Defibrillators & CPR
Shocking Video -- Caught on AED
"We said, if people are going to really survive cardiac arrest, we should design a unit that's built for 10 year olds, or for anybody walking down the street, because time is of the essence and speed to shock is all that matters."
Editor’s note: In late October, at this year's National Safety Council Congress & Expo, Defibtech LLC introduced a new automated external defibrillator called the ReviveR™ VIEW. According to Greg Slusser, vice president of sales and marketing for the Guilford, Conn.-based company, it is that second word in the product's name -- VIEW -- that sets it apart from other AEDs in the marketplace, because it features a video screen built into the unit offering full-color video instruction for anyone to aid a victim of sudden cardiac arrest. Slusser talked with the OH&S managing editor on Nov. 6, 2009, touching on the technology behind the unit and the need for more AEDs in general. Excerpts from the conversation follow:
OH&S: I was able to see a demonstration of the ReviveR VIEW at NSC last week. For those who did not catch that demo, how would you describe the unit?
Greg Slusser: Basically, what people see is an iPod -- an iPod screen showing video. Because we have been able to watch movies on our iPods for two years, and, you know, play DVDs on a computer or in our cars or on a GPS in our cars, people see this unit playing a video and think, "Well, it's novel, but that's the way things are done today, right?" But this is not that. This is a very different thing than playing a pre-programmed video.
A DVD has a sequence of events it plays -- whether it's on your computer or whatever the medium. This is not that. The unit is actually reading an ECG about a patient and determining the rescue sequence that the lay responder needs in order to save this patient. So it is by no means playing a tracked video; what it's doing is it's giving directions, based upon how that patient presents, on how to save somebody. It's reaching in the data files and pulling information out and giving real-time instruction based upon the heartbeat, or lack thereof, of a patient.
Hmm. I don't think you get that when you're just seeing the demonstration.
Slusser: No, and the reason people don't is because we expect that video should be played on everything we have, because it has for years. But, no, this unit is making decisions internally, based upon studies of thousands of patients and what their ECGs are and their heart rhythms, on how to instruct someone to save someone's life. So it's so far away from just the actual showing the video of it . . . . And the reality is, it's a very, very difficult thing to do.
So the video is actually different every time because it is responding to the individual in distress? The video changes?
Slusser: Well, yes and no. When you turn the unit on, it's going to give you instructions as to how to use the unit. So it's going to say: "Call for help. Remove pads from the back of the unit. Remove shirt from the patient. Place the pads on the patient's bare chest." And then it's going to go into the analyze mode, and when it's doing its analysis, based upon the ECG -- because the patient can present a million different ways, depending upon what the unit is picking up -- it's then going to give directions accordingly. It will determine if the patient has a shockable rhythm or a non-shockable rhythm, and if it's a shockable rhythm the first time, do you do CPR, do you do CPR with rescue breath, and so on. It goes through the whole routine based upon what's going on with the patient. So the only parts of the video that would be consistent would be the very beginning and then the CPR instructions, which are based upon what the AHA guidelines are at the current time.
How long was the idea in development?
Slusser: Three years.
Going back three years, was the initial idea in response to a demand from users saying they needed or wanted this video aspect in their AED?
Slusser: To provide background and help set the picture: We came out with an AED unit called the Lifeline® six years ago, and in its design it has a very contrarian view of what an AED should be. Prior to that unit, all AEDs were designed for EMTs and paramedics, emergency personnel -- first responders, in general. So we designed a unit because we didn't agree with that. We said, "If people are going to really survive cardiac arrest, we should design a unit that's built for 10 year olds, or for anybody walking down the street, because time is of the essence and speed to shock is all that matters."
