HIGH-TECH DEVICE COMING OUT OF THE ER AND INTO BUSINESSES, STORES

Defibrillators are bringing life-saving technology out of the hospital emergency room and into businesses, factories and stores.

Automated external defibrillators, referred to as AEDs, are medical devices that can be used in cardiovascular emergencies to restart a heart with an electrical shock.

In the past, these machines were found only in hospitals or in emergency vehicles. But in the last few years, AEDs have come down in price and been made so easy to use that the American Heart Association and the American Red Cross would like to see them in workplaces, public places and carried by police and fire vehicles.

"The reason we've started encouraging their use is because the survival rate for cardiac arrest is so much greater with an AED and CPR (cardiopulmonary resuscitation) than with CPR alone," said Sandy Wendel, an instructor for life-saving classes at the American Red Cross Southeast Missouri Chapter in Cape Girardeau. The chapter this month began offering training in using AEDs in its life-saving classes along with CPR and first aid.

The survival rate with CPR alone is 20 to 30 percent, said Cathy Tenkhoff, a registered nurse in the St. Francis Medical Center education department, who is an AED trainer as a regional faculty member for the American Heart Association. When an AED is on the premises and can be used within one minute, the survival rate goes up to 80 to 90 percent, she said.

Tenkhoff and Wendel explained why: When a person goes into cardiac arrest, heart rhythms become chaotic and blood stops circulating. CPR, which involves chest compression and blowing air through the victim's mouth, will help circulate oxygenated blood, but it won't get the heart started again. The only way to change the rhythm is to defibrillate or give the heart an electric shock. Emergency response teams often have defibrillators, but the national average for ambulance response time is seven minutes. The chance of surviving cardiac arrest goes down 10 percent for every minute treatment is delayed.

With an AED on premises, treatment can begin immediately, thus increasing survival chances considerably, Wendel said.

Buying an AED is a substantial investment, but it's an investment an increasing number of companies are making, Tenkhoff said. The machines cost $3,000 to $5,000 each. But the increased survival rates were enough to convince Martha Cassel, director of Cottonwood Residential Treatment Center, that an AED was worth the cost.

"We feel if an individual ever stopped breathing, we would want to do everything possible to improve the outcome," Cassel said.

Cottonwood, a Missouri Department of Mental Health facility for severely emotionally disturbed children, recently purchased an AED and employees were being trained in its use last week.

"We train our staff in CPR and how to handle choking. We look at this as another life-saving technique," she said.

Cassel, who went through training Friday, said she was impressed with how easy the AED is to use.

"It's about as simple as you can get, but that's the point," she said, adding simple is better when you are dealing with an emergency situation.

In the Red Cross training room and using a training model AED, Wendel demonstrated how easy the machine is to use.

Immediately after you turn on the machine, it's computerized voice begins guiding you through the steps you need to take to use this shoe-box size device.

"Place the pads on the patient's chest," says the voice, referring to the two pads attached to the machine by wires. The pads have sensors which send information on heart rate back to the machine and electrodes which deliver a shock if needed. Diagrams on the pads show where they should be placed.

"Analyzing heart rate. Do not touch the patient," the voice calls out. In the scenario Wendel was using, the device determines the heart needs defibrillating.

"Shock needed," the voice tells the operator. "Press the shock button. Do not touch patient." The button to deliver the shock lights up. When it is pressed, an electric shock is delivered through the pads on the chest.

"Analyzing heart rate. Do not touch the patient," the voice calls out again, as its sensors determine whether the heart has started beating again. In this scenario it hasn't. But before another shock is administered, the machine notes the need for oxygenated blood to be circulated.

"Administer CPR," the voice tells the operator.

This pattern will be followed until the heart begins beating again or help arrives.

"Once the machine is turned on, it tells you what to do," said Wendel. It will tell you if the pads are not on correctly, when to deliver a shock, when to do CPR.

It also determines if defibrillation is not needed and an AED will not deliver a shock if one is not needed, Tenkhoff said.

"AEDs are terrific," said Cape Girardeau Fire Chief Dan White, who said the device is carried on many of the city's fire trucks.

"They are easy to operate, ease to use and very effective," he said. "Everything is computerized. The computer makes the decision on whether a shock is delivered."

Because the machines are so easy to use and increase survival rates so significantly, organizations concerned with saving lives like the American Red Cross and American Heart Association are encouraging their placement in malls, businesses, factories, stores and other public places.

"An AED could be of benefit any place where there is the possibility that someone would collapse from sudden cardiac arrest," Tenkhoff said.

In Hawaii, all electric company vehicles have AED devices and drivers are trained in their use, said Sandy Primonato, health and safety director at the American Red Cross Southeast Missouri Chapter. "People there know to look for one of these vehicles if someone has a heart attack," she said.

Brian Walsh of the American Heart Association's St. Louis office said an effort is ongoing in that city to get AEDs placed in law enforcement vehicles, since the police are often the first ones on the scene of accidents.

He noted that 350,000 people die each year from cardiac arrest. Walsh said widespread use of AEDs could save at least 2,500 of those.

Cassel at Cottonwood said AEDs give an additional avenue to help should someone go into cardiac arrest.

"We don't anticipate ever having to use it," Cassel said. "But we also don't anticipate other emergencies, yet we do earthquake drills and fire drills and tornado drills. It's always best to be prepared."

AED TRAINING

For information on training in the use of automated external defibrillators, call Cathy Tenkhoff, who teaches American Heart Association AED classes at St. Francis Medical Center, at 331-5107; or Sandy Wendel, an instructor for life-saving classes at the American Red Cross Southeast Missouri Chapter in Cape Girardeau, at 335-9471.