Real-Life Miracles

Vail Ski Resort deployed an AED one morning on a ski slope and recorded its first save with the device a few hours later.

• By Arthur Levy
• Jun 01, 2007

ACCORDING to the American Heart Association, more than one in three American adults have one or more types of cardiovascular disease. The National Heart, Lung, and Blood Institute’s Framingham Heart Study has followed participants since 1948 and their offspring since 1971. The study estimates the overall lifetime risk of cardiovascular disease (CVD) and found more than half of men and nearly 40 percent of women in the United States will develop CVD during their lifetime.

Nearly 2,400 Americans die of CVD each day, according to AHA. CVD claims more lives each year than cancer, chronic lower respiratory disease, accidents, and diabetes mellitus combined.

“We are getting better and better testing to allow us to screen populations for families with risk of heart disease, people with elevated cholesterol, people who smoke—to find out, first of all, whether they are at risk for having heart disease. And, secondly, if they do have heart disease, then we can address the risk of Sudden Cardiac Death as the first symptom,” said Dr. Nelson Trujillo, an interventional cardiologist in Boulder, Colo. “We hope that people will have symptoms,” Trujillo added. That’s because for more than half of the people who have a heart attack, the first presentation is that event, “and in that group a number of people will die suddenly as the first symptom of their heart disease,” he said.

Screening for heart disease includes blood tests, stress test, electrocardiograms (EKGs), and imaging such as calcium scores that indicate heart disease. Treatment may range from a change in lifestyle, such as diet and exercise, to taking medications such as Statin drugs, which reduce cholesterol.

Sudden Cardiac Arrest (SCA) causes 300,000 to 400,000 deaths in the United States each year. On average, 27.4 percent of out-of-hospital cardiac arrests receive bystander cardiopulmonary resuscitation. SCA most frequently occurs in adults in their mid-30s to mid-40s, and it affects men twice as often as it does women. SCD is rare in children, affecting only 1 to 2 per 100,000 children each year. Children can go into SCA, however, from trauma related to sports injuries and congenital heart abnormalities. Estimates are 200 to 400 young U.S. athletes die on playing fields of cardiac arrest each year, but “we don’t have accurate public health measures,” said Dr. John P. Payne, director of cardiac electrophysiology at the University of Mississippi Medical Center. AHA recommends screening for high school and college athletes before they compete, including a physical examination plus a family history. Family history is important, experts say, because many cardiomyopathies are inherited. The use of EKGs in screening athletes is currently being debated; a recent study by Italian physicians reported in the Journal of the American Medical Association says the use of an EKG in screening athletes has reduced SCA events by 89 percent.

Causes and Treatments
SCA is not a heart attack. A heart attack is a “plumbing problem” that occurs when one or more arteries of the heart is blocked, preventing the heart from receiving blood. The lack of oxygen-rich blood can damage the heart muscle. SCA is an “electrical problem.” AHA defines Sudden Cardiac Death, or cardiac arrest, as the sudden, abrupt loss of heart function in a person who may or may not have diagnosed heart disease. The time and mode of death are unexpected. It occurs instantly or shortly after symptoms appear. The most common reason for patients to die suddenly is cardiovascular disease—in particular, coronary heart disease. About half of all deaths from coronary heart disease are sudden and unexpected, regardless of the underlying disease; half of all deaths due to atherosclerosis (arteries lined with fatty deposits) are sudden. SCD is a major health problem causing about 330,000 deaths each year among U.S. adults before they reach either a hospital or emergency room.

Other causes of SCA include electrocution, drowning, choking, respiratory arrest, viruses, and trauma.

SCA is treatable, but every secondcounts. AHA reports that about 80 percent of SCA events occur in the home, almost 60 percent are witnessed, and 95 percent of SCA victims die before reaching the hospital. OSHA reports that more than 10,000 cases of SCA occur at work. If a person collapses from SCA, brain damage can occur in four to six minutes. CPR and defibrillation using a portable automated external defibrillator can save lives.