And so we designed a unit built for teachers and kids and lay responders -- whoever might pull the thing off the wall -- and that was such a divergent view in the marketplace that EMTs and paramedics and first responders threw a fit. They said, "It's a toy. It's two buttons. It's not professional" [and so on]. Between you and me, if I do go down and I'm given the choice of having a first responder save me or a 10-year-old kid, I'd pick a first responder. But if I have to wait 10 minutes for him to show up versus a kid doing it in one minute? I want the kid doing it.
What is the window there with sudden cardiac arrest? Ten minutes is way too late, right?
Slusser: There is 90 percent survival if you're shocked in two minutes and zero percent survival at 10 minutes. So it goes down 10 percent a minute. Those numbers are from four months ago, from a study about survivability. And now we know that lay responders are the ones who save people from cardiac arrest. Not to take anything away from EMTs. You know: They're strapped; they can't be everywhere at once, and it's not realistic to expect they can.
So we continue to design units for lay responders because speed to shock is all that matters. And the number one reason that people don't adopt AEDs is fear of liability and training. The Good Samaritan Law/Cardiac Survival Act says that you have to have people trained in an AED in your staff and then you're not liable, but still 95 percent of businesses in the United States do not have AEDs -- only 5 percent do. Think about this: Hotels don't have them, a lot of sporting venues don't have them, churches don't have them.
A lot of places are fearful of high turnover of employees, of having to keep them trained in CPR. Many are worried that if someone pulls the AED off the wall and uses it improperly, they're going to be sued. So the biggest concern is the liability of actually having an AED, even though there's Good Sam laws in place. And so it's kind of a confusing thing.
So what did we do? We just made an AED that is language-independent, that has a video on it that makes it even easier to use and gives somebody, a lay person, the confidence to deliver a shock. And so for all those folks who have been trepid about adopting an AED -- the 95 percent of places that don't have one -- that excuse or legitimate objection is now gone. And so that's why we did this.
I'm an AHA instructor, and I can train people and give them AHA cards on CPR in all 50 states. OK, if I'm standing next to you, guiding you through a rescue, saying to do this, do that, push this button, that button, you're probably going to have a little bit more confidence, right? Well, with this unit, I'm standing right next to you.
You said the unit is "language-independent." Does that mean it can be programmed in any language?
Slusser: In the continental United States, with the exception of Puerto Rico, the FDA mandates English-speaking AEDs regardless of the demographics of your community or plant. Said another way, you know Spanish is the predominant language in certain parts of the United States, so there is a big objection to that requirement. But if for a certain percentage of your employees English isn't their first language, now look at the picture: The unit is showing you what to do regardless of what it's saying to you.
How long have AEDs with audio prompts been on the scene?
Slusser: Every unit on the market's been speaking for about seven or eight years, in one form or another.
So I'm guessing a potential plus for this new unit is that even in a noisy environment where the audible features might get lost in the shuffle, it would still be able to guide someone with the video and words on the screen?
Slusser: Well, OSHA has regulations for ambient noise in an environment. But think of baggage handlers at an airport who need to wear hearing protection. Not only is it a loud environment, but their ears are actually covered, and there could be a jet engine screaming in the background. I've been in manufacturing environments or commodity/grain processing plants and places like that where it's also just loud as all hell, and the audible cues don't help at all. And so, yes, in those cases, there's text on the bottom of the screen, too, so you can read it or you can watch the pictures.
What is the size of the screen in the middle of the unit? It doesn't say on the spec sheet I have here in front of me.
Slusser: It's about 3 inches by 4 inches.
The other dimensions of the unit are here; it says its size is 7.3 by 9.5 by 2.3 inches and that it weighs less than 3 pounds. How do those numbers compare to a conventional AED?
Slusser: It's the smallest and lightest on the market.
Even with the video component?
Slusser: Oh, yeah. It's 1.3 pounds lighter than our other AED. It's also the first approved on the market in, I think, four years by the FDA. The FDA hasn't really thought highly of AED manufacturers lately. There have been a lot of recalls this year.
What about the power? Is the power it takes to run the video separate from the power supply that delivers the shock?
