Sudden Cardiac Arrest (SCA) Scenerio
In an iconic scene in Ocean's Eleven, elderly Saul grips his chest in an apparent heart attack. Unbeknownst to the guards who begin attending to him, Danny Ocean and his crew rob the vault the guards were there to protect. Once Saul is wheeled into the back of an ambulance, he changes from his dark suit to his characteristic Hawaiian shirt and goes on his way.
In reality, sudden cardiac arrest looks a little different. It looks like 23-year-old British professional soccer player Fabrice Muamba who collapsed during a game in 2012. After 78 minutes of resuscitation and more than 15 shocks with a defibrillator, Muamba's heart finally began beating on its own. He left the hospital nine days later and had since made a complete recovery but retired from professional soccer.
It looks like Alexander Dale Oen, a world-class Norwegian swimmer who, at 26-years-old, died while training for the Olympics.
And, according to the American Heart Association, it looks like the roughly 9,500 children under the age of 18 who suffer from out-of-hospital cardiac arrest every year.
What is the Difference Between a Heart Attack and Sudden Cardiac Arrest?
Because sudden cardiac arrest (SCA) contains the words "cardiac arrest," people automatically assume that it is the same as a heart attack. While the two conditions are similar in many ways, they are very different in others. The circulatory system inside of your body that moves blood to and from the heart is often compared to the plumbing in a house. When the "pipes" are clear, blood moves freely from the heart to the organs, muscles, and tissues where it is needed. When the arteries become blocked with excessive amounts of plaque, blood does not move as efficiently. Eventually, the reduced blood supply to the heart causes parts of the heart muscle to die. Someone who is having a heart attack might complain of chest pain, numbness down one arm, shortness of breath, nausea, or dizziness.
On the other hand, when sudden cardiac arrest happens, the heart stops pumping blood through the body and instead begins to beat in an unorganized way. This "quivering," known as fibrillation, causes the person experiencing it to pass out or collapse and begin gasping. As the brain stops receiving blood from the heart, the person may even experience a seizure that lasts for 10 to 30 seconds. While a heart attack can certainly lead to SCA, it is possible to have a heart attack without it.
Which begs the question...
How do you treat Sudden Cardiac Arrest?
Call 9-1-1 and wait for an ambulance, right? Wrong.
For every minute that Cardiopulmonary Resuscitation (CPR) and defibrillation is delayed, the likelihood of a person surviving SCA decreases by 10 percent. Even on the best of days, in ideal conditions, without traffic, an emergency response team is unlikely to reach the victim until it is too late.
So, what do you do?
First, it is vital to begin CPR as soon as possible. Not only does CPR keep blood flowing to the brain, when combined with rescue breathing, but it can also help oxygenate the blood until the heart begins beating again.
However, CPR does not address the root cause of the problem the fibrillating or quivering of the heart. The only way to stop this irregular heartbeat and bring the heart back into rhythm is to administer an electric shock, called defibrillation. This is most commonly done with an automated external defibrillator or AED.
What is an Automated External Defibrillator (AED)?
Think of it this way, if fibrillation is bad you want to defibrillate the heart as soon as possible. But unless someone happens to have an SCA in the middle of a hospital, you are unlikely to find a cardiovascular surgeon on hand to do the dirty work.
Which leaves you. Yes, you. The shopper two aisles over. The passerby in the airport. The person waiting in line at the bank. Since you might have to use it one day, you probably should know what an AED is.
Once upon a time, defibrillators were large, cumbersome machines that were wheeled from one room in the hospital to another. These carefully calibrated, sensitive machines would deliver a supercharged burst of electricity to a patient's chest that would force the heart to stop and then (hopefully) begin beating normally again. In the decades since their invention, defibrillators have become smaller, more portable, easier to use, and more sensitive to an individual patient's needs. Yet, they were still relegated to the hospital where they were only used by highly trained medical personnel. This left a large portion of the population without access to potentially lifesaving technology. The challenge then became to make defibrillation accessible to everyone and easy enough to use that any layperson could use it.
Enter the automated external defibrillator. With pictorial instructions, automated programs, and built-in fail-safe technology, AEDs can now be used by anyone, at any time, in any location. You are likely thinking, "That's great, but..."
How do you use an AED?
Figuring out how to use an AED may seem impossible. Fortunately, AED designs are created for people who are willing to help but may not have a clue what they are doing. All you have to remember is "SCAT."
