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Public Defibrillators Turn Bystanders into Rescuers

Clear instructions let them save heart attack victims

WEDNESDAY, Oct. 16, 2002 (HealthDayNews) -- Three years ago, Sherry L. Caffrey, a paramedic who was training 911 operators for the Chicago Department of Aviation, came to her bosses with a bright idea: Why don't we put defibrillators, the devices that restart hearts that have gone into cardiac arrest, in all three city airports?

The bosses agreed, created the Chicago HeartSave Program, and put Caffrey in charge of it. Defibrillators were placed throughout the passenger terminals of O'Hare, Midway, and Meigs Field airports, spaced so they were no more than "a brisk 60- to 90-second walk apart," with prominent signs showing where they were and telling how to use them.

A report in tomorrow's issue of The New England Journal of Medicine describes the results of the first two years of that experiment. A total of 21 people had cardiac arrest, 18 because of atrial fibrillation, which is often fatal. Four of them died before anyone could get a defibrillator to them. Eleven people with atrial fibrillation were successfully resuscitated; 10 of them were alive and well a year later.

But what is "truly extraordinary," Caffrey says, is that six of the successful resuscitations were done by passersby who had no training or experience in using a defibrillator.

"When I thought of the concept, the audience was flight attendants, who are trained to use defibrillators," Caffrey says. "Never did I imagine that we could get rescuers who had nothing to do with the project."

Those rescuers were guided not only by written instructions but also by voice prompts on how to open the device and where to place the pads that give the electric shock to restart the heart. "We had about a 60 percent survival rate," Caffrey says. "We're very excited about that."

So is the American Heart Association, which has made defibrillator access a leading priority. "This is a remarkable study," says Dr. Vinay Nadkarni, director of pediatric critical care training at Children's Hospital of Philadelphia and chairman of the association's emergency cardiovascular care committee. "It has really started to demonstrate the efficacy of public access defibrillators."

When a heart stops, time means life or death. If treatment starts within one minute, the survival rate is over 90 percent. If it starts in 10 minutes -- about the time it takes for emergency medics to get to a home -- the survival rate is 10 percent. The idea that many lives could be saved by having defibrillators in public places for anyone to use is being explored in a major National Heart, Lung, and Blood Institute study that includes 23 sites across the nation.

That study is based on a premise similar to Caffrey's; that trained personnel will do most of the resuscitation. "One of the aspects of the Chicago study is that the willingness of bystanders to supply cardiopulmonary resuscitation was 100 percent," Nadkarni says. "There was a ripple effect, with the advertising in the airports resulting in a high response rate and a high success rate. This is interesting and very encouraging."

The results of the nationwide study, expected in a year or so, will help decide whether something such as the Chicago airport concept should be applied to many public areas, such as shopping malls and sports clubs, Nadkarni says. Caffrey thinks that the cost of defibrillators should not be a major factor in that decision.

"The defibrillators cost $3,000 apiece when we started," she says. "Now they are down to $2,000, and there are new models going for $1,000. If you look at what a human life is worth, it is certainly more than $3,000. We certainly got our money's worth."

What To Do

For instructions on what to do when someone experiences cardiac arrest, go to the American Heart Association, which also has a page on defibrillation.

SOURCES: Sherry L. Caffrey, E.M.T., director, Chicago HeartSave Program; Vinay Nadkarni, M.D., director, pediatric critical care training, Children's Hospital of Philadelphia; Oct. 17, 2002, The New England Journal of Medicine
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