Next Stop: Convergence

The latest technology can help users "manage the interplay between the right time to do CPR and the right time to do defibrillation."

Editor's note: The "next stage" of AEDs promises to combine CPR and automated external defibrillation in a new, user-friendly way, says Jamie Froman, director of marketing for the commercial AED business of Philips Medical Systems (www.philips.com). Froman, who works in the company's Seattle, Wash., offices, discussed recent developments in AEDs and CPR on Nov. 22, 2005, with Occupational Health & Safety's editor. Excerpts from the conversation follow:

We've been publishing articles about AEDs since 1997, and it has pleased me to see them so widely adopted. What do you think has been accomplished so far, and where do you hope they'll go next?

Jamie Froman: The growth in the AED market, particularly in the workplace, has been just amazing. You and your publication have followed the progress of it since the mid-90s. There are two or three key factors that have helped this come along.

One is a real grassroots interest in helping to make safer workplaces, both from the health care professionals' side as well as employees being interested. But from a technology point of view, the ease of the devices, the reliability of the devices--those two have been major factors. Those are the two big drivers, I think.

The devices are now so easy to use. They've gotten less expensive, more capable, smaller, with longer life. They've become much better in a short span of time.

Froman: The over-the-counter status of one of our defibrillators, in particular, we believe has been a major driver. . . . An extraordinarily easy-to-use device that has self-testing capabilities in it for reliability achieved over-the-counter status January 19, 2005. That has been just fabulous. People really gain a lot of confidence by the knowledge that this device is so easy to use that it's available without a prescription.

I can imagine they do. I've not yet talked with anyone who has put one in a home, like a fire alarm or a smoke alarm. The anticipation is that this will become, sooner or later, a common home device?

Froman: I think it's mutually reinforcing. There are folks who are placing a device in the home because they perceive it to be an easy-to-use safety tool for their home. And we have the sister device to the home device . . . that's being placed in a lot of workplaces. And I think people look over and say, "Heck, this is easy enough to be in a house, it must be good for my corporation, as well," and vice versa.

At the Dallas meeting of the American Heart Association in November 2005, we were talking about the study in JAMA that indicated health care professionals often don't administer CPR as well as expected--they don't follow the AHA guidelines. You're aware of the JAMA study?

Froman: Yes, I think that was quite a groundbreaking study for the whole industry. Those studies focused on hospital responders and on advanced lifesaving responders in the EMS marketplace. The gist of the study was that there's a lot going on in an advanced lifesaving resuscitation. These are highly trained folks, but they have to do a lot of things. So the notion is that these high-end tools that we recently announced [to measure CPR performance against the guidelines] for advanced lifesaving professionals can in fact support and help folks to do better CPR.

It's a tool that would be valuable not only in training, but also in situations where CPR is actually being administered?

Froman: Absolutely. This tool is really the only integrated tool that both measures what the user is doing and provides feedback that's really customized to what that user is doing. . . . It's designed to help them deliver CPR in accordance with the guidelines. What's fascinating about this market is that there are a lot of folks looking at this.

You mean looking at the quality of CPR as it's currently being administered?

Froman: We're getting a lot of information about the quality of CPR and now have introduced this tool to the hospital and EMS marketplaces that can help support their responders to deliver high-quality CPR.

As I understand it, this device was used for that study. They needed something that could measure how CPR was being administered and then test that against what was recommended.

Froman: Exactly.

I was trained years ago in CPR inside the Houston Astrodome, in a group of maybe a hundred people with their resuscitation manikins spread out on the floor. There wasn't any way to know whether you were doing it exactly right. We've trained so many Americans in CPR; do we now need to retrain them all?

Froman: The American Heart Association recently came out with this new "CPR Anytime" kit. I think it's worth touching on. The really cool thing about this kit is that it will make it easier to train people, and I think that's really important.

The kit is small, affordable, easy to use--all of which helps more people to get trained in CPR. I know the Heart Association is interested in dramatically broadening the number of people who are trained in CPR. And this kit and other kits that I think they have lined up in the future are really what it's all about.

This also came out during the Dallas meeting: A study showed a 20-minute video was as effective as the four-hour CPR course that's been used.

Froman: That's amazing.

It is, to me.

Froman: I think that was by Dr. Ahamed Idris [of AHA's Emergency Cardiac Care Committee and the University of Texas Southwestern Medical Center, Dallas] and some collaborators of his. . . . The idea is that by using this mini-manikin and this defibrillator, in less than half an hour you can train people.

