Question of the Week
December 20, 2004


Have you heard of AEDs (Automated External Defibrillators)? Would you know how to use one if you needed to? Sure, the instructions are right there, but in an emergency, very few have the time--or the presence of mind--to open the directions for the first time. So, what are AEDs, and why do we need to know about them?

"The automated external defibrillator (AED) is a computerized medical device. An AED can check a person's heart rhythm. It can recognize a rhythm that requires a shock. And it can advise the rescuer when a shock is needed. The AED uses voice prompts, lights, and text messages to tell the rescuer the steps to take. AEDs are very accurate and easy to use. Lay rescuers with a few hours of training can operate an AED safely.... If AEDs are so easy to use, why do people need formal training in how to use them? An AED operator must know how to recognize the signs of a sudden cardiac arrest, when to activate the EMS system, and how to do CPR. It's also important for operators to receive formal training on the AED model they will use so that they become familiar with the device and are able to successfully operate it in an emergency. Training also teaches the operator how to avoid potentially hazardous situations."

...And why do we need to know about them?

"In the time it takes you to read this page, sudden cardiac arrest will have claimed another victim. In the past year, 250,000 Americans died of sudden cardiac arrest: nearly one death every two minutes. Up to 50,000 of these deaths could have been prevented if someone had initiated the Cardiac Chain of Survival, and an automated external defibrillator (AED) had been available for immediate use at the time of the emergency.... Many victims have no history of heart disease, or if heart disease is present, it has not functionally impaired them. Unlike a heart attack, which is the death of muscle tissue from loss of blood supply, many victims of SCA have no prior symptoms. SCA can strike anyone, at any time, anywhere."

AEDs are not just for older people with heart disease in health clubs. As they find their way into more public places--including schools--they are touching the lives of teens, as well.

"January 13, 2003 A 16-year-old student with no previous history of heart problems collapsed in class on December 16th and was resuscitated, thanks to quick action by high school staff and students and the availability of an on-site defibrillator. Andrea LeFleur, from Orange-Ulster BOCES High School in New York, told another student she felt weak and within minutes her heart had stopped beating. The school nurse, several teachers and a student, who is a volunteer firefighter, all helped in the rescue. The school's automated external defibrillator (AED) had been installed a few weeks before, in response to a new state law requirement."

AEDs are designed to be used by those without a medical background. Training is beneficial; and the time to learn how to use an AED--and whether or not it is the best course of action--is not when you have someone unconscious before you. Someone without training could read the directions (as someone else goes to call 911), and may be able to help if no one else is there. But then there are questions: Is it safe in all situations? How do you know who will benefit from its use? We have read how they have been used to help teens, and they were designed to be used to help adults. What about children?

There are some concerns:

"Young children are much smaller than adults and therefore require a much lower energy setting for delivery of the same defibrillation dose (J/kg) used in an adult. AEDs designed for use in adults have energy levels (or a single energy level) capable of delivering a substantially higher dose (J/kg) to young children. Another concern is that infants and small children with sinus tachycardia or supraventricular tachycardia can have very high heart rates that might be misinterpreted as 'shockable' rhythms by an AED with a diagnostic program developed for analyzing adult arrhythmias."

Even with these concerns:

"Current evidence suggests that AEDs are capable of appropriate sensitivity and specificity for pediatric arrhythmias and are both safe and effective for defibrillation of children 1 to 8 years of age. Ideally pediatric pads/cables should be used, whenever available, to deliver a child dose.... The task force strongly encourages industry to continue to develop pediatric rhythm diagnostic programs and investigate appropriate pediatric AED energy doses. The task force applauds efforts in this area and will conduct a comprehensive review of new data as they become available."

It used to be that lifeguards and babysitters, as well as teachers and others who are responsible for the care of others, would be required to have CPR training. With so many people who can be helped, and AEDs in more and more locations, AED training has been added to what used to be classes in first aid and CPR.

