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Responding to Heart Attack with AEDs 

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Are you prepared to answer a call for help?
By: Carl Hartman, MD

We have recently come through the rush of the holiday season, which for many of us means shopping in crowded malls, traveling through busy airports and gathering in public spaces for various reasons – tree lightings, grand illuminations, New Year’s parties and such. Whether or not you find the hustle and bustle to be a joy or a nuisance, some recent reflection on the holidays has compelled me to use this column as a reminder of our personal responsibility as citizens to act quickly if trouble presents itself.

I’ve used this column in the past to talk about warning signs for heart disease, to help identify and reduce the risk factors associated with heart disease and other common heart ailments.  This column focuses instead on how we can react if we are faced with an unexpected situation where someone’s life is in danger. Sudden cardiac arrest, which happens to nearly 300,000 people each year, is – as the name implies – immediate and severe and requires swift attention to prevent death.  Because there is little warning, these are the kinds of cardiac episodes that are most likely to happen in public places. While many of us have never had to witness such traumatic events in public, we still need to be aware of our options if we should ever encounter such a circumstance.

When someone suffers sudden cardiac arrest (loss of blood pressure and pulse), time is one of the most critical factors. According to the American Heart Association, brain cell death and even permanent death begin to occur in just four to six minutes after the event. Calling 9-1-1 immediately is necessary, but it is unlikely that highly-trained emergency medical personnel will be able to respond in such an immediate time frame. 

If you should find yourself in a public space, you need to identify where an Automated External Defibrillator is located - often hanging on walls or on columns. Several years ago, communities throughout the country began installing AEDs in public venues because of the proven benefits of providing electrical shock to a heart that has stopped. Today, AEDs are widely available for use in shopping malls, airports, hospital lobby areas, tourist attractions, gyms…basically anywhere large groups of people gather or pass through.

While they are often available, people need to understand how to use them. The good news is that these machines have been created using standard operating procedures and they include simple, automatic verbal instructions for people to follow. Knowing some basics about CPR is helpful, but even if skills are rusty people should perform chest compressions in conjunction with applying the defibrillator. You do not need to have prior AED training to use the device.

The latest AHA guidelines for CPR, published in the journal Circulation in October of 2010, clearly state that chest compressions are the foundation of CPR. Mouth-to-mouth is not necessarily required for a patient to receive benefit. Combining the use of chest compression (60-80 compressions per minute) and defibrillation significantly helps to improve a patient’s chances of survival.

External defibrillators and AEDs are placed on the skin of the chest of the patient.  An AED can monitor the heart rhythms and provide instruction on whether defibrillation is necessary. These machines use lights, voice and text to guide the user through the process. Another lesser known fact is that the machine will not shock if the automatic assessment of the patient does not indicate sudden cardiac arrest. In other words, the manufacturers of AEDs have tried to make them as user-friendly as possible. Your ultimate goal should be to initiate treatment immediately and continue until EMS or other trained medical personnel can respond.

So with this valuable tool available in more and more public places, what would prevent people from using them? The Good Samaritan law was enacted to help reduce hesitation if bystanders encounter someone who is injured or ill. It essentially protects people from fear of legal action. 

I talk to my patients, friends and family about the importance of being prepared and I now pass this message on to the readership. Don’t be caught unaware…you never know when you might encounter someone in trouble. Chances are rare, but in the event that you need to act quickly I can promise you that saving a life is perhaps one of the greatest rewards we can receive.

Carl Hartman, M.D. is a board certified cardiologist practicing with Cardiovascular Associates.  He serves as the medical director of Cardiac Services at Sentara Heart Hospital in Norfolk, Virginia.  Dr. Hartman is also an Associate Professor of Medicine at Eastern Virginia Medical School.  He received his Doctor of Medicine (MD) degree at State University of New York at Syracuse and completed his postgraduate training at Duke University.



Related Links:
American Heart Association
Sentara Heart Hospital

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