Scan the environment. Are there any hazardous conditions that could further endanger you or the person you are trying to help? Is there standing water under the victim? Are they laying on a metal surface that could conduct electricity? Take a second to ensure the person is lying on a dry, non-conductive surface.
CPR. Begin CPR as soon as possible. If you are unsure whether you are performing CPR correctly, many AEDs have a CPR coaching system that will guide you through the process. Even though CPR guidelines have changed over the years, one thing remains the same. Sing along to the Bee Gees in your mind as you pump a person's chest, and you will be administering chest compressions at the appropriate speed.
Apply the pads. There has to be a way for the electricity generated inside of the machine to travel to the person's body who needs it. This is done via a specialized conductive pad attached by wires to the AED. These pads need to be placed directly on the skin with as little interference as possible. This requires you to expose the chest of the person you are helping. You may also need to shave any body hair that might prevent the pads from being applied directly to the skin. Pad placement is relatively straightforward. You are trying to create an electrical circuit that will travel through the heart of the victim. One pad is placed on the right side of the person's chest, directly above the nipple while the left pad is placed on the left side of the chest, just above the bottom of the ribcage. Don't worry if you forget where the put the electrodes. Every AED will have a pad placement guide included in the instructions, and most will ensure the placement is correct by reading the victim's heart rate before administering the first shock.
Turn on the AED. Some AEDs have a two button operating system that requires you to turn on the AED and then press a "shock" button once instructed to do so. Others begin to run an automatic protocol as soon as they are turned on. All you need to do is listen to the auditory cues the AED will provide or watch the AED screen for further instructions.
For a more detailed description of what to do in the event of a Sudden Cardiac Arrest, check out How to Use an Automated External Defibrillator.
How do I know when to use an AED and when not to?
Since AEDs were designed with the layperson in mind, they are also equipped with failsafe measures that prevent them from being used inappropriately. Unlike manual defibrillators that can be applied and used as an external pacemaker to bring the heart back to its normal rhythm, automated defibrillators only administer one electric shock at a time, and only when called for.
As tempting as it may be to view AEDs as the cure for all cardiac arrest, they are only effective under two conditions, also known as "shockable rhythms."
Ventricular Fibrillation (VF) - During VF, there is not enough blood flow to and from the heart. What results is a "quivering" heartbeat rather than a strong, steady one. Stemming from the bottom chambers of the heart, VF will eventually lead to the heart-stopping altogether and certain death if left untreated.
Pulseless Ventricular Tachycardia (VT) - VT is caused by "heart palpitations" that where a short in the body's electrical system causes a fast, regular heartbeat. Short bursts of VT can happen as a result of heart disease or even electrolyte imbalances and sometimes causes lightheadedness or chest pains. On the other hand, Pulseless VT does not produce adequate blood flow to and from the heart. At this point, the person can deteriorate rapidly into VF.
Outside of these two conditions, using an AED will not be effective at treating someone experiencing a heart attack. That is why, once the electrodes are attached to the victim, the AED will read the existing heartbeat and determine if the person is experiencing one of the two shockable rhythms. If so, the machine will advance through the protocol. If not, it will continue monitoring the patient and, if equipped with the feature, guiding rescuers through proper CPR procedures, but it will not administer an electrical shock.
It is also inadvisable to use an AED if there is a safety concern. Remember, AEDs use electricity to shock the heart. The same electricity that can save one person's life can take another's if you are not careful. It is vital to keep the victim dry and away from standing water, an excellent conductor of electricity. You should also avoid using an AED if the person is lying on a metal bridge, plate or table. Remember, electricity is always looking for a ground. If you are touching the metal table the victim is laying on when you administer the shock; the electricity will travel through the table and through you to reach the ground.
But telling you what an AED is used for and when to use it is only good if there is an AED to use. Which leads us to...
Where can I find an AED when I need one?
In a perfect world, AEDs will be hanging in every school, airport, retail store, event center, sporting arena, pool, gym, and gas station across the country. In fact, any place where the public gathers should have an AED available.
Currently, 17 of 50 states have legislation in place requiring AED's in schools. Even though SCA in children is rare, there have been instances when student-athletes have been saved by coaches who had access to lifesaving equipment. This threat, together with the threat of SCA in adult teachers and staff members have made AEDs a growing fixture in school districts across the nation.
Workplaces are also adding AEDs to their emergency preparedness plans. Since heart disease is the leading cause of death in the US and 9 out of 10 people experiencing sudden cardiac arrest will die while waiting for emergency medical personnel to arrive, more and more offices are adding AEDs to their first aid supplies to protect their employees. Combining the equipment with emergency preparedness plans and training offers workers an additional layer of security while at work.
