Shock First, Ask Questions Later

From the WebMD Archives

May 3, 2001 (Boston) -- The next time you hear a cop say "you're under arrest," he may be helping someone get to the hospital rather than to jail.

Because they're often first on the scene of an emergency, equipping police with life-saving portable defibrillators has the potential to double the chance that a person who goes into sudden cardiac arrest on the street will make it out of the hospital alive, report physicians at the annual meeting of the North American Society of Pacing and Electrophysiology (NASPE) held here.

In Miami-Dade County, Fla., where over a five-month period in 1999, every police car was equipped with an automatic external defibrillator and every officer was trained in its use, 18.3% of people who experienced sudden cardiac arrest due to ventricular fibrillation survived to be discharged from the hospital, compared to about 10% of those treated on scene by EMS services for the same condition in the previous 13 months, according to two separate studies.

"The difference is that, typically, the police get to the scene more than two minutes faster than paramedics, because they are already out there on the road, and for sudden cardiac arrest, every second counts," says researcher Robert J. Meyerburg, MD, professor of medicine and physiology and director of the division of cardiology at the University of Miami School of Medicine, in a written statement.

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According to NASPE, about 350,000 people in the U.S. die from sudden cardiac death each year; about half of the cases are caused by ventricular fibrillation, in which the heart goes into a chaotic rhythm and loses its ability to efficiently pump blood to the rest of the body. Left untreated, ventricular fibrillation can lead to heart attack, stroke, and in some cases death in as little as 10 minutes.

Defibrillators deliver an electrical charge to the heart to shock it back into a stable, coordinated rhythm. Automatic external defibrillators take the technology a step further by using a computer attached to the small, lightweight device to read the heart rhythm and determine whether the patient's heart is in need of a shock. If a shock is deemed to be appropriate, the operator of the device can press a button to deliver the shock. Shocks are delivered only when the computer detects an episode of ventricular fibrillation.

In recent years, automatic external defibrillators have been popping up -- and saving lives -- in public spaces such as golf courses, airplanes, hotels, and shopping malls.

Mark Schonfeld, MD, associate clinical professor of cardiology at Yale University in New Haven, Conn., tells WebMD that what happens on the street can have a profound effect on what happens in the hospital and afterward.

"There's no doubt that the treatment modalities we have for patients who survive cardiac arrest are spectacular," he says. "But unless they make it to the hospital to begin with, their prognosis is ominous."

Above and beyond that, though, is the timely delivery of therapy out in the field, because if it's not done in the field then the outcome is also catastrophic.

"Unless they receive immediate medical care, patients who experience a sudden cardiac arrest away from medical attention may suffer severe brain damage from lack of oxygen in the brain," Schonfeld says.

In a study similar to the Miami studies, researchers from the Mayo Clinic in Rochester, Minn, the first U.S. city to equip and train police to use defibrillators, report that "long-term survival rate for sudden cardiac arrest can be very high when a community has a well-organized, prompt emergency defibrillation program."

Mayo Clinic internist T. Jared Bunch, MD, and colleagues looked at what happened to patients who received defibrillation in the field over a 10-year period, and found that of 118 patients who made it to the hospital alive, 52% survived to discharge. In comparison, in some cities only 1-2% of patients survive out-of-hospital sudden cardiac arrest, according to NASPE.

Schonfeld tells WebMD that in Seattle and Miami, two communities where aggressive, well-coordinated emergency cardiac care plans are in place, patient survival rates are significantly higher than in other U.S. cities.

"There is no doubt that these [automatic external defibrillators] have had a significant impact," he says. "They are ever-present in the community, and the ability to apply these will have a major impact in terms of survival for out-of-hospital cardiac arrest."