Automated External Defibrillators—Deploying Slowly

Two-thirds of SCA deaths occur without any prior indications of heart disease.

• By Jim Madaffer
• Feb 01, 2015

Sudden Cardiac Arrest. Read the daily news and you will recognize these three words. Sudden Cardiac Arrest (SCA) kills an estimated 7 million worldwide and 460,000 people in the United States each year, according to the American Heart Association.

SCA kills more people than Alzheimer's disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer, and suicides combined, according to the Sudden Cardiac Arrest Foundation.

Having an Automated External Defibrillator (AED) nearby when SCA strikes increases the survival rate by nearly 70 percent. This begs the question, why don't we see more AEDs? While fire extinguishers are required everywhere, most paramedics and firefighters will tell you they've used an AED far more often than a fire extinguisher.

Despite slow deployment, these lifesaving devices are gaining more steam and seeing more support across the country. Some state and city governments now require the placement of AEDs, while others have passed laws protecting AED owners and enablers. Travelers see them in airports and more frequently in government buildings and businesses. The tide is turning to the point that not having an AED could result in potential liability.

The Facts
What exactly is SCA?

It is different than a heart attack. SCA, or ventricular fibrillation, occurs when the electrical system of the heart short circuits, causing the heart to quiver rather than pump in a normal rhythm. Most of the time, it takes a sudden shock from a defibrillator to get the heart back in sync and pumping again. SCA is different from a heart attack, which is usually a plumbing problem (blockage, constriction, etc.) But those who have heart disease are at higher risk of SCA.

Here are some other eye-opening statistics from the Sudden Cardiac Arrest Foundation:

• There are a reported 1,000 SCA-related deaths each day—26 of which are children.
• Some 120,000 women die from SCA each year.
• Two-thirds of SCA deaths occur without any prior indications of heart disease.
• The vast majority, 95 percent of victims, die from SCA because of the lack of timely medical attention.
• Finally, SCA can happen to anyone, even those who have no sign of heart disease.

Despite these facts, many victims of SCA can be saved if more AEDs are deployed. Reports show that when AEDs are used within the first minute, a victim's heart will start again.

The difference between life and death is minutes: The chance of survival from SCA is reduced by 10 percent for every minute defibrillation is delayed. That is a shocking statistic, considering that the average response time for first responders is eight to 12 minutes in the United States.

AED Laws
AED laws vary from state to state. Arizona, Illinois, Michigan, New Mexico, and Rhode Island mandate the use of AEDs. Oregon requires AEDs in all large facilities, such as movie theaters, warehouses, and big-box stores.

AEDs are required in schools in 19 states. Most noteworthy is Oregon, which requires AEDs in all public and private schools, including campuses of higher education.

At the federal level, the Federal Cardiac Arrest Survival Act was signed by President Bill Clinton in 2000 and requires AEDs in federal facilities.

There is also progress at the local level. For example, the City of San Diego passed an ordinance in November 2008 mandating AEDs in most new buildings and a requirement to train someone to use them. The ordinance was the first of its kind in the state of California. San Diego's law and the San Diego region's public access to defibrillation program ("San Diego Project Heart Beat") are credited with saving many lives in the coastal city.

Following San Diego's lead, at least three other major U.S. cities have implemented laws mandating AEDS:

• The City of New York passed a local Law in 2005 requiring the placement of AEDs in nursing homes, senior centers, stadiums and arenas, and city parks.
• The Chicago City Council passed an ordinance in 2011 requiring AEDs in buildings operated by the City of Chicago, Chicago Public Building Commission, Chicago Public Schools, and Chicago Public Library.
• The City of Las Vegas recently included mandatory AEDs in all high rises as part of its fire code.
• In the small city of Temecula, Calif., the city pays up to 50 percent of the cost of an AED and training for any building owner who chooses to install it.

Protecting Good Samaritans
One of the arguments against AED mandates is that users may face liability if something goes awry. However, there are plenty of Good Samaritan Laws that protect those who attempt to help a victim.

Good Samaritan Laws, which are meant to encourage individuals to help others without the risk of liability, are found in all 50 U.S. states.

The following states further protect those who acquire, enable, or own AEDs: Alabama, Arizona, Arkansas, California, Georgia, Hawaii, Illinois, South Carolina, Virginia, Washington, Wisconsin, Wyoming.

'It's Not a Loaded Gun'
Robert Roy knows firsthand the importance of an AED to save a life. Roy, who works for a charter school management company in Temecula, lost his youngest son Travis to SCA in 2005. Travis collapsed at school on May 20, suffering SCA caused by a previously undiagnosed heart condition called Hypertrophic Cardiomyopathy.

"Travis collapsed at school in between classes," Roy said. "After 23 minutes without circulation, they were able to revive him, but the damage had been done."

Travis, who became blind and paralyzed, died on June 25 in his parents' arms. He was 14.

Roy has since sprung into the limelight, lobbying for AEDs, particularly in schools. "It's been an emotional roller coaster," said Roy, who also founded the Travis R. Roy Sudden Cardiac Arrest Fund. "I'm only doing this as a parent who lost a child."    

Most AEDs are priced at about the cost of a desktop computer, ranging from $1,200 to $1,500.

"I don't let the schools tell me they don't have money when they can buy an AED for less than the cost of a computer," Roy explained. "Schools are often the rally point for national disasters, so they should have the equipment needed for first responders. It just makes sense for disaster preparedness but also from a humanitarian point of view."

Despite the affordable cost, there is still skepticism. "Some people think you can hurt someone with an AED, but you can't accidentally shock someone," he said. "It reads the victim's heart rhythm and if a shock isn't required, it will not deliver a shock. It's not a loaded gun."

Looking Ahead
AEDs have been available for nearly two decades now. They are proven to save lives. Statistics leave little doubt that having an AED nearby when SCA strikes increases survival rates.

More recently, as consumers and business owners have realized the lifesaving potential of an AED, they are beginning to become more commonplace. In fact, more and more businesses are realizing the potential for liability by not having an AED on the premises.

Technology has improved and prices continue to drop. Smartphone apps are available to let you know if an AED is nearby. One manufacturer now offers a home unit for sale through a major discount retailer, complete with a training manual and an eight-year warranty.

It is my hope and belief that one day AEDs will be as common as fire extinguishers.

This article originally appeared in the February 2015 issue of Occupational Health & Safety.