Copyright 2006 The Atlanta Journal-Constitution
By DUANE D. STANFORD
The Atlanta Journal-Constitution (Georgia)
Richard Nelson doesn’t remember the day he almost died.
Friends told the 84-year-old Snellville man he collapsed on the floor of the clerk’s office at the Gwinnett County Courthouse in Lawrenceville in September.
A sheriff’s deputy began CPR while another grabbed a device from the building’s atrium to shock Nelson’s heart. It took two jolts to bring the vital muscle back to life.
A half-hour earlier and Nelson would have been home with his wife, who didn’t know CPR.
“I thank God that the defibrillator was available and the expertise was available,” Nelson said.
A review by the Gwinnett County Fire Department of sudden cardiac arrests found two-thirds of them happened at homes, not in public places such as Gwinnett’s courthouse. But few homes are within quick reach of the kind of device that helped save Nelson’s life.
So Gwinnett fire officials want residents of subdivisions or homeowners groups to pool their money and buy them. Gwinnett fire officials will then train them to use the equipment.
“We want these to be as common as fire extinguishers in homes,” said Gwinnett EMS Lt. Greg Schaffer.
Called an automated external defibrillator, the machine is simpler to use than the manual defibrillators familiar from TV shows like “ER.” The automated machine monitors the victim’s heart rate and determines whether a shock is needed. A digital voice walks a rescuer through the sequence, warns him or her to stay clear of the shock and says whether subsequent jolts are necessary.
Experts say the machines, which cost anywhere from $1,000 to $1,500, are the best insurance against death from sudden cardiac arrest. A three-year study by the University of Pittsburgh Medical Center found that people shocked by defibrillator-carrying police officers were 10 times more likely to survive cardiac arrest than those who went untreated until an ambulance arrived.
Emergency medical experts have pushed for years to get automatic defibrillators into government buildings, churches and schools. Gwinnett now wants to become the first county in Georgia to make widespread use of automatic defibrillators in neighborhoods.
In Fulton County, the Medlock Bridge subdivision has a defibrillator at both of the community’s swim-tennis centers. It’s one of the few subdivisions in metro Atlanta with the units, Gwinnett fire officials said.
A young girl convinced the community to purchase the units following the death of a boy who went into cardiac arrest after he was hit by a baseball pitch. Residents have access to the clubhouses 24 hours a day.
Even subdivisions without a common gathering area can participate in Gwinnett’s program, said fire department spokesman Thomas Rutledge. The community could put a device on a resident’s porch if necessary, he said.
“It’s a program that no doubt is going to save some lives in the county,” Rutledge said.
A leading cause of death in the United States, sudden cardiac arrest kills more than 300,000 Americans every year, often without warning signs, according to the American Heart Association. Eighty percent of cardiac arrests happen at home, and in a majority of those cases a friend or loved one is present.
Sudden cardiac arrest happens when electrical systems in the heart malfunction due to an abnormal heart rhythm. The heart then stops beating. Automatic external defibrillators can restore normal rhythm by, in essence, rebooting the heart. One expert referred to it as “electric medicine.”
Last week, a 16-year-old boy collapsed while running on the track at Berkmar High School and later died. He had a congenital heart defect. In October, Lewis Rogers, 49, of Lilburn died after a heart attack on a tennis court at Rhodes Jordan Park. The same weekend, Hawks center Jason Collier, 28, woke up at home to chest pains and shortness of breath, and later died. Doctors determined the basketball star had an undiagnosed enlarged heart and an abnormal heart valve.
According to the heart association, 95 percent of all sudden cardiac arrest victims die before reaching the hospital. Experts say defibrillators can change that statistic for patients. Gwinnett’s emergency medical crews all carry manual defibrillators that have a cardiac monitor, but that isn’t enough, Schaffer said. Studies have shown survival rates drop by 7 to 10 percent every minute after cardiac arrest. If a shock is administered within three minutes, a patient’s chance of survival is about 65 percent. At nine minutes, the chance of survival drops to about 6 percent.
The average response time for Gwinnett fire units is eight minutes.
For fire officials, the statistics add up to an obvious need.
“The more AEDs we get out there, the more paramedics we have out there,” said Gwinnett Fire Lt. Craig Stanley.
But the solution has been slow in coming. “We’re not seeing a lot of AEDs in the community,” Stanley said.
Late last year, fire officials invited representatives of neighborhood watch groups to a meeting to learn about defibrillators. Four people attended.
Frank Poliafico, director of the AED Instructor Foundation, said part of the problem is fear.
People think the machines require medical training, or that employing one might somehow open the user to lawsuits, even though Georgia’s “Good Samaritan Law” protects people from civil liability when they volunteer first aid in an emergency.
So even when people do buy a unit, there is no guarantee it will be pulled out of the box, much less used in an emergency.
“As idiot-proof as they are, they’re not human nature-proof,” he said.
Poliafico, who used to oversee New York City’s emergency medical service, said people who aren’t used to being around death --- or the possibility of death --- can have a tough time coping with an emergency.
“The greatest fear in life is death. The second-greatest fear is screwing up in public. Now put those two together,” Poliafico said.
Other inhibitions get in the way, as well, he said, like the fear of ripping a woman’s shirt off in public or uneasiness about touching a stranger.
Poliafico praised Gwinnett’s effort to get the units into neighborhoods, but he said it won’t work if the department doesn’t stay in constant contact with the communities to make sure residents know where the defibrillators are and how to use them.
“This is a skill people are going to use once in a lifetime, if at all,” Poliafico said, “and it will be one of the scariest times of their lives.”