Isn't that a drain on the unit?
Slusser: Well, sure it is. Every time you turn the unit on, it hits the power. So the question is, really, does it pose a concern by being an additional drain as opposed to otherwise?
That's what I was getting at.
Slusser: It's a fair question. As a matter of fact, it comes up every time I present the unit, especially with those in the know. . . . Probably the easiest way to answer it is to say we're really proud that the longest-life battery on the market was in the old Lifeline AED. That has eight hours of runtime, or 200 shocks.
And the specs on the ReviveR say it has 12 hours or 200 shocks.
Slusser: Right. So we've just increased the runtime of the battery by 50 percent. Part of the rationale is now you have an AED that you can actually use for in-services or training of your staff. So now you pull it off the wall and, say, run through a mock rescue. You can turn on the video, you can play with the unit, you can lay someone down, and you can go through a mock rescue by playing the video to make sure everybody's ready.
Going back to the biggest objection of the 95 percent of people who don't have AEDs and how they're afraid to pull it off the wall because their team won't be prepared to use it: Well, now you've got a unit that shows you, regardless, and you can use it to teach them. . . . And let's back up further and say, OK, so it has a 50-percent-longer-life battery that is obviously useful for training, but why wouldn't you keep a spare battery anyway? At the cost of $200 for a battery, for all the benefits that the unit brings, my response is, who cares? The unit's going to tell you when the battery is completely drained and you have to replace the battery, but at that point it will still have 20 life-saving shocks in it. . . . And the only time that would ever occur -- that you were in need of saving 20 lives -- would be if it was in use in an ambulance. Because if you have 20 people go down with sudden cardiac arrest in your work environment, something else is wrong.
But to get back to the battery, the people who are selling the unit every day [Cintas has an exclusive distributorship for the unit] were very concerned that their customers could be depleting a life-saving unit because it is so much fun and so educational to play with it. And so the answer is, "We know that." It's designed to be played with, and so we built all these redundancies into it.
For the businesses and venues that do have AEDs: It would depend on the size of the place, but it would seem you'd want as many units as possible spread out to be available wherever someone might drop. Is the cost of the VIEW, with its extra technology, prohibitive in that case, compared to conventional units?
Slusser: Well, you're going to pay for it, sure. It's $2,495, and the MSRP on most of the units on the market is between $1,495 and $1,995.
Does the extra cost include CPR guidance? I wasn't sure what I was seeing on the screen when it gave an option for "CPR with breathing" or "no breathing."
Slusser: AHA is the organization that does all the resuscitation science around the world, meaning it's 30 compressions and two breaths at 100 compressions a minute for two minutes. How did they come up with those arbitrary numbers? It's because the current science says that it's the best way to resuscitate somebody, and they're the ones with the guidelines for training for sudden cardiac arrest. It's four hours of training, and 45 minutes of that four hours is on AEDs. And so the whole thing has to do with how the victim is presenting, how the victim is doing while he's laying there. So did you see him fall down; did you not see him go down? Is the patient responsive to you? Does he have a heartbeat? Is there something stuck in his throat? It's all this stuff that goes with resuscitation.
And this AED unit asks those questions, guiding the rescuer?
Slusser: No, absolutely not. It's not a paramedic in a box. It's an AED to save someone from sudden cardiac arrest. That's what all of them do, and that's what they're designed to do.
It says here in the brochure that that "box" has military-grade specs, that it can be dropped and is dust protected.
Slusser: You can actually drive over it.
It doesn't mention that here.
Slusser: It's got a 1,000-pound crush test . . . and we've rated it conservatively.
Getting back to the resuscitation aspect of it: The literature says the unit can be upgraded. Is that so that when the prevailing science changes, the tweaked guidelines can be uploaded?
