Cardiac defibrillators are saving people’s lives, but not everyone has quick access to them.

By Kathryn Trim

Julie Lycksell and her daughters, Lisa and Laurie, are thankful their local police equipped squad cars with defibrillators.
 
Photo taken from Better Homes & Gardens Magazine, Nov. 98

When Julie Lycksell walked into a restaurant on February 6, 1998, to celebrate her forty-eighth birthday, she never dreamed she’d end up grateful just to be alive.

Julie, who lives on Long Island, New York, was about to order dessert when she slumped over onto her husband’s shoulder.

All color drained from her face. Her heart stopped beating. Her husband and a doctor from a nearby table frantically started CPR and someone called an ambulance.

Without any warning, Julie–who had never experienced any heart problems–was in sudden cardiac arrest, her chance of survival dwindling with every passing minute.

Less than 60 seconds after the 911 call, Suffolk County police officer James Brierton rushed through the door carrying a machine about the size of a laptop computer. He attached two electrodes to Julie’s chest, and with the press of a button, an electric shock restarted her heart–giving her the best birthday present ever.

"In twenty-six years as an operating room nurse, I’ve used a defibrillator on hundreds of patients," Julie says. "I just never thought someone would need to use one on me."

The little machine that could. Every year in the United States, more than 350,000 people collapse from sudden cardiac arrest. Few are as lucky as Julie. Ninety-five percent die before help can reach them. But now, more and more people are surviving, thanks to a lifesaving shock from a machine called an automated external defibrillator.

In sudden cardiac arrest, a chaotic rhythm–or fibrillation–overtakes the heart, causing it to stop beating. There are generally no warning signs, and people often have no prior history of heart disease. The person collapses immediately and then loses consciousness. A defibrillator machine uses an electric shock to jolt the heart, allowing the normal rhythm to regain control.

The new battery-operated defibrillators cost about $3,000 and are easy and safe to use, even for someone with little or no medical knowledge. There are several different models available, but most of them monitor heart rate and pulse and, if required, direct the rescuer to push a single button that sends an electrical shock to the victim’s heart.

"The machine does all the decision making. All you have to do is hook it up and follow the directions," says Dr. Terry Valenzuela, an emergency medicine professor at the University of Arizona in Tucson.

A defibrillator won’t advise to shock unless the victim is in a shockable rhythm, and there’s no way to override the computer and shock someone if it’s not required.

While CPR buys valuable time, defibrillation is key to saving a cardiac arrest victim. For each minute the heart doesn’t beat, the chance for survival goes down by 10 percent. Within four to six minutes, brain tissue begins to die. After only 10 minutes, 99 percent of sudden cardiac arrest victims are dead.

Another rescue tool.
It’s estimated that at least 100,000 cardiac arrest victims could be saved each year if first responders, such as police officers, firefighters, security staff, and flight attendants, were trained and equipped with defibrillators. Anyone planning to use a defibrillator is required to take a three-hour training course and CPR training.

In Rochester, Minnesota, a study found that police arrived at medical emergencies before an ambulance 44 percent of the time. The city’s ambulances already had the defibrillators, but by installing defibrillators in Rochester police cars, the survival rate for cardiac arrest jumped from 30 percent to almost 45 percent–one of the highest rates in the country.

Just seven months before Julie’s sudden cardiac arrest, the Suffolk County Police Department equipped all its squad cars with defibrillators.

But not all first responders have them. In fact, half the nation’s ambulances aren’t equipped with the machines, according to a 1997 survey by the American Heart Association (AHA), which is leading the charge for all emergency responders to have defibrillators. But there are several obstacles to overcome, such as cost and legal restrictions, before the machines are widespread.

American Airlines and Qantas Airlines have installed defibrillators on all or most planes. Delta Airlines is scheduled to have its entire fleet outfitted with the machines by the year 2000, and United Airlines says it will begin installing them on all their domestic and international flights starting this month. Flight attendants will be trained on how to use the machines.

Putting defibrillators on every airplane would save an estimated seven lives a year, according to a 1997 study by Dr. James Atkins, a cardiologist at the University of Texas Southwestern Medical Center.

Lifesaving for the layman.
In addition to equipping traditional first responders, proponents of defibrillators want to put them wherever the people are. In May 1997, Boyd Gaming Corp. installed defibrillators at seven of its Las Vegas casinos.

"Casinos are about the size of a small town," says Stan Smith, director of risk management for Boyd. "The paramedics do a great job, but once they get through the door they have to get through all the people."

In the past year, Boyd has trained about 700 employees, mostly security officers and office workers, to use defibrillators, which has reduced the medical response time to about one to two minutes.

The Meadowlands sports complex in East Rutherford, New Jersey, which seats up to 110,000 fans, updated its emergency medical team with several portable defibrillators in 1992. The sports complex already had a hospital-like defibrillator, but most cardiac arrests at the Meadowlands happen in the top two rows of the stadium, says Fran Guthrie, the Meadowlands emergency medical team manager. It’s hard to get the bulky equipment up there fast enough. With the lighter, more portable defibrillators, the cardiac survival rate at the stadium has reached about 80 percent.

Jumping through hoops.
With the current situation of who does and who doesn’t have defibrillators, it’s truly a stroke of luck being in the right place at the right time. Or, it could just be a matter of living in the right state.

Only half of the United States have laws that allow nonmedical people to use a portable defibrillator. Many older laws refer to the era when earlier versions of the machines required the person operating it to make a medical judgment. There are also legal concerns about liability. There is a push to include defibrillators in states’ versions of the Good Samaritan law. This would ensure that the responder could not be sued if he or she tried in good faith to save the victim’s life and something went wrong.

The fears are unfounded, says Pat Stieg, Minnesota director of public advocacy for the AHA. "These machines are virtually foolproof, but there is always someone who says ‘what if and won’t use them until they’re covered by law out of fear of being sued,’" he says.

The AHA and community activists are working to ensure that all state laws are friendly toward the use of defibrillators. These groups expect that all states will update their laws concerning defibrillator use within the next year.

Cost also can be an issue, especially for smaller communities. Although the $3,000 price tag is quite an improvement over the original $10,000 price a few years ago, many communities simply haven’t budgeted for such an investment. However, the value of having defibrillators nearby is becoming well-known, and many communities are taking it into their own hands to raise the needed money.

The biggest advocates for buying defibrillators are cardiac arrest survivors. Julie Lycksell is back working full-time at the hospital and spends much of her spare time spreading the word about the little machine that saved her life.

"They’re worth the money, even if they save just one life," she says. "One of those lives was mine."