"American Red Cross first aid, CPR and AED programs are designed to give you the confidence to respond in an emergency situation with skills that can save a life. Additional training in bloodborne pathogens, oxygen administration and injury prevention can be added to CPR and first aid training to prepare you to prevent and respond to life-threatening emergencies."

But you're not a lifeguard, and you're not a teacher. You don't work in a hospital. So why do you need training? Whenever you are around one of these things at school, there's always someone else there, right? While someone with training may not be all that easy to find at school, there probably is someone there. What about when you are out at the mall with your friends? Do you babysit? Some homes already have AEDs, and the FDA has just made it easier for people to purchase them.

"September 16,  2004
The U.S. Food and Drug Administration (FDA) announced today that a certain AED model, the Philips HeartStart Home Defibrillator, may be sold without a prescription.... The device is specifically designed for use by laypersons. 'We do not believe that the prescription requirement provides significant efficacy or safety benefit for personal purchase and use of AEDs, and indeed is an impediment to more widespread availability of this life-saving therapy in the setting where it occurs most often,' said Mary Newman, NCED Executive Director, and Vince Mosesso, MD, NCED Medical Director in their remarks before the panel. Sudden cardiac arrest occurs most often in the home. According to NCED, a change enabling over-the-counter sales of AEDs to consumers has the potential to have a strong positiveimpact on survival nationwide without incurring risk to future SCA victims or their rescuers."

Why would people need AEDs in their homes?

"Between 50 and 80 percent of SCAs [sudden cardiac arrests] occur in the home, often without warning or witnesses, thus making the use of a traditional external defibrillator manned by trained personnel an occurrence that is seldom an option."

Right now, it is cost prohibitive for most families to purchase an AED, but that didn't stop from recommending them as holiday gifts this year.

"Plenty of people will ring in the new year with a resolution of better health. If any of them are on your shopping list, why not give them a jump-start with a healthy holiday gift? Here are the health editors' top picks:... About the size of a hardback book and weighing 3.3 pounds, HeartStart can be used without a prescription on adults and children over age 8 and weighing 55 pounds or more. The easy-to-use device analyzes a patient's heart rhythm and only delivers a shock if needed. Voice instructions guide the user through the process. It will also coach a user through the steps of CPR. Price is $1,495..."

Understandably, most people do not plan to spend $1,500 this holiday season for an AED to have at home. Even if you do not have one at home, chances are you will be traveling to a place that does. Schools, airports, stadiums, malls, and other locations where large groups come together are getting them more and more. Even without an AED, CPR can help a person hang on until help arrives. If you don't have a chapter of the Red Cross nearby, check with your local fire station or police department and see what training they offer. Above all, if you--or anyone you are with--experiences symptoms of heart trouble, get help right away.

"December 13, 2004--It may be considered the most wonderful time of the year by many--but Christmas is also the deadliest day of the year for Americans. According to a new study by the Journal Circulation, more Americans die from heart attacks and other natural causes on Christmas, the day after, and on New Year's Day than on any other days of the year. The report indicate the deaths are probably because people are feeling too busy or too festive to go to the hospital over the winter holidays season. Though it's time to celebrate, it's also time to keep an eye on your health.... One of the reasons is obvious; Shoveling snow puts a strain on the heart if you're not used to that much exercise. The holidays contribute to heart attacks because of higher levels of stress.... Plus, there's holiday eating. Studies show even just one meal high in saturated fat can increase your odds of having a heart attack. Another often overlooked cause: the flu.... Inflammation of the vessels leading to the heart can help cause a heart attack. Cold weather can cause vessels to narrow, another heart attack trigger."

Questions of the Week:
Why is AED training important, even if you don't have an AED? Why is CPR training still important if there is (or is not) an AED nearby? What is the first thing you should do if you suspect someone is having heart trouble? How can you know when to use CPR, and when is it unsafe to use an AED? As a kid, a teen, or an adult, what should you know about basic first aid, CPR, and AED use?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

[email protected]
Health Community Coordinator
Access Excellence @ the National Health Museum

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