Arresting Cardiac Arrest

Arresting Cardiac Arrest

New law will require automatic defibrillators in every public high school.

David Hedrick had been at a picnic at Cabin John Regional Park on July 18 last year. He played a little softball and then headed to the YMCA in Silver Spring for a workout. That’s the last thing he remembers.

“Later that night my wife told me I had a heart attack,” said Hedrick, who works at Rockwood Manor in Potomac. “My life was saved by a defibrillator.”

THE YMCA HAD recently installed an automated external defibrillator (AED), a machine that delivers an electric shock to people in cardiac arrest, helping to reestablish a normal heart rhythm. Automated external defibrillators are essentially the same devices used by emergency room doctors, but have built-in computers that analyze the patient’s condition and determine whether or not a shock is needed.

The defibrillators are designed with audible prompts and pictorial instructions aimed not at medical professionals but lay people.

“Basically all you have to know is how to open it up, turn it on, put on the pads,” said Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, a state agency. “There’s evidence now that in a very short amount of time you can teach a layman to use these devices.”

But Bass said there is a difference between efficacy — whether the devices save lives when used promptly and correctly — and effectiveness.

“Effectiveness is the real world,” he said.  “If they can't get it to the patient fast enough then it isn’t going to be effective.”

WITH THAN IN MIND, Del. Susan Lee (D-16) sponsored a successful bill in the Maryland General Assembly that will require local boards of education to develop plans to place a defibrillator in every public high school. Sen. Sharon Grosfeld (D-18) sponsored the Senate version of the bill.

“The bill is very simple. It just said the school boards have to implement this,” Lee said. Pennsylvania and New York have passed similar laws and at least one Maryland County — Anne Arundel — already has defibrillators in every high school.

“Most Las Vegas casinos have AEDs,” Lee said. “You’re more safe in a casino than you are in a high school, because you have AEDs. They’ve saved a lot of gamblers’ lives.”

Automatic defibrillators are on hand in stadiums, airports, prisons and throughout the Maryland General Assembly.

Hedrick recalled inquiring about defibrillators after his heart attack. A friend who works for the federal govenment told him, "Come down here. We he have them on every floor."

The bill has been dubbed “Andrew’s Law,” a reference to Montgomery Blair High School student Andrew Helgeson, who died May 25, 2005, weeks before his graduation.

Helgeson was goalie and co-captain of the Blair lacrosse team and was also a wrestler and academic standout who was to receive a school-wide leadership award on the same day that he died.

Helgeson died at home, where the devices, which cost $1,500-$2,000 each, are still very rare. But between 2001-2004, Bass’s agency recorded 24 cases of cardiac arrest in Maryland schools.

AEDs have already been placed in some of the most trafficked public locations—stadiums, airports and malls—and high schools are a logical next choice from a public health standpoint because their potential value in life-years saved is higher in places with many young people.

Lee said that implementing her bill would cost less than $500,000 statewide, including the cost of training.

THE LEGISLATION calls for close coordination between the Institute for Emergency Medical Services Systems, the Maryland Department of Health and Mental Hygiene and other agencies in providing guidelines on placing the devices and training staff to use them.

“The important issue is not just so much that you put an AED in schools but where you put it and how accessible it is,” Bass said. “I was at my daughter’s school for a play a couple weeks ago and there was a sign that said ‘AED in Nurse’s Office.’ I know how to use an AED but I don’t know where the nurse’s office is. And it’s probably going to be locked when I get to it.”

A victim’s chance of survival drops 7-10 percent each minute after entering cardiac arrest and after 10 minutes is virtually zero.

While having trained staff use the defibrillator is the best option, Lee pointed to programs in which sixth-graders have been trained to use them and instances where bystanders with no training have used them successfully.

The machines are “conservative, if anything” in determining when to allow a shock to be administered, according to Bass, and will not deliver a shock to someone that does not need one. Unless there is evidence of malicious intent or “totally reckless” behavior, users — trained or not — are protected by good Samaritan laws and schools are free of civil liability in connection with the defibrillators, Lee said.

DOZENS OF SPEAKERS, including relatives of sudden cardiac arrest victims, heart attack survivors and medical experts testified in support of Lee’s bill.

“We didn’t anticipate the amount of support that we got. We got emails. We got an outpouring of support from the public,” Lee said.

And while defibrillators in schools will hardly eliminate the 3,500 sudden cardiac arrest deaths in Maryland each year, Lee said that the program is a first step.

“At one time fire extinguishers were considered some kind of strange technology,” she said. “Now you have them in every single building. And it’s required by law now.”

Hedrick made a similar analogy. No one denies the value of sprinkler systems in schools, even if they go unused for decades, he said.

Without a recent push to install defibrillators in health clubs, where cardiac arrests are more common than elsewhere, “I’d have been dead,” Hedrick said. “I feel fortunate that I was at the ‘Y.’”