SHOULD YOUR DEPARTMENT ADOPT AN EARLY DEFIBRILLATION PROGRAM?
EMS IN THE FIRE SERVICE
The automated external defibrillator (AED) works. How well it will work in your community depends on your department and the quality of the system you implement. The early defibrillation program, however, may not be suited to every department. When determining whether early defibrillation is right for your department, you must ask yourself some difficult questions, such as the following discussed by R. O. Cummins in “EMT-Defibrillation: Is It Right For You?” (JEMS, 19H5):
- How many cardiac arrests does your community have? It’s estimated that one out-of-hospital cardiac arrest per 1,000 people occurs per year in the United States. If your community has about 10,000 people, approximately six will experience ventricular fibrillation. Early defibrillation likely will convert three of them in the field, and one or two eventually will go home from the hospital. If your community is small, the effort to establish and maintain an early defibrillation program may not be worth the time and expense. Hie investment might be better spent on improving some other component of the EMS system.
- What is your average response time? Rapid response time is a critical ingredient in an effective program. Citizens must have access to an efficient dispatching system if response times are to be gotnl enough to support the program. If your unit arrives more than 12 minutes from die time a person collapses, your system probably is not ready for early defibrillation.
- Are most cardiac arrests witnessed? Unwitnessed arrests usually are discovered many minutes after the collapse, when it is too late to do much good. Were most of your cardiac arrest calls over the past years witnessed? If not, early defibrillation will have little effect on improving the rate of survival. The best reported save rate for unwitnessed patients is only two percent.
- Is CPR started early? CPR must be started quickly, either by private citizens who know CPR, citizens being “talked” through CPR over the telephone during the emergency, or emergency crews on arrival. If CPR is not administered within four minutes of the collapse, ventricular fibrillation quickly subsides, and responders trained to defibrillate will have no rhythm to restore w hen they arrive.
- Is advanced life support (ALS) available? Paramedics may be so well dispersed throughout your community that there is no need to develop an early defibrillation program. A four-minute difference between the arrival of first responders and paramedics seems to be the break point. If paramedics arrive more than four minutes after first responders, then early defibrillation likely w ill improve surv ival chances. If paramedics arrive in less than four minutes, it likely will make no difference. If ALS is not available in your community, much of the value of early defibrillation will be lost, because about half of the people who are defibrillated will refibrillate. The drugs given by ALS personnel and the superior ventilation provided by intubation prevent patients from refi-
- brillating. The patient either must be given ALS by responding paramedics or must arrive at the hospital within 12 minutes after first responders defibrillate to minimize the possibility of refibrillation.
CITIZEN AWARENESS CRUCIAL
Hie concept of early defibrillation involves more than placing defibrillating equipment on responding units. A systems approach must be used if published survival rates are to be achieved. An efficient prehospital chain of survival is the best approach to responding to a sudden cardiac death. The chain has four links: early access, early CPR, early defibrillation, and early advanced life support. Citizens as well as emergency personnel affect the success of an early defibrillation system.
Preparations must include a public education program and department procedures established according to medical, local, and state requirements. Objectives should include the following:
- Stress that citizens call EMS immediately when there is a heartrelated incident.
- Prepare a greater number of citizens to administer CPR.
- Train emergency dispatchers to give CPR instruction over the telephone.
- Have emergency units arrive within the shortest possible response times.
- Provide for quick advanced care through responding units or quick transport to the hospital emergency department.
