a special program of the National Emergency Medicine Association (NEMA)
Transcripts: 543-5 to 544-2
Week: 543.5 Guest: Dr. Roger White, Prof. Of Anesthesiology, Mayo Clinic, Rochester, MN Topic: Use of Automated External Defibrillators by police, Part One of Three Host/Producer: Steve Girard
NEMA: One of the most popular phrases seen amidst the colors of a city police cars is, "...to serve and protect". In more and more communities around the country, police officers are sharing a job with ambulance crews and firemen...the resuscitation of people having heart attacks. We're talking today with Dr. Roger White, professor of anesthesiology at the Mayo Clinic in Rochester, Minnesota...who has been involved in a project in which policemen save lives in a new way....
WHITE: First, a defibrillator is a device that is able to deliver an electrical shock to a heart in a patient who is in cardiac arrest, caused by a rhythm abnormality we call ventricular fibrillation....therefore the word, defibrillator'. An AED stands for automated external defibrillator, which simply means it is a defibrillator that delivers a shock, just like all other defibrillators, but in addition, it analyzes the heart's rhythm automatically, so the operator doesn't have to know how to interpret the heart's rhythm, in order to deliver a shock appropriately.
NEMA: Your city of Rochester, Minnesota is one of the jurisdictions proving the usefulness of equipping police cruisers with AED's....What started the process...?
WHITE: We have enjoyed the benefit of police response to medical emergencies in this city for several years. The ability of the police to arrive before the ambulance was well recognized, but we had not documented it quantitatively, so we analyzed a year's experience of the frequency with which a squad car reached the scene of a medical emergency before an ambulance, and it occurred sufficiently often, that we decided we would do a two year trial project, by placing defibrillators in squad cars, to see whether we could, first of all, have police reach the scene before the ambulance, and number two, have sufficient time to attach the defibrillator and deliver a shock before the ambulance arrived. So, it was basically started as a trial project, a feasibility study, to see whether our hypothesis worked. That started in November of 90...we did the two year study with only four defibrillators, one in each sector of the city, and we observed that there was a quite high survival rate when police officers delivered the shocks. So, at the end of the two year study, we decided we would continue to look at it, and expanded the numbers of defibrillators from four to eight, and then we went from eight to twelve...and we are continuing to analyze the system's performance and collect data, and we stopped in July of 95 and looked back at the whole 58 month period prior to that, and we observed, again, that we were achieving very high survival rates. Whether it was police or whether it was paramedics who reached the patient first. And it basically showed that it doesn't matter who gets to the scene of the cardiac arrest first, as long as they get there quickly and have a defibrillator, they are able to achieve a quite high survival rate from this form of treatable cardiac arrest.
NEMA: Over time, survival rate among cardiac arrest victims in Rochester increased by at least 19% with the use of defibrillators by police officers. We'll talk with Dr. White about those statistics and what the future holds for these portable lifesavers in our next program. I'm Steve Girard.
Week: 544.1 Guest: Dr. Roger White, Prof. Of Anesthesiology, Mayo Clinic, Rochester, MN Topic: Defibrillation Units in Police Cars... results, Part Two of Three Producer/Host: Steve Girard
NEMA: We're talking again with Dr. Roger White, professor of anesthesiology at the Mayo Clinic in Rochester, Minnesota. We've discussed the beginnings of a program which puts potentially life saving automated external defibrillators in the hands of police officers...who are many times first on the scene of a cardiac arrest. Doctor White, how much did the survival rate change when police in your city used the AED's...?
WHITE: Prior to the institution of police defibrillation, we had enjoyed a quite high survival rate from ventricular fibrillation, cardiac arrest. We had been running 28 to 30 % survival. Now, the national average is somewhere in the range of five to ten percent, so we were the benficiaries of a high survival rate when we started, and that was in large measure, due to the rapid response of our ambulances. When we analyzed our data from the inception of the addition of police, through July 95, and that covered a 58 month period, I think....the overall survival rate for this form of treatable arrest was 49%. So, we are obviously benefitting from rapid defibrillation and achieving high survival rate, even though we started with a relatively high one. I think the results were reported for this period of time were the highest survival rates from treatable cardiac arrest, that have been reported. And the full report will be published in November in a medical journal.
