DEFIBRILLATORS 1 DEFIBRILLATORS Responding to Sudden Cardiac

DEFIBRILLATORS 1

DEFIBRILLATORS Responding to Sudden Cardiac Arrest 2

DEFIBRILLATORS The Odds Annual Deaths from Cardiovascular Disease – U. S. Sudden Cardiac Arrest All Other Cardiovascular 250, 000 695, 800 American Heart Association. Heart Disease and Stroke Statistics - 2003 Update. Dallas, TX. : American Heart Association; 2002. Total Deaths: 945, 800 3

DEFIBRILLATORS Common Causes of Death in the U. S. 1 House Fires (1998 ) 2, 895 2 Prostate Cancer (2001 ) 2 Breast Cancer (2001 ) 3 Automobile Accidents (1996 ) Total 1 SCA (annual ) 31, 500 40, 800 43, 300 118, 495 250, 000 1 http: //www. americanheart. org 2 http: //www. cancer. org 3 U. S. Statistical Abstract of the United States, 1998, Table 138. 4

DEFIBRILLATORS The Stakes Annual Sudden Cardiac Arrest (SCA) Events – U. S. 680 patients per day (one every 2 to 3 minutes) 80% out-of-hospital 50% of men, 63% of women, have no prior symptoms < 5% survive 95% die without very early treatment American Heart Association. Heart Disease and Stroke Statistics - 2003 Update. Dallas, TX. : American Heart Association; 2002. 5

DEFIBRILLATORS SCA Fiction vs. Fact STEREOTYPE REALITY Male and Female Old Any Age Risk Factors Overweight Smoker High cholesterol Often No Clear Risk Factors Medical History Heart Attack Often No Cardiac History Chest Pain Dizziness Often No Symptoms Gender Age Presenting Symptoms 6

DEFIBRILLATORS The Benefits of Early Treatment of SCA American Heart Association 100, 000 SCA deaths prevented annually* Recovery prospects for survivors are high 80% alive at one year 57% alive at five years Total SCA Events: 250, 000 *estimated 7

DEFIBRILLATORS The Heart Pump: a series of events. . . • An electrical event … • stimulates a mechanical event … • which results in a rhythmic and coordinated pumping action of the heart muscle 8

DEFIBRILLATORS Sudden Cardiac Arrest: A Heart in Distress • Uncoordinated, very fast heart rhythm – Ventricular fibrillation (VF) – Some ventricular tachycardias (VT) • Ineffective heart pump • Unconscious, no breathing, no pulse • Death certain without defibrillation 9

DEFIBRILLATORS What Is Defibrillation? • Electric shock to the heart • Stops uncoordinated activity • Allows coordinated heart rhythm and pumping action to resume • Only effective treatment for ventricular fibrillation 10

DEFIBRILLATORS Chain of Survival Defibrillation an EARLY priority Adapted from the American Heart Association 11

DEFIBRILLATORS Why “Early” Treatment? 100 90 Chances of success are reduced 7% to 10% each minute % Success 80 70 60 50 40 30 20 10 00 1 2 3 4 5 6 7 8 9 Time (minutes) Cummins RO, et al. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC, Circulation (Suppl) 2001; 102: 8, August 22 12

DEFIBRILLATORS Survival Rates Defibrillation No CPR Delayed Defibrillation 0 - 2% survive CPR Early CPR Delayed Defibrillation 2 - 8% survive CPR Defibrillation Early CPR Early Defibrillation 20% survive CPR Early CPR Very Early Defibrillation Early ACLS Defibrillation ALS ? survive minutes 2 4 6 8 10 13

DEFIBRILLATORS Best Case Scenario What Happens When You Call 911? Identify emergency/ Activate emergency response plan 911 call 30 seconds 1 minute Alert ambulance and rescue squads (dispatch) 30 seconds Responders to their units 30 seconds Travel time to location 5 minutes* Unload equipment/ Distance to patient 2 minutes Assess patient/ Apply defibrillator/ Deliver shock 1. 1 minutes** TOTAL 10. 6 minutes *Travel time varies depending on weather, traffic, distance (vertical and horizontal), and ambulance (with defibrillator capability) availability. **Cummins RO, et. al. Automatic external defibrillators used by emergency medical technicians: a controlled clinical trial. JAMA. 1987; 257: 1605 -10 14

DEFIBRILLATORS AEDs to the Rescue Uniquely small, lightweight and rugged Low-maintenance Safe, effective, and easier than CPR Designed for lay rescuer Expand lifesaving opportunities 15

DEFIBRILLATORS Heart. Start FR 2+ Defibrillator OPERATION 16

DEFIBRILLATORS Verify SCA • Assess ABCs unresponsive not breathing normally 17

DEFIBRILLATORS Using the Heart. Start FR 2+ 1 2 3 • Turn on defibrillator. • Apply pads to patient and plug in connector. • Deliver the shock. 18

DEFIBRILLATORS Heart. Start On. Site Defibrillator OPERATION 19

DEFIBRILLATORS Verify SCA • Assess the victim unresponsive not breathing normally 20

DEFIBRILLATORS Using the Heart. Start On. Site 1 PULL green handle PLACE pads on chest PRESS shock button 21

DEFIBRILLATORS What if the victim has a pulse and I can’t feel it? Can I hurt someone using the defibrillator? Is there legal liability? • Cannot make things worse • Heart. Start Defibrillators designed to shock only when needed • Product indemnification policy • Good Samaritan laws, AHA standard of care – Possible reverse liability 22

DEFIBRILLATORS What happens if I reverse the pads? Can I defibrillate on water, snow, ice or metal? Can I defibrillate a child? • Analysis & therapy not affected by pad reversal • OK to defibrillate on water surfaces and metal – Standard safety precautions • Using Heart. Start FR 2 and On. Site Defibrillators is acceptable < 8 years old with Infant/Child pads 23

DEFIBRILLATORS Sudden Cardiac Arrest DOES Happen • On-site Early Defibrillation Programs enhance 9 -1 -1 EMS systems… resulting in more lives saved • Rapidly becoming a standard of care • Early defibrillation programs have already demonstrated success by saving lives in a variety of environments Las Vegas (Clark County), Nevada 24

DEFIBRILLATORS The Ultimate Reward Jerome Fuentes Bob Adams Bridgette Mc. Donald 25

DEFIBRILLATORS Something to think about “Public Access Defibrillation has the potential to be the single greatest advancement in the treatment of prehospital SCA death since the development of CPR. ” AHA Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Textbook. 26