If you saw someone collapse from sudden cardiac arrest in a public place, would you know what to do?
Many people likely have a Hollywood-inspired concept of how to respond, with visions of performing mouth-to-mouth CPR, the victim waking up and coughing after a few pumps on their chest.
That happens only in the movies, said Colette Larson, Take Heart program coordinator at Essentia Health-St. Joseph’s Medical Center. There is, however, a machine that in conjunction with hands-only cardiopulmonary resuscitation (CPR) has the potential to revive someone on the spot, and it’s Larson’s mission to teach as many people to use it as possible.
Survival rates more than double
The machine is called an automated external defibrillator (AED). It is a portable device found in many public places that can administer electric shocks to the heart of someone experiencing cardiac arrest.
The American Heart Association reports immediate CPR and early defibrillation using an AED can more than double survival rates for victims of cardiac arrest. Without familiarity with the device, however, many bystanders hesitate, uncomfortable with the idea of using a machine that delivers shocks.
That perception is one Larson aims to change through the distribution of AEDs and trainings on how to use them in case of emergency.
“It’s easy and it’s not scary, even though people think it’s scary,” she said.
Larson said the Take Heart program has helped to install AEDs at 82 locations and train more than 12,000 people in the Brainerd lakes area.
It might be even more crucial for distribution of these machines and trainings to take place in rural areas. According to a Sept. 5 story by Minnesota Public Radio, rural survival rates of cardiac arrest tend to be lower compared to the metro, due in part to longer ambulance travel times.
One of the latest AED trainings took place Tuesday night at the St. Mathias Park Recreation Center after the park board received a grant to install one at the building.
Jim Guida, vice president of the St. Mathias Park Board, is also a conservation officer with the Minnesota Department of Natural Resources. He said after several conservation officers in this district received AEDs to carry in their squad cars, he thought about how important they could be in the community.
“It is now going to stay in the park, and we’re going to have one available for large group gatherings,” Guida said. “We want to make sure that if there is something like that up at the park that our park is prepared for that.”
Members of the park board and residents attended Larson’s session where they learned about the correct responses to increase the chances of survival in an emergency situation.
CPR is critical
Before jumping into a how-to on an AED, Larson first went over how to perform CPR.
“You have to know how to do CPR if you’re going to want to use that (AED),” she said. “If the AED is not needed, the only other thing you can do is chest compressions.”
Mouth-to-mouth CPR is no longer the recommended course of action on adults; hands-only CPR that does not require administering breaths is not only as efficient, Larson said, but also increases the chances of bystander involvement.
“Most people won’t even step in in an emergency if they think they have to do mouth-to-mouth,” she said.
In an emergency where someone has collapsed, Larson said to follow what she called the “Three Cs”: Check the person for responsiveness and also check their breathing by placing a hand on their chest and one on their stomach; call 911 and send someone to grab the AED if available; and start chest compressions.
To perform chest compressions, place hands with locked elbows on the center of the victim’s chest and push, hard and fast. CPR is most effective when a depth of two inches into the chest is achieved at a pace of 100 beats per minute. Larson suggested the song “Stayin’ Alive” by the Bee Gees is a good guideline to follow to maintain this pace.
Beginning CPR as soon as possible is crucial, she said, to improving chances of survival. When a victim’s heart is no longer pumping on its own, properly performed chest compressions keep blood flowing throughout the body.
“The whole goal is to keep oxygen up to the brain, so we don’t have cell death,” she said. “Why? Because then when the paramedics show up, if they get a pulse back, and we know you were doing CPR the whole time, they have a much better chance of walking out of the hospital neurologically intact.”
The AED will guide you
Ideally, while one person is performing CPR, another person would be readying the AED. It does not take much preparation; in fact, popping off the lid, applying the chest pads and pressing the “on” button is really all it takes. The AED comes with a small “ready pack” which includes trauma scissors and a small razor blade, tools that might be important depending on the situation.