Even retail stores have gotten into the act, recognizing that bystanders are crucial to the survival of victims of SCA. While many retail outlets are reluctant to acquire and maintain an AED, citing the liability for their use, federal law limits the liability of anyone who tries to use an AED to save the life of someone in cardiac arrest. It further limits the liability of the store so long as the AED is properly maintained and stored securely.
Let's say your office or school is one of the many that doesn't currently have an AED or plan in place for its use. What then?
Which AED is right for me?
The short answer? It depends.
While crucial to saving the lives of people who need defibrillation, buying an AED is expensive. It is also a process fraught with decisions about features, pads, batteries, maintenance, and storage. So, let's break this question down...
What AED brands are available?
There are six major, trusted AED brands on the market today. Each is designed and manufactured in different areas of the country, and each has AEDs with specialized features that set them apart from the competition.
Cardiac Science is responsible for more than 500,000 AEDs in almost 100 countries throughout the world. Known for the Powerheart AED, and headquartered in Wisconsin, Cardiac Science has been manufacturing AEDs since 1991. With fully automatic and semi-automatic models, Powerheart AEDs offer a flexibility of use with unparalleled training services that help would-be users feel more confident in their ability to handle a life or death situation.
Defibtech is the result of a partnership between Dr. Glenn Laub and his friend engineer Gintaras Vaisnys. Founded in 1999, Defibtech has since devoted its energy to creating a user-friendly AED that performs all of the necessary vital functions at a fraction of the price of their competitors. The Defibtech Lifeline series has a variety of features including optional video screen that demonstrates pad placement, guides you through proper CPR technique and offers feedback for shock administration. With verbal prompts as well as on-screen instructions, Defibtech takes the guesswork out of saving someone's life.
Heartsine's line of Samaritan Public Access Defibrillator (PAD) AEDs features an eight or ten-year battery warranty, which increases the life of the product and patented rapid recovery time, which reduces the time between an electric shock and when it is safe to resume CPR. Heartsine's Samaritan PAD models also feature real-time CPR feedback which gives rescuers visual and auditory feedback on the effectiveness of their chest compressions.
Phillips HeartStart Defibrillators are among the first to be made available for home use without a prescription. Designed for safety and ease of use, both the HeartStart Onsite and the HeartStart FRX models feature peel and place electrodes, CPR guidance, and one-touch functions that allow the AED to intelligently analyze the patient's needs and perform its function without human interface. Built for rugged environments, HeartStart defibrillators are ideal for schools, gyms, manufacturing facilities, or EMS response for their ease of use and durability.
Physio-Control (formerly known as Medtronic) has been manufacturing devices like their LIFEPAK defibrillators since 1955. Based on the work of Dr. Karl William Edmark in the 1950's to perform the first defibrillation, Physio-Control introduced the first portable model just a decade later. While the LIFEPAK 12 and LIFEPAK 15 models are designed for medical professionals, the fully automated LIFEPAK 1000 defibrillator, LIFEPAK CR PLUS and LIFEPAK EXPRESS are Physio-Control's latest AED offerings. Complete with built-in monitoring systems and voice and video prompt, these AEDs are simple to apply, simple to use and easy to maintain.
Zoll Medical's devices rest on the research performed by the father of electrophysiology, Dr. Paul Zoll. One of the pioneers of the modern pacemaker, Dr. Zoll saw an opportunity to provide not only high-quality pacemaker technology but also defibrillation to the masses. Today, the Zoll AED Plus and Zoll AED Pro can be found throughout the country. Characterized by Real CPR Help technology, each defibrillator is designed for maximum portability and transferability to EMS and hospital personnel.
Should I choose a semi-automatic or fully automatic AED?
This comes down to personal choice. Semi-automatic AEDs require the user to press two buttons, one to turn the machine on and one to administer the electric shock. Not only do semi-automatic AEDs cost less, but they also allow rescuers to control when the shock is sent through the victim's body. This allows any other helping bystanders to step away from the person and avoid accidental shock fully. Fully automatic AEDs simply must be turned on. The machine will then go through the entire rescue protocol on its own until EMS arrives or until the person is resuscitated. Fully automatic models are perfect for situations when you are likely to have only one rescuer, such as small shops or offices. They also take the uncertainty out of the process of trying to help a victim. All you need to do is place the pads, turn the machine on and listen to the voice prompts for when to stop CPR and stand back and when to resume compressions.