NEMA: I'll bet communities around the country have shown some interest in your program ...
WHITE: That's correct. When we presented our data in May of this year at a major medical meeting, following the presentation of these data, we started to get a lot of calls, expressions of interest in the work we were doing and the results we were getting. That was followed by an ABC World News Tonite report on the results of our work..I think that was in May...and that was followed by further expressions of interest, and then CBS morning news reported a similar account. So, both of these national news agencies provided additional visibility that followed by a whole lot of calls....to the point where we just prepared a standardized, what we call a police packet', that includes everything that has been written about our experience using police with defibrillators.
NEMA: Down the line, what is in the future for the use of the AED...?
WHITE: It seems to me that the first initiative all of us who work in this area need to take is to be certain that every community enjoys the benefit of this treatment. By utilization of the EMS system already in place...whether it's fire service, private ambulance, police service..whatever. Whoever is already there, going to medical emergencies, in our opinion, should be automated external defibrillator equipped.
NEMA: Dr. White can be reached at the Mayo Clinic in Rochester, Minnesota. We'll talk with him again on the future of defibrillators in saving lives throughout the community. I'm Steve Girard.
Week: 544.2 Guest: Dr. Roger White, Prof. of Anesthesiology, Mayo Clinic, Rochester, MN Topic: A growingnrole for Defibrillators throughout the community, Part Three of Three Producer/Host: Steve Girard
NEMA: We've been talking with Dr. Roger White a professor at the Mayo Clinic in Rochester, Minnesota about the use of automated external defibrillators by police officers to save the lives of people in cardiac arrest. Doctor, you've said that you'd like to see everyone make it a priority to ensure every community has access to a defibrillator, so that under the EMS systems already in place, the first responder to a cardiac incident will have the best chance to resuscitate the patient. What else do you see for this area...down the road a bit....
WHITE: We envision the possibility of placement of these easy to use, easy to maintain devices in other, public settings. That might include things like security guards trained to use them in high rise buildings, certainly sports arenas....we hope that commercial aircraft will soon express an interest in placement of defibrillators. But those are areas, at least some of those areas need further exploration to find a cost effective basis for them. Right now, I think, every community across the United States should decide where they can already place defibrillators in systems, EMS systems, that are already working, but are not so equipped.
NEMA: How did you find the police taking to the AED responsibility throughout the process...?
WHITE: I would say with confidence that if you were to approach any city of Rochester police officer now and ask him or her for thoughts on their role in this area...this very non-traditional area of police involvement, you would get a positive response. I think that the police officers here in this city, consider this a very welcome addition to what they're able to do for the people of this city. Initially, when we started this study, there definitely was some skepticism, some uncertainty about taking on this very, very unusual responsibility...but over the time period, and as new officers have come aboard and we train them, the reception has been clearly, unmistakenly positive. This is really a very positive venture for a police officer to go to the home of a community citizen, and provide this form of treatment in a positive way, and contribute to survival to people in the city.
NEMA: I guess that as more jurisdictions begin to use the automated external defibrillation units, there will be more information, perhaps confirmation of what you've found in your project in Rochester.....
WHITE: Cities that have expressed an interest following their hearing about the work we've been doing, I hope will contribute to the pool of scientific data, and like us, publish the results, so that other communities can make intelligent, objective decisions on whether or not this is something that they might be able to do. I certainly don't necessarily think that police defibrillation fits into every city. But it has been basically a totally unthought of form of delivery of defibrillation in the past...and all I would like to see happen is for more and more cities to take a look at it and decide whether they have in place a mechanism that would most likely make police defibrillation effective.
NEMA: "...to protect and serve". Police have given their lives to give meaning to mottos like that...now they get a chance to save lives without putting theirs on the line... with the help of a small piece of equipment called an automated external defibrillator...perhaps coming to your town soon. I'm Steve Girard.