A bare chest is required to apply the pads correctly, which means shirt removal is necessary and shaving could be as well.
“If you take their shirt off and their chest looks more like a rug than just a little bit of hair, you need to shave first,” Larson said. “This has to be stuck to the skin to be able to read an electrical signal.”
The one-piece pad is easy to apply: Place the ‘X’ in the center of the chest, right where compressions are being performed, and the two pads go into the correct locations. Accompanying pictures illustrate this in case of any confusion. This spot with the “X,” called the “puck,” contains a computer chip that analyzes electrical signals in the heart which determine whether a shock is necessary.
Once the machine is powered on, all that’s left to do is follow its lead. The machine delivers instructions aloud and via a small screen on its face and will guide rescuers through each step, including how long and when to perform compressions and if and when to administer a shock. It even provides feedback on the effectiveness of the chest compressions that are being performed, with instructions like, “Push harder,” or “Good compressions.”
The job of the computer chip is to determine whether a shock is warranted; a shock is only effective when a victim is experiencing cardiac arrest as a result of ventricular fibrillation, or V-fib, the most common cause.
V-fib is “electrical chaos” in the heart, Larson said, that causes the heart to quiver uncontrollably rather than pumping in its usual manner.
“I guess you could say your heart is having a little seizure, because it’s not pumping blood,” she said.
Delivering a shock doesn’t actually jump-start the heart, as is the common belief.
“We’re actually wiping it out and we’re stopping it like your computer,” Larson said. “So if you’re typing on your computer and your computer screen freezes, how do you fix it? You reboot.”
The heart is “rebooted” in a similar fashion. With the chaotic electrical signals cleared with a shock, the heart has a chance to begin beating the way it should on its own.
The machine will not deliver a shock unless the computer chip detects V-fib.
“It doesn’t work like a Taser,” Larson said.
To prove this, she once applied the pads to her own chest on a live machine and asked her children to press the “shock” button. It came back with the command, “No shock advised.”
The only way someone could be incidentally shocked from an AED would be if they were touching the victim while the shock was administered.
“Make sure you clear the patient before you push ‘shock,’ because you can shock somebody who’s touching them,” she said. “You’re not going to hurt them, though. They won’t like you. They’ll get over it. You’ll be fine. Just make sure you say, ‘Clear.'”
An AED is the only way a victim of cardiac arrest would ever wake up on the scene.
“If we get that device on within the first three to five minutes, and you’re in that erratic rhythm it can fix, it can actually wake you up,” Larson said. “Most often you don’t see people wake up from chest compressions only.”
Even if the victim wakes up, Larson advises keeping the pads attached and the machine on until emergency personnel arrive and take over, because the possibility of recurrence is real.
Bystanders make the difference
How fast someone responds in a cardiac arrest emergency makes a dramatic difference. The American Heart Association reports for each minute that passes with CPR or defibrillation, survival chances decrease by seven to 10 percent.
“They’re called public access devices for a reason,” Larson said. “They’re in the public for anybody to use.”
People shouldn’t be afraid to step in, because good Samaritan laws will protect individuals who attempt to save someone’s life, she said.
“A lot of people are intimidated on the whole idea of shocking somebody to get them back, having them come back to life,” said Guida. “It’s going to be commonplace now to have (AEDs) in facilities that have open doors, that people can come in to.”
A system called AED Link, helps bystanders utilize the machine in emergencies. When someone calls 911, the operator can identify an AED within 600 feet of the emergency. Locations with AEDs can register their machine and indicate willingness to be notified if an emergency happens nearby. An automatic message would be sent by AED Link to the contact person at the location in the case of an emergency within 1,200 feet.
This system is in use in Hennepin County, in the Allina EMS service area and 28 other EMS systems in the United States and Canada. According to the company’s website, 911 knowledge of AED locations has improved usage of the machines by an increase of 3,500 percent, from .5 percent to 20 percent.
“It’s not us that save lives,” Larson said. “It’s you guys.”