Editor’s Note: This 2010 article has been superseded by Block EMS as a solution with wider reach in populated cities.
The Tandem AED/EMS strategy has an in-house AED delivering its lifesaving treatment well within four minutes. EMS then arrives some minutes later to consolidate the rescue.
It’s a simple, tandem sequence that resolves a major issue for a large percentage of the population – EMS cannot reliably access SCA victims inside four minutes, and in high rises it is nearly impossible.
AEDs exist expressly to deal with this time limitation, otherwise we could all wait 10-20 minutes for paramedics to arrive and treat us with their own monitor/defibrillator.
But between the idea and the reality falls the shadow – the notion that the AED can repair the broken chain of survival between EMS and high rise residents has received a lukewarm reception among rescue professionals. They make every attempt to get the job done, of course, but we have assigned them a challenge that cannot reasonably be accomplished, given the realities of bustling cities.
EMS people have a self-reliant culture that does not look for outside assistance or other agencies to fulfill their obligations, and truth be told, it is not their effort that is lacking. It is the role of AEDs in our society being insufficiently in focus – a deployment gap that requires some nurturing before the AED can take up its intended place among us.
AEDs are our responsibility
The AED revolution in heart safety will have to survive under its own auspices, which is as it should be. These vertical communities that AEDs can best protect do have a few things to learn about this miracle in a cabinet, sitting down there in the elevator lobby:
- AEDs are a sacred trust, not targets for vandalism or theft.
- AED contracts cost very little, and are shared across the whole complex.
- Contracted inspection, monitoring and maintenance services should be implemented, not just bare AEDs.
- Each PAD should have a resuscitation network within the building to support rescues.
So cost and maintenance are not valid issues when a single device can serve so many. Liability exposure has been largely eliminated by Good Samaritan laws; indeed the absence of an AED in populous buildings is increasingly seen as possible negligence, which breeds liability.
What then remains to get this done?
- A universal mandate, preferably via the Fire Code, that all high rises must have a Public Access Defibrillator (PAD).
- Resident/worker volunteer recruitment in that building
- Ongoing education around the AED’s presence, purpose and operation.
Those living in high rise buildings need to be made aware of their heart safety nakedness. We cannot expect a friendly fireman to knock on our apartment door and say “BTW, you have little protection against sudden cardiac arrest in this building.”
Nor is the ambulance paramedic about to stop by and confess that your trust in him/her is misplaced during SCA emergencies. They are doing their very best, but they face barriers they cannot control, and it is now up to society to instantiate the role of AEDs as a mature technology.
This message needs to be disseminated by others, including the press, heart safety advocates, the medical and legal professions etc. The idea that politicians might resolve this matter is losing currency, as thousands die, and AED deployment will remain chaotic until the urban limits to early defibrillation are addressed.
If elevator lobbies become firmly associated with AEDs in the public mind, a foundation is there on which to anchor an AED Registry, and to trim back wasted vehicle sorties by large fire trucks, redundant ambulances etc. The costs savings that will occur once EMS vehicular services can be rationalized will pay for any number of AEDs, as required.
The toll up to now of premature death and brain damage is obviously incalculable.
CPR training equates to personal education:
- The presence of an AED in the lobby will evoke discussion while awaiting the elevator.
- It is an easy matter to place a comprehensive manual in every mailbox, annually.
- Dedicated websites can go through the rescue procedures to any detail level.
- Seminars and CPR training can be scheduled at regular intervals within each building.
A good example of how AED awareness can spread through the community can be read here, whereby an iPhone app alerts nearby CPR people. The compact, common features of high rises make heart safety expertise easy and affordable to obtain, and the residents can be expected to embrace this network as a shared amenity, knowing it is there for their health interests alone.
In-suite security completes the fabric
One limitation remaining to address is the fact that 85% of SCA’s occur in the home, and a large fraction of these are not witnessed. Cellular alerts grant high rise people, living or working alone, one last wish at this moment.
Cell phone applications allow one-button pressing to alert 6 to 10 people within the building complex. Thus, someone in crisis has one last option at hand to alert that volunteer network, even if nobody else is there to witness their incident. Even with just 5-10 seconds before losing consciousness, these victims nonetheless can be accessed and resuscitated in time.
This wireless technology can intervene with any heart attack, stroke or serious falling incident – and offers broad protection against these principal hazards and other trauma. Building complexes can become tidy heart havens if we want them to be – with radical savings in lives, medical treatment, and EMS resources.
Summary – Converting to a HeartSmart™ Community
Tandem AED/EMS will raise building complexes from ‘unsafe’ to ‘safest’ status, and deftly repair this physical gap in EMS services. Indeed, any building adjacent to a high rise protected by this topology can share its single AED, and share volunteers from/to their surrounding footprint.
Once mandated (and there is no reason why municipalities could not amend their existing fire codes today) these AED-smart communities will mature independent of EMS and health care funding, freeing the AED phenomenon to at last find fruition on its own merits, via the same folks it will protect. Not simply an incremental improvement – SCA survival is expected to be an order of difference higher – it represents a complete sea change in pro-active heart safety, and a cornerstone within any AED Registry, heart surveillance or NG 9-1-1 scheme.
At this stage AED/EMS need not be foisted onto fire department administrators as a sole plan of action. CPR communities and trainers are there for precisely this purpose – and they can rightly be granted every opportunity to proudly perform as neighbors and citizens.
Thereafter, if a paramedic arrives at the ten minute mark, to consolidate the rescue and transport the patient to hospital, start hypothermia – and all aftercare – the patient will have a 75+% chance of survival without brain damage. It will be OK, too, if the ladder and pumper trucks remain at the fire hall. The NG 9-1-1 dispatcher will note that this high rise has a networked AED, and instead may assign a 9-1-1 SCA specialist to support the assisting parties if needed, or connect to live medical direction.
This SCA will still be a grave emergency, yes. But a patient 95% doomed by an overstretched response time from a single responding agency? – not any more.
– Dwight G. Jones, Elevaed Technologies