Some emergency equipment is so ubiquitous it has become background clutter in our lives. Fire axes and water hoses reside behind glass in most hotels and fire extinguishers are mandatory in public businesses. All swimming areas have readily accessible flotation devices and first-aid kits of varying degrees of utility are now commonplace in public spaces.
Commercial air travel offers some unique medical challenges, but modern airliners, particularly those equipped for transcontinental service, are lavishly outfitted with medical gear. Cramped airline seats are notorious for inducing blood clots in those susceptible and I have been present for a couple of unexpected in-flight emergencies myself after a lifetime of flying. Given how many passengers are airborne at any given time, it is inevitable that there will be the errant medical crisis while traveling at 500 miles per hour 5 miles off the ground.
Flight attendants undergo basic medical training and most sizeable flights will include physicians, nurses, veterinarians or paramedics on the passenger manifest who can help out if things go wrong. Frequently, the capacity to keep a person calm, administer oxygen and perform CPR if needed is about all that may be expected of patrons on an airplane, but commercial aircraft are well equipped to meet these sorts of in-flight medical emergencies.
In recent years, the automatic external defibrillator (AED) has found a place in many high-traffic areas. They are frequently available in shopping malls, sports arenas, schools, large chain stores, airports, libraries and government buildings across the country. AEDs actually have their own universal symbol nowadays that directs passersby to their location. Keep your eyes peeled as you maneuver through life and chances are you will see placards for these devices in the places you frequent. In a real emergency, grab somebody who looks official and tell them what you need. In most shopping centers, construction sites and sports venues, help will be forthcoming.
AEDs come in all shapes and sizes, but most modern versions are not much larger than a traditional lunch box. They are becoming commonplace in shopping malls, sporting arenas and airports. My local Baptist church has one. While a lifesaving kit such as this may sit out of the way for a decade or more without being used, when the critical moment comes, an AED can literally make the difference between life and death.
In a nutshell, an AED takes the guesswork out of identifying and treating dangerous cardiac rhythms during cardiopulmonary resuscitation (CPR). A large percentage of the population has taken a CPR class. I took my first course during high school physical education. CPR is a fairly simple process that can be administered by most reasonably healthy people. The basic CPR protocol informs a layman first responder as to what should be done to address patients who are choking or who might have had a catastrophic cardiac event. The details regarding the number of rescue breaths versus the number of chest compressions change over time, but when distilled to its essence, CPR strives to keep oxygenated blood flowing to the brain and critical organs after a patient has had a cardiac arrest. The presence of an AED revolutionizes the care that a layman can provide to a patient in extremis due to a cardiac arrhythmia.
There are lots of bad things that can happen to the human heart but one of the more common is a cardiac arrhythmia. In these cases the normally ordered and organized electrical firings that control the four chambers of the heart and drive it to pump blood efficiently and effectively are disrupted. There are maybe half a dozen major varieties of these rhythms and keeping mental track of them in a crisis can be overwhelming. The AED, however, takes all of the heavy lifting out of the process.
Using a series of hardwired computer algorithms, an AED analyzes a patient’s cardiac status and then makes audible verbal recommendations as to the appropriate course of action. All AEDs are designed to be easy to use in a crisis.
An AED doesn’t have a lot of controls. There are even illustrations on the outside of the device that demonstrate the CPR process as well as the correct placement of the stick-on cardiac pad. There is a big button marked “On” and another marked “Shock,” but that is about it. The electrical connection is typically a Z-shaped stick-on pad that serves to monitor heart activity as well as administer a shock, if necessary. There is also a smaller pad designed for pediatric patients.
Once you happen upon someone who is unresponsive, you should make a quick assessment of the situation. Check to see if the patient is breathing and whether or not they have a pulse. Use two fingers and check at the neck. This is harder to do than it sounds. There is usually at least one person getting hysterical and you need to focus through the background clutter to do what needs to be done. If there is no pulse, you need to start chest compressions. Recent studies have shown that chest compressions are more important than rescue breathing.
Use the heel of one hand while interlocking fingers with your other hand for support and depress the sternum at a rapid cadence. Be fairly vigorous with this. There is a natural depth that you can feel when you are doing it correctly. This is a violent, unpleasant process. In older patients, properly executed CPR will frequently break ribs. Remember that this is a last-ditch lifesaving protocol.
Once you have the AED present, open the patient’s shirt and attach the electrical pad in accordance with the directions on the machine. Now push the “On” button and follow the machine’s verbal instructions. The AED will always start its diatribe with an audible command to “stay calm.”
The AED will direct you to step back from the patient so it can analyze the patient’s heart rhythm. If a shock is necessary, the machine will tell you to get clear of the patient and to push the “Shock” button. An AED will not shock a patient of its own accord; it must always be manually activated. If a shock is not appropriate, the machine will verbally direct you to resume CPR. If any of your skin is contacting a patient when they are shocked, you will regret it immediately.
There are several dangerous heart rhythms that the AED will recognize. Pulseless electrical activity, ventricular tachycardia and ventricular fibrillation are but a few. In the old days we had to look at a rhythm strip from an EKG, identify which rhythm was present and then decide what the best response might be. This was fairly straightforward in a classroom working on a big plastic dummy. With a real patient arresting along with the concomitant vomit, incontinence, frenetic activity and hysterical loved ones, however, it was hard to do well at times. The AED takes care of the really difficult part of coding an unresponsive patient. In practice, the device works so well that a layman can operate it with the most rudimentary training. In fact, 911 operators are trained to walk a caller through the process over the phone if need be.
It’s not much like the movies. CPR in the real world is a nasty, frightening, unpleasant experience that seldom works out very well. If you suffer a cardiopulmonary arrest, you really only have about a one-in-10 chance of ultimately surviving the event. However, for those who suffer a deadly cardiac rhythm at a place equipped with an AED, this device and an initiated bystander can literally save a life.
The internet has brought greater access to information of all sorts and along with that comes greater awareness of potential hazards in public areas. As a resultm our society is now liberally peppered with first-aid kits, firefighting equipment, portable oxygen tanks and AEDs.
AED devices can be found online at sites like Amazon.com for as little as $900, and they are becoming more and more common in public spaces throughout America. It also isn’t hard to find CPR training most anywhere in the country. Contact your local hospital and it can point you in the right direction. It is a great idea to invest a little time to understand lifesaving procedures and the equipment during times of peace so you will know what to do when an emergency occurs.
In a perfect world you would never use your lifesaving skills and your local AEDs would never see the light of day. If that opportunity arises, however, and you are present during a cardiopulmonary arrest, then some basic skills can save someone’s life.
This article was originally published in the SURVIVOR’S EDGE ™ Summer 2015 issue. Subscription is available in print and digital editions here.