“Clearly, the best treatment for SCA is electricity,” Trujillo said. “When we find a person in SCA, we hope to find their heart fibrillating—beating irregularly at such a rate that it can’t pump blood effectively any more. We can restore the heart’s rhythm and ability to pump blood by applying an electrical shock. The ability to defibrillate the heart is our best chance to get that person back.” He said he recommends that many of his patients with diagnosed coronary artery disease keep an AED in their homes and have family members trained in its use and in CPR.

As more and more AEDs are placed in public shopping malls, buildings, schools, and corporate offices, the public is aware of their use to save lives. While the number of AED saves grows, many people are still unaware of the devices or how to use them. Many people fear if they use an AED, they may needlessly shock a SCA victim. The fear can be alleviated by training and knowledge about how AEDs will shock only when the device’s computer has determined there is a need for a shock.

AEDs Used from Slopes to Pipelines to Terminals
The Vail Ski Resort recently purchased several additional AEDs for the ski patrol. An AED was delivered one morning and placed in service. Early that afternoon, a 67- year-old man collapsed on the slopes. The ski patrol arrived within minutes and used the new AED to administrator a life-saving shock. Vail has more than 70 staff members trained in AED and CPR use, and AEDs are placed throughout the ski area. Suncor Energy maintains more than 390 miles of pipelines carrying crude oil from Wyoming to its refinery near Denver. Suncor has AEDs spread with its staff along the pipeline, and these units must function during emergencies amid the cold and wind of winters and the hot blowing dust of summers. Suncor also has AEDs at its refinery and corporate office and has trained its staff in their use. Lt. Tim McGraw, a detective for the University of Colorado Police Department, was traveling through Hartsfield Airport in Atlanta when he saw a man collapse in the passenger terminal. A doctor nearby also saw the man collapse and began CPR. McGraw had seen AEDs in the terminal and asked an airport employee to get one while he joined in performing CPR. When the AED arrived and the pads were connected, the AED advised not to shock. McGraw and the doctor continued CPR and again checked the AED. This time, the AED advised to shock the victim, and several shocks were given. The shocks were successful, and the man recovered.

All commercial aircraft now are required to carry AEDs. American Airlines was the first commercial airline to place AED on all of its aircraft; American reports 76 passengers on its flights have been saved by an AED. American also has AEDs installed on all floors of the corporate office in Fort Worth, Texas, and at maintenance facilities.

MedAire Corp. of Tempe, Ariz., provides medical assistance to 90 commercial airlines through its Global Response Centers. When an in-flight medical problem occurs, the centers can connect flight crews with medical advice anywhere in the world. Flight crews accessed AEDs 141 times during 2006, the company reports.

Coronary artery disease is not the only cause of SCA. Warren Heim of Boulder, Colo., was in good health when his occurred. He was at an athletic club with a light workout planned in preparation for a wrestling tournament the next day, and he remembers starting to black out about after running about 20 feet on the track. “It was very acute, it was very intense,” Heim said later, “like being on a couch and getting up suddenly where you start to black out.” He lay on his back on the track, moving in and out of consciousness. The club had no AED at that time, so 911 was called. An ambulance was in the neighborhood and arrived within minutes.

“As soon as the ambulance crew arrived, a wave of darkness rolled over me from my knees to my head,” Heim recalled. He regained consciousness hearing paramedics saying his heart had stopped and was restarted. The next thing he recalls was waking up in the intensive care unit at a local hospital more than three hours later.

Heim learned later that he had another sudden cardiac arrest episode in the ambulance. His cardiac arrest was caused by a virus.

Testing Standards for Harsh Environments
AEDs must be able to operate safely in any environment, including rain, snow, and temperature extremes. An international standard, IEC 529, is used to identify the level of protection provided by a defibrillator’s enclosure against solid particles and water. If your company purchases an AED, check the manufacturer’s technical specifications to make sure the device will operate in any environment.

IPX1 testing includes testing an AED by simulating rain falling on the device at a rate of 2.4 inches per hour. IPX4 testing places an AED in an enclosed chamber where water is sprayed on all sides for 10 minutes. In IPX5 testing, the AED is sprayed on all sides with pressurized water using a calibrated nozzle for three minutes. Other IPX testing ratings are for dust particle size.

This article originally appeared in the June 2007 issue of Occupational Health & Safety.