Slusser: The unit has special features for upgrading. If you think about it, it's a software/hardware device, and so the unit's telling you, it's showing you, what to do based on the latest science that's out there. Defibtech doesn't make this stuff up. This is clinical data that's sorted out over the years that says, "This is the best way to save somebody," period, and it's from the AHA.
So the instruction that's depicted there in the video comes from AHA guidelines?
Slusser: Technically, the 2005 AHA Guidelines for Resuscitation and Sudden Cardiac Arrest. In 2010, it is expected that the AHA resuscitation guidelines will change. How are they going to change? I don't know. I'm not a doctor who's doing the science. If you look at it: The hands-only protocols were announced last year, so they made some changes to not do rescue breathing if you witness sudden cardiac arrest or if you're uncomfortable doing rescue breathing or you don't want to put your mouth on someone else's. And so they changed the guidelines again. That's why our unit says, "Do you want to do rescue breaths or not?" The AHA doesn't say do one or do the other; they're just saying you can do either one. In any event, they're the ones that all the AED manufacturers are dancing to.
Now, to back up: When the guidelines changed in 2005, we had to reprogram all of our units. And when the guidelines change in 2010 -- or whenever it may be -- to whatever it may be, based upon the prevailing science and the stuff that they work on, the units will have to be changed. What we're really proud of is that we upgrade our units for free. We do it with a chip, and it takes about 90 seconds to do it. But the most important thing is that we never take a unit out of service. A lot of my competitors have to send their units back. If you think about that, if your AED is off the wall, you no longer have an AED. . . . Ours has a computer port on it now to do that, and it has an SD card, and nobody else on the market has either.
AHA hasn't said exactly when in 2010 to expect those changes -- just next year sometime?
Slusser: I'm not the AHA, but they've been -- I don't think "communicating" is the word, because they haven't been -- but they've kind of been teasing everyone about doing a lot of resuscitation science, trying to understand it again, and that it may lead to changes in the future -- that kind of thing. But they did it in 2000, they did it in 2005, and they've been letting everybody know for about the past year that they are more than likely going to do it again.
Did AHA have any hand in the production of the VIEW's video?
Slusser: No, absolutely not. They won't align themselves with a single manufacturer, and I think that allows them to maintain their impartiality very well.
Have there been studies, during beta testing I guess, showing that having the video definitely makes using an AED faster, that just being able to see the procedure done and not having to listen or re-listen to audio prompts helps to speed things up and remove questions?
Slusser: We're in the process of studying that, the pure effectiveness of having video on it, its ease of use, and, third, the speed, I suppose. But what I will say about the unit is that I don't need video; I don't need audio. I'm an instructor, and I know how to deliver a shock to someone. And so it's not going to delay me. If you're down and I grab the unit and I turn it on and I put the pads on you, it won't go through all those gymnastics. It will go right to the issue at hand, and it'll read your ECG in 8 to 12 seconds and be prepared to charge and shock. So I don't have to run through "Find pads in back," "Remove shirt from patient," "Place pads on patient's bare chest," and all that stuff.
Right. If you're a professional responder, you can use any AED.
Slusser: Sure. Every AED on the market will save a life if you know how to use it. Every car on the market will get you to the grocery store. So, it's the same thing, absolutely.
There's a slide that I put up when I do training. On the left side of the slide is a dirty, wet, exhausted firefighter with an older manual defibrillator on his lap. On the right side of the slide is a schoolteacher with a book in her hand and an AED. And the whole story behind Defibtech is that the entire industry has been designing for the guy on the left, a trained first responder, and from the get-go we've designed for the person on the right of that slide, which is the schoolteacher, or whoever will be the closest to the unit.
It comes back to speed to shock being all that matters with an AED and survivability in cardiac arrest. It's not the credential, the degree, the background that you have as a first responder. It's not about the person who delivers the shock. It's how fast you get the shock. Speed to shock is the single most important criterion to survivability in cardiac arrest. And that's why we designed the unit for accessibility for a lay responder to be able to deliver shock with the highest rate of success.