Why you need an AED at home...

You have until sundown on November 5th to get in on this!

Check http://www.slicc.org/AED_deal and learn how having an AED in your home can quintuple your chances of surviving a sudden cardiac arrest. (Seventy percent of all cardiac arrests occur in a private residence, and the ambulance can't get there fast enough to yield more than a ten percent survival rate.)

SLICC is running its annual AED group purchase again, and the AED being offered is about 40% less expensive as the best price I've found on the web!

The older you are, the more strongly I'd urge you to participate.

Bob

Feedback makes industry work well. Why not for EMS?

Let's take a look at two scenarios where two individuals are performing chest compression on two SCA victims.

Both rescuers were recently trained and received their CPR cards.

Rescuer #1 got a call this morning and on arrival began chest compression while waiting for her partner to set up the AED.

Rescuer #2 got a call this morning and on arrival began chest compression while waiting for his partner to set up the AED. Rescuer #2's situation was different in that he had another instrument that watched what he was doing. The device played a sound at a rate of 105 per minute. The device warned him loudly when he left more than 1.8 pounds on the victim's sternum at the top of the "full recoil" upstroke. The device advised him for each compression when the depth was OK.

Which of the two rescuer's had a better chance of performing guideline-compliant chest compressions?

SLICC's measurement of a large number of bystanders and EMS personnel showed that this sort of feedback was necessary and that providing guidance was not effective in curing the problem over a period of two months or more.

Feedback - the process of influencing a process by reporting on quality on a current basis - is what industry relies on to control the quality of what they produce.

A applaud the AHA's recent requirement that such feedback devices must be used in CPR courses beginning in January. I wish it were able to extend that ruling to all EMS personnel.

Bob

Performing CPR requires three abilities"

1. Compress the chest to a depth of 2 to 2.4 inches.
2. Compress it 100 to 120 times a minute.
3. Get at least all but 1.8 pounds off the chest at full recoil/

Here's the problem:

1. About 0% of all households where both adults can compress their spouse's chest to two inches.
2. Most Bystanders compress at too slow a rate.
3. Most Bystanders "lean" - i.e., leave more than two pounds of force on the chest at the top of the full recoil stroke.

The only reasonable solution is to have an AED at home. 

Another problem: only 44% of the arrests are witnessed. There is a device that will call 911 + other, specified parties when you arrest. If the rescuer is in the same residence as you and you have an AED at home, your odds of survival go from zero percent to more than 50%, if you have an AED at home.

This was an interesting week. I encountered several surprising things.

1. Earlier this week, there was a Today Show segment on CPR with Dr. Oz. It was this session that informs us that to perform Chest Compressions you have a depth choice from one to two inches. (The depth guideline became 1.5 to 2 inches in 2005. The depth guideline became 2 inches in 2010. The depth guideline became 2 to 2.4 inches in 2015.)
2. Dr. Oz showed how to apply the AED pads and got it wrong: The pad on the victim's left side is supposed to go on the left side wall, not just lower than the left nipple. (We're trying to make a "heart sandwich" out of the heart and the two pads. The AED works better that way.)
3. Dr. Oz forgot to tell the audience how to tell when someone they encounter has had a sudden cardiac arrest. (non-responsive and not breathing normally.)
4. I wasn't able to find a way to get the corrections to the Today Show.

By the way, when the depth guideline went to 1.5 to 2 inches, a significant number of instructors weren't able to renew their certificates because they weren't able to compress to 1.5 inches on a manikin whose stiffness was significantly less than than the average adult.

Driverless cars and Sudden Cardiac Arrest...

Driverless cars will be actively sold before the end of this decade. They will phase in over the following 20 years.

Recent evidence shows that the accident rate with a driverless car is far less than with a human at the wheel.

One consequence is that, if the "driver" is wearing a device such as iBeat, the car can re-route and head for the closest ER when that passenger / driver is recently clinically dead.

Sure beats calling an ambulance.

Bob

What are your odds of having a Cardiac Arrest within a year?

Your chances of having a sudden cardiac arrest in the next year depend on a lot of factors...your health, your family history of arrests, your age...

Your age? How does your age have anything to do with it?

• About 20% of all out-of-hospital cardiac arrests happen to people under 50. Ditto for people in their 50's, ditto for those in their 60's, ditto for those in their 70's, and the same for those 80 or older.
• The total size of these population blocks gets smaller and smaller as you get older.
• The graph below shows the percentage chance of your having an arrest in the next 365 days.

Keep in mind that these figures about age distribution are approximate. It was a lot easier to calculate and remember by using the 20% number for each age bracket. The distortion isn't major.

When you couple this info with the facts that (1) 70% of all out of hospital sudden cardiac arrests occur in the home, and (2) the ambulance is going to have a difficult time getting to the victim within ten minutes (10% survival) or within 3 to 4 minutes (50-60% survival), you really might want to consider an AED for your home.

Bob

AED vs. CPR

The difference between performing CPR and using an AED

1. An AED is a device that examines the victim's heart rhythm and advises the rescuer as to whether to administer a shock or to resume chest compression. The AED either delivers the shock when you press the button or it delivers the shock automatically.
2. CPR pushes oxygen-bearing blood to the heart muscle and brain. The preservation of these two organs determine the degree you can function if resuscitated. CPR also delays the transition from a shockable rhythm to a non-shockable rhythm.

Which is better?

1. Only very rarely will CPR bring a victim back without use of electricity and / or drugs. And because your probability of being brought back declines every minute after your arrest, Having an AED with you really bends the odds in your favor.

It's smart to insure against catastrophic outcomes.

1. There is fire insurance to replace your home or goods if they burn
2. There is life insurance to replace part of a paycheck when that person dies
3. There is auto insurance to help repair or replace a wrecked car.
4. ,,,and an AED provides the best available chance of surviving a sudden cardiac arrest!

Thought for the day: It's so much better to have an AED and never need it than to need it and not have it. Check out the group purchase savings at http://www.slicc.org - just click on AED_deal near the top of the left menu.

Bob  (bobt@slicc.org)