Defibrillators in Schools: Lifesaving Lessons

Advocates say portable devices save victims of sudden cardiac arrest

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, June 24, 2003 (HealthDayNews) -- On a March day in 2000, a routine lacrosse shot hit goalie Louis J. Acompora in the chest.

He scooped up the ball with his stick, started up the field, then appeared to trip and fall. Spectators thought the 14-year-old Long Island, N.Y., boy had the wind knocked out of him. But he lay on the field unconscious, without a pulse.

Within minutes, he was dead.

Louis suffered sudden cardiac arrest, which triggered an abnormal heart rhythm. He'd be alive today, his parents say, if there had been a device called an automated external defibrillator (AED) at the high school where he died.

A portable AED, about the size of a hardcover book, could have delivered a shock that would have restored the normal beating of Louis' heart, say his parents, John and Karen Acompora.

Heart experts agree.

So now, the couple has embarked on a campaign to spread the word about AEDs and get them into schools nationwide in hopes of preventing other deaths from sudden cardiac arrest.

"We have an obligation," says John Acompora. "We cannot keep this to ourselves. How can we know this is going to happen again and not do something about it? We had to get the message out. So we said, 'Let's make this our cause.'"

Through the Louis J. Acompora Memorial Foundation, the couple has created and distributed some 5,000 kits with printed information, a CD-ROM and a video about AEDs and sudden cardiac arrest. And Karen Acompora has traveled throughout the country and to Canada to push for AEDs in schools.

The efforts led to passage of a law requiring AEDs in schools throughout New York state. School districts in states including California, Florida, Illinois, Iowa, Pennsylvania and Washington also have brought AEDs into schools.

And a bill signed into law last spring authorizes $30 million in federal grants to states and localities for the purchase and placement of AEDs in public places.

The move to bring AEDs into schools reflects a growing awareness about sudden cardiac arrest and use of the devices to treat it. Sudden cardiac arrest that occurs outside of hospitals causes some 250,000 deaths annually, the American Heart Association (AHA) says.

An abnormal heart rhythm called ventricular fibrillation causes sudden cardiac arrest, and defibrillation is the only known therapy, the AHA says. For every minute that passes without defibrillation, a victim's chance of survival decreases by 7 percent to 10 percent, the AHA says, so in eight to 10 minutes without defibrillation, death is nearly certain.

As happened in Louis Acompora's case, paramedics with defibrillators may not arrive in time to save a victim.

Louis, who had no heart defects or disease, suffered a particular type of sudden cardiac arrest called commotio cordis, in which ventricular fibrillation is caused by blunt trauma to the chest that occurs at a precise time in the heart's electrical cycle.

The timing, not the force alone, causes commotio cordis. And Louis suffered the fatal blow even though the ball hit his chest protector.

AEDs, some of which cost around $2,300 to $3,000, are simple to use. After adhesive electrode pads are put on a victim's chest, the AED's computer determines the heart rhythm and, if a shock is needed, delivers one through the chest wall to the heart. Audible or visual prompts guide users.

"The AEDs are one new way that people can really respond [to sudden cardiac arrest] and don't have to feel helpless. They can help someone who just had a sudden cardiac death to bring them back to life," says Dr. Vinay Nadkarni, chairman of the American Heart Association's Cardiac Care Committee.

Nadkarni, an associate professor at the University of Pennsylvania School of Medicine and a physician at Children's Hospital of Philadelphia, says all schools should have a resuscitation plan that includes AEDs.

But, he stresses, the devices should be considered only part of a comprehensive plan that includes CPR and AED training.

Widespread availability and use of AEDs could save as many as 50,000 lives a year in the United States, the AHA estimates.

In February, as part of a pilot program, Chicago put AEDs in 51 high schools, eight elementary schools and 13 sports facilities in its school district.

"It's another link in the chain of survival... Every minute is critical in terms of survival," says Wendy Haas, director of the school system's Bureau of Employee Health Services.

Now, the Illinois legislature has approved legislation requiring AEDs in all schools.

Haas, however, calls the measure an "unfunded mandate" that will require schools to be creative in seeking money to pay for the AEDs.

"They're being mandated by law, but there's no money to cover the mandates," she says. "It sounds like a good thing to do. Everybody agrees it's a good thing to do."

Paying for the AEDs will require some schools to seek help from foundations or other organizations or hold fund-raisers, Haas says.

The investment is worth it, says Karen Acompora, who continues her tireless efforts to spread that message.

"It keeps me very busy, and it is what Louis would want me to do," she says. "I wish somebody had done it for us. I wish somebody had taken steps to make sure that defibrillators were made available" at Louis' school before his death.

Acompora says seven lives have been saved by AEDs in New York state schools. She urges decision-makers in other states to follow New York's lead.

"People wait for tragedy to happen in their backyard before they do something," she says. "Now, you have knowledge. Don't wait."

More information

For more on automated external defibrillators, visit the American Heart Association. To learn more about efforts to put AEDs in schools, check the Louis J. Acompora Memorial Foundation.

SOURCES: John and Karen Acompora, parents of Louis J. Acompora, Northport, N.Y.; Vinay Nadkarni, M.D., associate professor, University of Pennsylvania School of Medicine, physician, Children's Hospital, Philadelphia, and chairman, American Heart Association Cardiac Care Committee, Dallas; Wendy Haas, director, Bureau of Employee Health Services, Chicago Public Schools

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