That's a big deal for corporations. People want to have their employees well trained, but it's a little tough to take a half day off. I think a kit like that could be quite something.

This could succeed on a really broad scale. As you say, corporations could train their entire workforces.

Froman: It's a very exciting prospect. From the defibrillator manufacturers' standpoint, we have started to introduce features into these AEDs that help support CPR by laypeople, as well.

How will they do that?

Froman: We talked about [measuring CPR performance by] the advanced lifesaving folks. What we have for the lay rescuer is . . . coaching, which is voice instructions [inside two defibrillator models] that remind the user about the basic steps of CPR.

You referenced your experience in the Houston Astrodome; my experience is that most people--lay people, well-intentioned lay people--take the CPR course and then may have trouble remembering specifically what the order of steps was.

They do, I agree.

Froman: Taking the cue from our AED voice instructions--which are very driving and sort of tell people what to do--the CPR coaching that we have implemented in those two defibrillators . . . offers the user the choice of pushing a little blue button if he or she wants more help. And if he or she does, it supports him or her and reminds what those breathing and compression cues are.

That's kind of a scalable solution. It's not as elaborate as the [advanced lifesaving] solution, but it might be just enough. It's a different kind of a user.

Does the unit measure what the person is doing, or does it simply instruct?

Froman: It instructs. It's a real balance in lay user populations, of making sure we can balance an elaborate tool with how usable it is for lay people. It's a tough balance, and we're looking at that.

That would help a lot if the general public became aware of it. One problem has been that even trained people, if a situation happens, may not step in. They might be scared, or there might be a liability question. But if they realized there was some right-on-the-scene tool that would tell them what to do, I believe a lot more of them would intervene.

Froman: It's a nice point that you make. I believe there's a New Zealand study that talks about how the mere presence of these voice instructions on CPR helps gives users more confidence.

I think that's true: The confidence isn't there. And in my case, I would think to myself, I haven't had this training in 15 years or longer. Maybe I should get it again so I wouldn't doubt any more. It would certainly help.

Froman: There is another feature that we introduced in the last couple of months that bears on this CPR notion. We introduced it on [a defibrillator] for first responders and targeted responders. It enables the device to analyze the patient's heart rhythm. Then, if it detects the ventricular fibrillation, VF rhythm--the rhythm that generally is considered to be a shockable rhythm--it does some further analysis on that rhythm and determines by the quality and nature of that heart rhythm whether it's most appropriate to go ahead and shock that patient or to have the user do some CPR on that patient.

Because, as you may know, some ventricular fibrillation rhythms that are not as strong--maybe the down time has been longer--might respond better to CPR prior to defibrillation. [We're] really trying to create this coordinated resuscitation tool.

Early on, it was all about CPR only. Then it was about defibrillators. I think we're entering a third phase here where we have this elegant resuscitation tool that can help manage the interplay between the right time to do CPR and the right time to do defibrillation. We believe Philips is really at the cusp of this new segment, this new stage of development of the resuscitation market.

Combining these two necessary practices is a breakthrough. Are other companies trying to do the same thing?

Froman: There's a lot of research out there. People are working through this right now. . . . I know a lot of different folks are chasing these things.

More than half of our readers work in manufacturing settings. Are AEDs broadly being adopted there?

Froman: I think American manufacturing is one of the areas that has most readily embraced the notion of automated external defibrillators. The combination of having people with medical background and training, combined with it being a more robust environment, there's just that higher level of awareness.

I presume you write for occupational health nurses and occupational health doctors?

Yes.

Froman: Those folks have been pioneers in helping to implement these programs. . . . They've been really integral to the whole movement, so there's a very high adoption of defibrillators in that group of companies.

I intended to ask whether AEDs have gone as far as they can in reliability and ease of use, but you've outlined something I had not considered--this merger with CPR. So that's one area where they're still advancing.

Froman: I agree. We believe with the over-the-counter status of our device we have achieved an awesome level of ease of use and, frankly, reliability. That particular device does over 83 self-tests on a daily, weekly, and monthly basis. People are looking for ease of use and reliability, and so we're pushing the envelope there, and then we believe there is this whole new frontier that we're embarking on.

The American Heart Association's products to get CPR into many, many more people's hands will help. So it works hand in hand.

Froman: Absolutely.

This Q&A appeared in the February 2006 issue of Occupational Health & Safety.

This article originally appeared in the February 2006 issue of Occupational Health & Safety.

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