Aug. 24It's a shocking statistic when put into terms of survival:
If you are suffering the type of sudden cardiac arrest that responds to automatic external defibrillation, having an AED unit nearby increases your chances of making it through from as little as 8 percent to as much as 70 percent, depending on who you ask.
The mitigating factor? Human. Do bystanders know there is an AED nearby? Are they willing to use it on you? Is it accessible, not locked away in an office or cabinet? Has it been checked regularly, so that the batteries aren't dead?
Nationwide, there are a million or two of the devices in public places and private businesses but if they're not close enough to grab and deploy within three to five minutes after a cardiac event, their usefulness plummets sharply. Ideally, there needs to be a device within 300 feet for it to do much good. Studies suggest this would require 30 million AEDs in use across the U.S.
And bystanders would have to know where they are and how to use them. Though rescue units carry the devices, "... the reality is, we're not going to get there in time most of the time," said Dennis Rowe, market general manager for Rural/Metro. "It's going to be the public intervening" in those first crucial minutes that makes the difference in survival.
There are obstacles to overcome. No public funding is earmarked for AEDs, which range from $800-$3,200 depending on the complexity of the model, for public use. Businesses and churches that want the lifesaving devices must purchase them on their own. Schools are often dependent on grants from nonprofits, frequently founded by parents whose children went into sudden cardiac arrest without an AED nearby.
In addition, the U.S. lacks a standardized method of logging where AEDs are in place and making sure they're maintained. Laws vary not only by state but even by city and county in some places.
Where are AEDs?
Tennessee state law requires AEDs, once in place, be "registered" with the state, with entities in each region responsible for keeping an updated list.
In Knox County, that's the health department, although Rural/Metro actually maintains the list, for the singular reason that dispatchers can then, in theory, tell emergency callers if an AED is nearby.
The list "encourages" those who have an AED to make sure to check batteries regularly and invest in training to use the devices, but the state has tagged no one to actually enforce the registry.
"It's not the state, nor the taxpayers, paying for (AEDS); it's (businesses and organizations) themselves," Rowe said.
Rural/Metro's best estimate is that there's about 155 AEDs in Knox County, including more than 60 in businesses and five or so in local churches. But it's entirely possible more have them especially churches, which may raise the funds and train members but neglect to register the devices once purchased.
Offhand, Rowe can't think of any instances in Knox County when an AED could have be used but was inaccessible or had dead batteries. He can call to mind a few times they've been used successfully, including an instance at Jewelry Television about a year ago.
Jennifer Noggle, director of human resources for Jewelry TV, doesn't remember that incident but does affirm that the business's West Knoxville campus, which recently gained an onsite acute-care medical facility for employees, has the devices and people trained to use them correctly.
"We have 1,200 people, all in one location," Noggle said. "It just really made sense that this would be something that would be a great benefit."
A few years ago, a News Sentinel employee collapsed at work with sudden cardiac arrest. Human Resources director Debi Welch remembers sending then-employee Toby Steele to fetch the onsite defibrillator, only to find that the battery unit was dead.
"Thankfully, we always kept a spare in the bag, so we had to change out the battery in the unit in the midst of the drama," Welch said. "In the meantime, a corporate auditor came over from the accounting cubicles who also knew CPR. Toby got the defibrillator to power up, and it did what it was supposed to: it talks and tells you what to do, to move away from the body. Then it administered the shock that restarted (the employee's) heart, but he still did not appear to be breathing, so the corporate auditor began administering CPR, and within a couple minutes his color was returning. Then, thankfully, the paramedics arrived. The doctor at the hospital said we saved his life!"
That long-term employee had heart surgery, recovered, returned to work and then decided to retire.
"If there was ever a doubt a defibrillator was worth the cost, that doubt is nevermore," Welch said. "We bought several more after that episode, and I am thankful every day we have them and hope we never have to use another one."
An AED at Central High School featured prominently in local news last fall after it was used by Coach Jon Higgins and students to revive freshman Hunter Helton after he collapsed with sudden cardiac arrest at an after-school basketball practice. Hunter, who had no history of heart problems, recovered, and Higgins and the students were honored for their role in saving his life.
All Knox County high schools, public and private, have AEDs, Rowe said most of them more than one. Tennessee law requires the first defibrillator to be placed near the school's athletic facility, which was where Higgins, who was trained in CPR and AED deployment, found the one he used on Hunter.
The AEDs in Knox County's public high schools were bought piecemeal by the school system with help from various corporations, including Knoxville Orthopedic Clinic and Tennova. But Catholic High was the first Knox County school to get an AED, 10 years ago. It was purchased by the Buffalo, N.Y.-based Madison McCarthy Cardiac Care Coalition for Children, founded by Suzy and Mike McCarthy of Buffalo after their 5-year-old daughter went into cardiac arrest and died at a public school. The McCarthys' niece and nephew were students at Catholic High at the time of the donation.
Such parent-founded organizations have been instrumental in getting AEDs into schools and other facilities where there are children. Two years ago, Knoxvillian Marianne Jennings whose husband, Dr. Jeff Jennings, is medical director of Knoxville Pediatric Cardiology was able to begin a Tennessee chapter of Project ADAM (Automated Defibrillators in Adam's Memory), a nonprofit program that seeks to place AEDs and provide training to staff in schools. Founded in 1999 in Wisconsin, the nonprofit was named after 17-year-old athlete Adam Lemel after his death from sudden cardiac arrest.
Though technically a statewide group, Project ADAM Tennessee has been heavily supported by East Tennessee Children's Hospital and, in its early stages, has focused on Knox County. Knox County now has at least one AED in each middle school, and Project ADAM is focusing on getting them in elementary schools, Jennings said.
