No medical emergency is more drastic than sudden cardiac arrest -- and the golf course is the fifth most common place for it to happen. And since the issue was first broached at the 2001 Golf Medicine Symposium in Morgantown, W.Va., some experts suggest that every golf course should be prepared to offer immediate, life-saving treatment.
"In a Florida study of cardiac arrests, everybody who had one on a golf course died," Edward A. Palank, MD, tells WebMD. "It does happen out there. And the golf course presents unusual geography that makes it hard for emergency-medical personnel to respond. It is remote; you can't immediately call 911."
The urgent need for treatment is due to the nature of cardiac arrest, in which the heart suddenly stops beating and begins to quiver instead. It comes without warning, and must be treated within 5 minutes. The chances of survival get 10% worse for every minute that goes by without treatment.
Such treatment has never been easier, thanks to new automated defibrillators -- machines that deliver an electric shock to jump-start the heart. Even a child can operate the new machines, which provide voice prompts that tell bystanders how to use them.
"These are designed first of all to be used by nonmedical personnel," Palank says. "You attach stickum pads to the stricken person's chest. You push the first button to analyze the heart rhythm. Then it tells you shock or don't shock. It is as simple as that. When it has been used, it has been extremely successful. For example, American Airlines has used it 99 times. In 14 of these cases the machine correctly said shock, and all 14 people were saved."
Palank says that several people are alive today because they were lucky enough to be playing golf on courses that keep the devices handy. The devices, called automated external defibrillators or AEDs, cost just over $4,000.
Vince Mosesso, MD, medical director for National Center for Early Defibrillation at the University of Pittsburgh, also addressed the conference.
"The key is that bystanders, the general public, and employees at golf courses and other venues have to act immediately if a person is going to survive a sudden cardiac arrest," Mosesso tells WebMD "And now it is possible for lay people to provide the needed shock."
Mosesso advises golf courses to set up a system that could get an AED to a patient in 3 to 5 minutes. A course could have one in the clubhouse -- perhaps in the pro shop, where a trained staff member can be on call at all times -- and another with a roving course ranger or marshal.
"We are going to see some innovative solutions," Mosesso says. "Some courses have put the locations of AEDs on score cards, and some have put dedicated emergency cell phones in every golf cart. It helps to have as many people as possible on the staff of the golf club trained in [the use of AEDs], and in country clubs many members should get training."
Mosesso says that even with increased availability of the new machines, people should still learn cardiopulmonary resuscitation, or CPR, techniques.
"CPR can help buy a little bit of time by maintaining some blood flow to heart and brain until defibrillation can occur," he says. "There are some patients who collapse who are not in a shockable rhythm, and in those patients giving CPR may preserve enough blood flow until medical professionals arrive on the scene. And if the machine says do not shock, you should still do CPR. The steps should be to call 911 immediately, start CPR, defibrillate, and get the patient to advanced medical care."
This is Part 1 of a three-part series. Click here for parts 2 and 3.
Originally published May 17, 2001.
Reviewed by Michael W. Smith, MD, May 2002.