O`ahu Lifeguards' Use
of the
Automatic (Automated) External Defibrillator (AED)
- An Overview -
- A Rescue Scenario -
- References -
AN OVERVIEW
In late 1998, the Ocean Safety and Lifeguard Services Division of the City and County of Honolulu's Emergency Services Department initially deployed twelve automatic (automated) external defibrillators (AED) islandwide on O`ahu.
The use of on-site AEDs to treat cardiac arrest is rising nationally. The single most important determinant of survival of either cardiac arrest or ventricular fibrillation is the time from collapse to defibrillation. Each minute of delay decreases the chance of survival by 7% to 10%. Most patients will survive if defibrillation is achieved in less than 3 minutes. However, few will survive if the delay is 16 minutes or longer, even when CPR (cardiopulmonary resuscitation) has been administered [O'Rourke RA: Saving lives in the sky (editorial). Circulation 1997; 96(9): 2775-2777].
An automatic (automated) external defibrillator is a medical device heart monitor and defibrillator that:
- is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia, and is capable of determining, without intervention by an operator, whether defibrillation should be performed;
- upon determining that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to an individual's heart; and
- has received approval of its premarket notification, filed pursuant to United States Code, title 21, section 360(k), from the United States Food and Drug Administration.
The AED is easily used by public safety personnel such as
lifeguards (i.e., ocean safety officers). The devices are small
(the size of a book), light (4 to 7 lb), and relatively
inexpensive (about $3,500 to $5,000 each). Several companies
market such devices, which are of high reliability and
quality.
Personnel, most any person for that matter, can learn to use an AED in about an hour. The user simply applies the two electrodes to the left apex and the right base of the chest. With most devices one pushes the "on" button and listens for a voice on the machine to direct whether or not to push the defibrillator button. In monophasic models, the electric current travels from the positive electrode pad to the negative pad. The current in biphasic models travels in both directions.
Maintenance is minimal on AEDs. Equipped with long-life batteries the devices have features that notify the users when battery replacement is needed.
Oahu's ocean safety services opted initially to use the Heartstream ® Forerunner ® AED.
A RESCUE SCENARIO
A near-drowning victim
is detected . . .
. . . and efficiently brought safely to shore.
Upon examination of the patient, the ocean safety officer first responders detect no palpable pulse or heartbeat.
Electrodes of the AED (automatic
external defibrillator) are applied . . . and the machine engages
in a brief diagnostic process. . . in the AEDs used by Oahu Ocean
Safety, all significant actions including EKG diagnostics are
recorded in the AED's PCMCIA card memory.
. . . should the AED find
the presence of venticular fibrillation or rapid ventricular
tachycardia, it will prompt the rescuer to stand clear and to
send an electrical charge to the patient to restore a normal
heart beat. The AED will recycle, re-analyse, re-shock the
patient depending on the heart rhythm that it detects. 
If the AED
detects no heart beat (asystole), it will prompt rescuers to
check airway, check breathing and check circulation, then
commence CPR (cardiopulmonary resuscitation), if
necessary.
It should be noted that Oahu's program has a well-defined medical command and control, and, medical and quality assurance infrastructure. There is a designated medical director; ocean safety lifeguard command personnel are actively involved with quality assurance and morbidity and mortality initiatives of the State EMS system; a specialized AED training and continuing education program is on-going; and a data retrieval and analysis program is under development for operational information and morbidity and mortality tracking and linkage.
American Heart Association, Inc. Heart and Stroke Guide, “Cardiopulmonary Resuscitation (CPR) Statistics”. www.americanheart.org/Heart_and_Stroke Guide 2000.
Callaway CW. “Improving Neurological Outcomes After Out-Of-Hospital Cardiac Arrest”. Prehospital Emerg Care 1997;1(1):45.
Becker LB. “The Epidemiology of Sudden Cardiac Arrest” (book chapter), Cardiac Arrest: The Science and Practice of Resuscitation Medicine (Paradise NA, Halperin HR, Nowak RM). Baltimore: Williams and Wilkins, 1996.
Valenzuela, Terrance D. et al. “Outcomes of Rapid Defibrillation by Security Officers after Cardiac Arrest in Casinos”. N Eng J Med, October 26, 2000.
“Improved Survival with an Airport-Based PAD Program,” Abstract 3990. Circulation, Supplement II, Vol. 102 No 18, October 31, 2000.
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