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If someone you know has a sudden cardiac arrest and you’re relying entirely on the local EMS to save them, what do you think their chances of survival are? Fifty percent, 75 percent or 90 percent?
Permanent brain damage normally occurs within 4 to 6 minutes after an SCA. Very few people survive beyond that time. SCA survival rates aren’t tracked by our local EMS. However, given their 7.46 minute average response time, which is better than the national average, and an almost total lack of support from the community prior to their arrival, survival rates in Taylor County are probably close to the national average of 5 to 8 percent.
If that is the case, why are they so low? It’s not the fault of local EMS. Most EMS departments are already doing the best they can with the resources they have. So what can be done to dramatically improve these rates?
As an American Heart Association CPR/AED instructor, one of the things I teach my students is the cardiac arrest “chain of survival.” It has five links for adult patients. The first three are the responsibility of bystanders who discover the SCA victim and take action prior to the arrival of EMS. They include:
1. Immediate recognition of the problem and activation of EMS.
2. Early CPR.
3. Early defibrillation with an automated external defibrillator.
The third link can also be the responsibility of EMS or the police, but survival rates are higher if an AED is used prior to their arrival. The last two of the five links involve advanced care by EMS and the hospitals. In most communities, the most neglected links are the first three. Yet they are the most critical ones for survival. There are two game-changing actions a community can take to dramatically increase survival rates. These actions are primarily the responsibility of the community, not EMS. First, get a lot more people trained in CPR. If CPR is started right away by bystanders before EMS arrives, survival rates can double or triple to 15 to 24 percent.
The new 2010 CPR standards make it much easier for laypersons to perform CPR. For instance, in many cases of adult SCA, you can now do hands-only CPR without doing mouth-to-mouth resuscitation. Also, laypersons are no longer required to check the pulse. Second, flood Taylor County with AEDs and make sure that a sufficient number of people are trained to use them. Studies have shown that survival rates for the most common type of SCA, ventricular fibrillation, can increase to as high as 74 percent when an AED is used within the first minute after an SCA.
I sent an email to former Campbellsville/Taylor County EMS director and current EMS major, Allen Bottoms, asking him several questions. Here are his answers to two of them. First, what percent of the time is CPR started prior to EMS’s arrival. His answer, “It is rare to have CPR initiated prior to our arrival.”
Second, how often was an AED used prior to EMS’s arrival? His answer, “I’m not aware of any AED uses prior to our arrival in my four years as director.”
I have been into several local businesses and asked them if they had an AED. The two most common answers I heard were “What’s an AED?” and “We don’t have one because of liability concerns.” Except for Amazon, I have not been able to find any local businesses, churches, doctor’s offices, government buildings, etc. that have one.
So why does early defibrillation have such a huge impact on survival rates? An automated external defibrillator is designed to be used by medical laypersons. It’s easy to use. When appropriate, it delivers a shock to the heart. All modern AEDs will deliver a shock if the four chambers of the heart are beating chaotically (not in sync with each other). That’s called ventricular fibrillation. Most will also deliver a shock if it’s beating so fast that the chambers of the heart can’t refill fast enough between beats.
That’s also a fatal arrhythmia called ventricular tachycardia. The shock from an AED is intended to stop the heart by stunning its electrical system. CPR can’t stop these kinds of arrhythmias. Only a defibrillator can.
A modern AED will shock the heart only if it detects one of these two arrhythmias. It will not shock a heart that is beating normally. Most older ones, and some new ones, only shock for VF. After the shock, if the heart is still viable (has enough oxygen, etc.), it can oftentimes restart itself (it’s designed to do that) and beat well enough on its own to sustain life until EMS arrives.
The golden window of opportunity to use an AED is within the first three minutes from the time the patient goes into SCA until the first shock is delivered. It can still be used after that, but this three-minute window is when it’s most likely to be effective. That means you cannot wait for EMS to arrive. The AED must already be at the scene, and must be used prior to their arrival by layperson bystanders.
So what else can we do as a community? There are at least seven things. First, demand of your legislators that our local businesses, churches, schools and other public organizations be given strong legal protection from lawsuits if they choose to have AEDs and have their staffs trained in CPR.
Second, insist that they be required by law to have AEDs if they have a medium to high number of employees or public traffic. They should be required to purchase enough AEDs and have procedures in place so that the first shock can be delivered within the 3 minute window of opportunity. It would be even better if they went the extra mile and took it upon themselves to set a goal of one minute. If they’re willing to take your money as a paying customer, they should also be willing to take steps to avoid having you die on their floor or parking lot if you have an SCA on their premises.
Third, learn CPR and how to use an AED yourself, especially if you have loved ones in your home, business or church who may be at high risk of SCA.
Fourth, grab the bull by the horns and lead the effort to get AEDs and CPR training into your own organization.
Fifth, get AEDs into all of our local city and county police cars. They can sometimes get to the scene much faster than EMS can.
Sixth, if you can afford it, donate AEDs to organizations that don’t have the money to purchase them, or work with local officials to try to secure grants to get them for free.
Seventh, local businesses should work hand-in-hand with EMS, the police department and the media to improve education and awareness about the opportunities that exist for improving SCA survival rates.
Taylor County can become a model for higher survival rates. We just need to do our part as a community to give our EMS professionals a real fighting chance to save our SCA patients. Maintaining the status quo of turning over one hopelessly dead body after another to them and expecting them to work miracles is something we should no longer be willing to accept. If enough of us get involved in the first three links in the chain of survival, I believe we will all be very pleased with the results. Amazon has already set a good corporate example. Who will be next to step up to the plate and do the right thing for their community?
• Gary Martin, of Campbellsville, is an American Heart Association BLS CPR/AED instructor.