But it's not just in the schools Jennings wants AEDs. "I want to protect kids everywhere," she said. In two years, Project ADAM Tennessee has placed 45 AEDs, half paid for through the nonprofit and its efforts, half paid for by ETCH.
Jennings will advise churches and other organizations that want to purchase the devices, helping with fundraising and providing training.
"You have to make somebody in charge of them," she said. "I go back through and give an education, make sure they know about replacing pads and batteries. I'm not giving it to somebody who's not responsible."
This past spring, Project ADAM helped make sure all the city's swimming pools and rec centers got AEDs, said Joe Walsh, director of Parks and Recreation. ETCH picked up the tab after Jennings went to president/CEO Keith Goodwin. The county so far has three AEDs at ballparks, at John Tarlton, Sportspark and Tommy Schumpert. Project ADAM helped purchase new cabinets for AEDs the former St. Mary's Health System had placed in Lakeshore Park years ago.
Earlier this month, Jennings attended a dedication of an AED at the new Northview Academy in Sevier County. That device was purchased by Norfolk Southern in honor of Chasity Roberts, the daughter of an employee.
Roberts, 21, frequently substitute-teaches at the campus, which includes elementary, middle and high schools, and has a congenital heart defect. This past February, she went into sudden cardiac arrest while at a Mardi Gras parade with relatives in Mobile, Ala. A nearby paramedic deployed an AED and revived her.
"They got to her in a minute and 20 seconds," said her mother, Kim Roberts. "If she had been here in Knoxville at my house, she would not be alive right now."
Funding for AEDs in buildings other than schools is various, often provided by health-care groups or nonprofits. The AEDs in West Town Mall were purchased with a grant from Regal Cinemas. AEDs in Maryville's Foothills Mall and Morristown's College Square were bought by the company that owned them. Knoxville Cardiovascular Group, East Tennessee Cardiovascular Surgery Group and American Heart Association purchased AEDs for McGhee Tyson Airport more than a decade ago. Back in 1998, Karns Volunteer Fire Department solicited community donations and county government funding to outfit five fire engines with AEDs. And just two years ago, University of Tennessee used federal stimulus money to purchase AEDs for all 10 campus police patrol cars.
All Knox County Senior Centers now have AEDs, with Covenant Health donating the last one, at Carter, this past March. Walsh said KCDC is chipping in to help put AEDs in all senior high-rise housing complexes.
"Thank goodness, no," none has yet needed to be deployed, Walsh said.
Simply having the devices isn't enough, of course people must be trained and willing to use them.
The first part is not that difficult to accomplish, Rowe said. The AED literally tells the user, step-by-step, what to do place the pads, step back, start CPR. The device will not shock someone if it detects the shock is not needed.
"My 6-year-old can do it; in fact, he has, though not on a person," Rowe said. "My daughter did her 4-H presentation on how to start an IV and use an AED. It's not something that requires a medical background. That's why they're designed the way they are."
Rural/Metro helps train about 2,000 people a year in CPR chest compressions and AED deployment, Rowe said. This includes both smaller classes in conjunction with agencies like Knox County Fire Department or Roane State Community College Health Sciences campus, and "mass" classes, training large groups of people at Knoxville Convention Center or on Market Square.
"In about 15-20 minutes, you can get the basic necessities for CPR chest compressions and operating an AED," Rowe said. AED operation is crucial, he added; "The data is pretty clear that chest compressions only is a tempering measure for time. It will maintain somebody in a survival state until first responders get there."
Training mainly requires learning to place the pads and turn the machine on. Rural/Metro uses "trainer" AEDs that send out verbal instructions but don't actually provide a shock.
Several years ago, the American Heart Association endorsed CPR training that included only chest compressions rather than mouth-to-mouth resuscitation. Studies found the effectiveness was comparable, but that was also because people were more likely to do the chest compressions than mouth-to-mouth.
Most places take it on faith that "good Samaritan" liability laws would protect those who use an AED to aid a stranger from later lawsuits. The device itself is virtually foolproof, and it would be hard to claim someone using one was intending harm, Rowe pointed out.
But the firm Readiness Systems, which consults with government and businesses about AED placements, gives Tennessee (along with 15 other states and the District of Columbia) an F grade for its state AED laws, because legal immunity when using an AED depends on compliance with state regulations intended to ensure the devices are operating correctly, well-maintained and in a place where people are properly trained to use it. Readiness Systems maintains Tennessee has too many requirements, which could "discourage" businesses from putting in AEDs, thus limiting the number of AEDs to which the public has access.
Rowe doesn't think Tennessee's laws are stringent enough to limit organizations from purchasing AEDs. They are, after all, a "relatively cheap investment" in terms of saving human lives.
"If implemented rapidly, and applied and correctly used at a minimum it could double your survivability" if you arrest with heart arrhythmia, he said.
Find AED/CPR training
American Heart Association: 865-584-4109
Benchmark Medical Services: 865-774-1166; http://www.benchmarkems.com
Cintas First Aid & Safety: 865-522-9192; http://www.cintastraining.com
Covenant Health: 865-541-4500
CPR Choice: 865-548-1500; http://www.cprchoice.com
East Tennessee Children's Hospital: 865-541-8618
Jefferson County Emergency Medical Services: 423-312-7510
Knoxville Fire Department: 865-595-4671
Roane State Community College, Knoxville Health Sciences campus: 865-539-6904; http://www.roanestate.edu/che
Rural/Metro Corp.: 865-573-5779
Tennessee Air National Guard: 865-985-4277
Tennova Healthcare: 865-545-3146
University of Tennessee Medical Center: 865-544-9190
Walters State Community College: 423-585-2672
American Heart Association: http://www.onlineaha.org/
American Red Cross: www.redcross.org
Free mobile CPR app: https://itunes.apple.com/app/hands-only-cpr/id336039551?mt=8
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