treatment, will die within minutes.
The AHA (American Heart Association) introduced the chain of survival model in 1990 to symbolize the sequence of events that must occur – quickly – to increase the survival rate from sudden cardiac arrest.
1) Early access, the first link, has two components: educating citizens to recognize cardiac arrest and having an emergency dispatch system in place to send trained personnel and equipment to the scene quickly. 2) Early CPR is the second link. Bystanders who perform CPR provide circulation and respiration to victims, buying time until the Emergency Medical Services (EMS) team arrives. 3) Link three, early defibrillation, is the most critical connection in the chain, and often the hardest to come by. It calls for victims to be defibrillated within 10 minutes of the onset of the cardiac event, so it is usually administered at the scene. 4) The fourth link is advanced cardiac life support, including medications and hospital care.
Defibrillation is the definitive treatment for VF- but it is effective only if it reaches the victim in time. A brief but powerful electrical shock applied to the person’s chest interrupts the VF and allows the hearts’ natural rhythm to regain control. Despite the proven effectiveness of this treatment, in most cities access to defibrillation devices outside of hospitals is limited. At present, it’s estimated that fewer than 10 percent of emergency response vehicles (including aid cars, fire engines and police cars) carry the devices.
Sudden cardiac arrest is responsible for more death – preventable deaths – every year than motor vehicle accidents and violent crimes combined. According to the American Heart Association, the growing use of AEDs by police can play a major role in saving tens of thousands of lives every year.
More importantly, AED programs help reinforce the positive relationships police officers have with their communities. It is perhaps one of the most tangible ways we can help people, and one that will be remembered the longest.
John FitzGerald is a certified Emergency Medical Technician, a member of the Somers, N.Y., Police Department and an EMS Systems Specialist with Physio-Control Corporation of Redmond, Washington.