But what is the difference between a defibrillator and an AED?
This is one of the most common questions people ask about AEDs. So common, in fact, that we wrote an entire blog post about it. An AED is a type of defibrillator, and it is the only type designed for non-medical personnel, but it is by no means the only defibrillator available. Internal defibrillators are designed to administer an electrical shock directly to the surface of the heart. Manual defibrillators administer shock at varying rates, but they also feature pacing technology that allows skilled medical professionals to capture the heart's current rate and bring it where it needs to be through slow electrical stimulation. Implantable defibrillators are work inside the body where they automatically shock the heart when it begins to beat irregularly without any interface at all. Even pacemakers feature defibrillators as they work to regulate the heart's rhythm. Bottom line, an AED is ideal for everyday people, but defibrillators come in all shapes and sizes.
So, now that you have narrowed your choices down to just a few, you are probably wondering...
How much does an AED cost?
While you cannot put a price tag on a human life, there is a very real price tag to potentially saving one. Fully automated AEDs with video instruction and auditory feedback tend to top out the price bracket while simple, semi-automated models and few additional features sit near the bottom. Depending on brand, accessories, warranty, and features an AED will run between $900 and $3,000 brand new.
Still with us? Because there is an alternative to purchasing a brand new AED.
What is a "refurbished" AED?
When it comes to medical equipment, most people don't like to hear the word "refurbished" because they automatically assume it has been "used." AEDs are the exception. In most cases, a refurbished AED has not been used in lifesaving measures. In fact, in most cases refurbished AEDs have never been turned on beyond testing the battery. Many AED retailers and durable medical equipment companies sell "service plans" with their new products. This service allows the retailer to send service technicians to the site once a year to inspect the AED, make sure it is in working order, replace any expired electrodes, and track the maintenance on the machine. After "x" number of years, the AED is then brought back to the retailer's office and swapped out for a new model.
But what happens to the AEDs that are in perfect working order, but have sat on site for one, two or even three years?
The FDA certifies certain companies to "refurbish" or "recertify" these AEDs for public use. Upon receipt, the device is thoroughly inspected and tested, all disposable components, like electrodes, CPR masks, or additional accessories, are replaced, and the AED is repackaged for resale at significant savings. In fact, most refurbished AEDs are sold at a savings of up to 50 percent.
Who would want to purchase a refurbished AED?
While many hospitals, medical centers, and clinics are required by law to purchase new AEDs, that is not the case for schools, offices, retailers, or other locations where an AED is useful. In many cases, purchasing a new AED for one or more locations is cost prohibitive, especially when we are talking about schools or city buildings. Rather than simply going without this lifesaving technology, refurbished models are an ideal option. Safe, effective, guaranteed for up to three years and cost-efficient, many places would rather purchase a certified refurbished AED if it means having one on site.
What do I look for in a refurbished AED?
While there are some important questions to ask yourself before purchasing a refurbished model, the most important thing to look for is that the AED has been refurbished rather than reconditioned. According to the FDA, a "reconditioned" model is restored to the condition it was in when it was new. This may sound attractive until you think about the software and hardware upgrades that happen over the lifetime of an electronic device. On the other hand, "refurbished" AEDs have been restored to like-new condition with all of the upgrades and updates that have come out since the device was introduced. This ensures that your AED will be tested, certified, calibrated, and ready to use the minute it comes out of the box.
Now that you are an expert in all things related to AEDs, you are probably wondering...
Where can I buy AEDs?
In spite of the fact that AEDs should be found everywhere the public gathers, they cannot be bought on every street corner. In fact, someone looking to buy one may find that AEDs for sale are almost elusive. Some manufacturers offer direct sales, and others require you to purchase your device from a retailer. In general, AEDs are best purchased from a medical equipment company like Foremost Medical Equipment.
Why? As much of an expert as you may feel right now, scrolling through this comprehensive guide to AEDs, there are still factors you have not considered. The equipment specialists at Foremost Medical Equipment are available to guide you through the selection process based not just on a budget, but target population, storage capabilities, potential traffic, and accessibility. Our team can also walk you through our available AED Program Management options that take the guesswork out of changing batteries and maintaining your device over the years. You can rest assured that you are getting the device you need at a price you feel good about, with protection for years to come. Best of all, our line of new and refurbished AEDs are available online for your viewing along with a line of accessories that complement your AED program. Call us today for a free over-the-phone consultation.