What Happens When A Piece Of The Puzzle Is Missing

Several years ago, the Malaysian government decided to solve its disease-carrying-mosquito problem by spraying the infested areas with DDT. This worked, but cockroaches then devoured the dead mosquitoes. This was followed by the region's gecko lizards consuming the roaches. The geckos (surprisingly) did not die from the residual poison, but their central nervous systems were greatly affected, causing the lizards to slow down. Moving up the food chain, cats ate the slow-moving lizards and started to die off in large quantities. Of course, fewer cats meant more rats, and the country's rat population soared. As a result, the World Health Organization was forced to step in and ban the DDT. In an effort to restore the ecological balance, it flew in planeloads of cats to kill the rats.

The chain reaction of trying to kill the mosquitoes resulted in a health crisis of great magnitude, but it shows what can happen when one piece of the puzzle has been removed.

For years, the fire service has committed many dollars and resources toward saving people in cardiac arrest in the form of training, apparatus, equipment and medications. But how many people has your EMS system saved from cardiac arrest? One, two, maybe five a year? If your EMS budget for the fire department is $1 million and you saved five people in cardiac arrest last year (who left the hospital neurologically intact), a more cynical person would say it cost $200,000 a save!

A person who is an idealist would say, "If it saves one life, it was worth it." You might also hear them say, "You would not care if it was your child or spouse." Or, "What about all the people we saved who we prevented from going into cardiac arrest?"

Regardless of whatever argument you choose to make, there has been one single piece of the puzzle missing for the last 30 years - until now. The piece of the puzzle that has been missing has been public access defibrillation (PAD). No doubt, early defibrillation in cardiac arrest is key to survival. Studies have clearly shown that as each minute ticks by, the chances of surviving a cardiac arrest are reduced by 7-10%.

As automatic external defibrillators (AEDs) have become "dummy-proof" and easier to use, more and more you can find them showing up in places other than a police car, engine company or ambulance.

In November 2000, President Clinton signed the "Cardiac Arrest Survival Act" into law. The law highlights the need to make AEDs the standard of care in public places. The legislation also requires the Secretary of Health and Human Services to develop recommendations and guidelines for the placement of AEDs in federal buildings.

Before the legislation was introduced, the first to jump on the bandwagon with public access defibrillation were airports, airlines and casinos. Walk through some of the major airports such as O'Hare International in Chicago and you'll find AEDs mounted on the terminals walls, generally a short distance from each other. Have a cardiac arrest in most casinos in Las Vegas and within about a minute you'll find a security guard at your side with an AED. As a result of the AED programs in the casinos and early defibrillation, some casinos are seeing above 50% survival rates from cardiac arrest.

But many others are starting to get into the act - golf courses, supermarkets, car dealers, automobile repair shops, schools, churches, shopping malls, restaurants, sports arenas, hotels, health clubs, office buildings and many other places where large numbers of people can be found. It is even rumored that several Fortune 500 CEOs have AEDs close to them at all times, including in their homes, offices, cars and corporate jets.

Some of the public places where AEDs are showing up are shopping malls owned and operated by the Kravco Company. The malls see over 100 million visitors each year. After making the commitment, within two months, Kravco had provided training and certification in the use of AEDs, emergency oxygen and cardiopulmonary resuscitation (CPR) to more than 150 staff members at 11 malls. Then, the company installed the life-saving devices in highly visible spots near customer service centers. Within months, three lives were saved as a result of the new program.

In other public places, AEDs are installed inside wall cabinets that are fitted with magnetic contacts and lead wires that tie into most new or existing low-voltage fire and/or security systems. When the AED is removed from the cabinet, an alarm sounds at a monitored panel indicating there is a medical emergency close to the AED cabinet. A medical team can then be dispatched to the site. The American Heart Association even suggests that AEDs will be as common as fire extinguishers on the wall one day.

So what can you as a fire department do? Initiate a public access defibrillation program in your community or assist others with their programs. Don't expect the public to do it by themselves. Educate your local leaders about placing AEDs in your municipal buildings. Teach those responsible for heavily populated or heavily traveled sites to implement an AED program.

Each day, about 1,000 people die from sudden cardiac arrest. Instead of bragging that we save 5% of those victims, we need to start saying that it is unsatisfactory since 95% do not survive. The last piece of the puzzle is now available. Now it is time to put it in place.