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Defibrillators and Police: A Life-Saving Combination

Boosts survival chances of those having sudden cardiac arrest

MONDAY, Aug. 12, 2002 (HealthDayNews) -- Giving automated external defibrillators to police officers on patrol increases the survival chances of people having sudden cardiac arrest.

That's the conclusion of a study appearing in the new issue of Circulation.

In most communities, fire department-based rescue squads equipped with automated external defibrillators (AEDs) respond to 911 calls.

"The problem with that system is that they're basically starting from time zero at some physical location remote from the patient, and it takes time to get to the patient," says Dr. Robert J. Myerburg. He is the lead author of the study and director of the division of cardiology and professor of medicine and physiology at the University of Miami School of Medicine.

"Those first few minutes are absolutely critical," Myerburg says.

A patient's chance of survival is best within the first minute, Myerburg says. By the second minute, the chances of survival drop to 50 percent. By the fourth minute, the odds are only 25 percent.

"Police are already on the road so if you simultaneously notify police and fire rescue people, the combination shaves about three minutes off the response time," Myerburg says.

Before giving AEDs to the police for the study, the response time was a little under eight minutes. Afterward, it was under five minutes. The survival rate for patients in ventricular fibrillation, which is when the heart's electrical activity becomes disordered, almost doubled, from 9 percent to 17.2 percent.

"We have made a lot of progress in technology, and the AEDs are just one example," says Dr. Gerald Hollander, director of clinical cardiology at Maimonides Medical Center in Brooklyn, N.Y. "What we're struggling with is the gap between what we know to be helpful and implementing the knowledge in a practical way. This is a good example of a relatively simple approach which can make a difference."

Having defibrillators out in the community like this is a big step, but not the final step. "This is part of what I view as a broad approach to community rescue problems, but it's not the end of the story," Myerburg says. "This is progress, but more progress needs to be made to get the percentage higher."

Some 250,000 Americans die from sudden cardiac arrest every year. Defibrillators are machines that give electric shocks to the heart to restore a normal rhythm. Portable defibrillators (AEDs) are now appearing in airports, casinos, stadiums, office buildings and other places where large numbers of people gather.

In the new study, researchers equipped 1,900 police officers in Florida's Miami-Dade County with 1,900 AEDs that they carried with them. All the police officers underwent four hours of training and had a chance to operate the machine during a practice session. The devices are "smart defibrillators," meaning they can recognize the heart rhythm and alert the operator that the rhythm is one that should be shocked, Myerburg explains.

The 911 system was then re-jiggered so that both police and fire/rescue teams were dispatched to medical emergencies at the same time.

The AEDs were assigned to individual police officers who took the units home with them when off-duty.

"The units were there for the neighborhood," Myerburg says, adding one police officer who was transferred to another job kept the AED with him and used it to save the life of a coach at a Little League practice.

While on duty, the police got to the scene before the fire/emergency teams about 60 percent of time, cutting response times to 4.88 minutes, compared to 7.64 minutes. Help arrived in less than five minutes for 41 percent of calls, compared to 14 percent for the standard response method.

Although the survival rate for the group of patients in ventricular fibrillation jumped to 17.2 percent, the overall survival benefit was only 1.6 percent, because more than half (61 percent) of the victims had conditions that could not be helped by a defibrillator.

The Miami-Dade police force has bought 400 more AEDs since the study was concluded, and the study authors are hoping other forces will follow suit.

"Nobody had looked at a large community that was uniformly equipped with defibrillators in police cars to see if it made a difference," Myerburg says. "We actually got the data. Other people can emulate this knowing that it makes a difference."

Interestingly, one of the places where technology is struggling to keep up is some hospitals. Currently, if a patient in a hospital has a fatal arrhythmia (a disruption of the normal electrical conduction system of the heart), the nurse who finds the patient has to call a special defibrillation team to come. Precious minutes are lost while the team travels from another area of the hospital.

"It seems almost absurd in a situation where we're putting automatic defibrillators in airports and casinos that professionals in the hospital setting are not more aggressive with these kinds of devices," Hollander says.

Maimonides is starting a program to use more automatic defibrillators in the hospital, Hollander says.

The hospital is also planning to adopt totally automatic defibrillators for high-risk patients in intensive care and other monitored units. The devices would be attached to the patients and, if it detected a fatal arrhythmia, would deliver the shock within 30 seconds.

What To Do

The American Heart Association has information on defibrillation and ventricular fibrillation.

SOURCES: Robert J. Myerburg, M.D., director, division of cardiology and professor of medicine and physiology, University of Miami School of Medicine, Miami; Gerald Hollander, M.D., director, clinical cardiology, Maimonides Medical Center, Brooklyn, N.Y.; Aug. 13, 2002, Circulation
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