Saving a Life With a Defibrillator

By Jay Romano

New York Times

May 14, 2006

In recent years, an increasing number of automated external defibrillators have been provided in office buildings, shopping malls and health clubs and even on commercial airliners. Why, then, are there so few of them in apartment buildings, particularly co-ops and condominiums?

"This issue has come up in a bunch of buildings we manage," said Neil Davidowitz, the president of Orsid Realty in Manhattan. "And the reluctance to install them basically comes down to concerns about potential liability."

It turns out, though, that such concerns may be unwarranted. Modern defibrillators — electronic devices about the size of a briefcase that administer an electric shock to restore heart rhythm — "are basically foolproof," said Dr. Diane Sixsmith, the chairwoman of emergency medicine at New York Hospital Queens, in Flushing. Dr. Sixsmith said that with the models now on the market, the operator has only to attach two pads to the victim's chest and turn on the machine.

"The machine will analyze the heart rhythm and tell you whether or not to administer a shock," she said. "As far as we know, these machines have never shocked someone who didn't need it and never failed to shock someone who did."

And while having defibrillators in commercial buildings is certainly helpful, Dr. Sixsmith said, having them in the buildings where people live is even more important.

"The majority of cardiac arrests happen in the home," she said. "And in 98 cases out of 100, the victim does not survive."

With cardiac arrest, every second counts. "If you restore the rhythm within four minutes, most people survive with no permanent damage," Dr. Sixsmith said. "For every minute beyond that, there is a 10 percent increase in mortality and an increase in the likelihood of brain damage." After about 10 minutes, she said, death is virtually certain.

"And when you live in a place like New York, traffic and other problems usually make it very difficult for an ambulance to get to a victim quickly enough to save him," Dr. Sixsmith said. But having a defibrillator on hand has pushed survival rates from 2 percent to as high as 75 percent, she said.

Sarah Gillen, chief executive of Emergency Skills Inc., a Manhattan company that sells defibrillators, said buildings that want to buy one need a "medical director" — a licensed physician — to provide a purchase authorization, monitor the training and report any use of the machine to the state.

Building employees and others who would use the machine can receive training from the American Heart Association; it takes about four hours, Ms. Gillen said.

Cardiopulmonary resuscitation, aid for choking victims and hands-on practice with the defibrillator are included.

The cost of each machine is about $2,000; training costs $100 a person.

Arthur I. Weinstein, a Manhattan lawyer and the vice president of the Council of New York Cooperatives and Condominiums, said the state's Good Samaritan Law protects from liability anyone who "voluntarily and without expectation of monetary compensation" uses a defibrillator in an attempt to revive someone in an emergency. The law also protects a co-op or condo, as long as it met the training and medical director requirements.

Errol Brett, a co-op and condominium lawyer in Great Neck, N.Y., said that one of his clients, North Shore Towers in Floral Park, Queens, bought five defibrillators several years ago. And last year, he said, a building employee, Deokaran Gunpat, received an award from the New York City Fire Department for using one to save the life of a resident who went into cardiac arrest.

"In my opinion," Mr. Brett said, "it would be negligent not to have one."

Outside the Coaching Manual: Knowing CPR, AED use can save young lives

Wednesday, May 03, 2006

By Mary Niederberger, Pittsburgh Post-Gazette

Tony Tye, Post-Gazette
Sam Nicholson, 12, right, and his friend Tommy
Wahl, 13, left, were playing basketball March 17
in Sam's driveway, when Sam went into cardiac
arrest. Tom called 911 from the phone in the
garage, a neighbor performed CPR, and medics
arrived and used an automatic external
defibrillator. Sam now has a defibrillator in his
chest. "Everything in the chain was there," said
his mother, or the outcome might not have been so good.

Early activation of the emergency medical-services system, early bystander cardiopulmonary resuscitation and early defibrillation: Those are the recommended responses by emergency medical professions to a sudden cardiac arrest.

Lynn Nicholson, of Bethel Park, saw that protocol save the life of her son, Sam, 12, after he collapsed in their driveway March 17 while playing basketball with a friend.

Lynn Nicholson, of Bethel Park, saw that protocol save the life of her son, Sam, 12, after he collapsed in their driveway March 17 while playing basketball with a friend.

Sam was stabilized at St. Clair Hospital before being flown to Children's Hospital of Pittsburgh. There, a pacemaker and defibrillator were implanted into his chest.

"They told us that everything in the chain was there," Mrs. Nicholson said. "That chain was absolutely flawless, but if any part had broken down, the results might not have been as good."

Now, the Nicholson family is working with Nora Helfrich, director of Tri-Community South, in an effort to encourage coaches of community sports leagues to get CPR training and to have automated external defibrillators at fields and gyms.

"Until it hits close to home like this did, people don't take it seriously," Ms. Helfrich said. "People are like, 'Oh ,well, you hear about it.' But you don't think it's going to happen to you."

Tri-Community currently is offering free CPR training to coaches in the Bethel Church (baseball) League and the Bethel Baseball Association as it has to other sports leagues. The training is free because Tri-Community instructors are volunteering their time.

Sam contracted a heart virus when he was 2 weeks old and had been treated for years with medication. His cardiologists had cleared him to play sports, Mrs. Nicholson said.

Sudden cardiac arrest is rare among young athletes, but it does occur.

In December, David Nelson, an eighth-grade high honor student at Norwin Middle School, collapsed and died while playing basketball. An autopsy was inconclusive as to his cause of death.

"It's not going to happen often, but when it does, having everything in place saves a life," said Dr. Robert Hickey, a pediatric emergency room doctor at Children's and chair of the American Heart Association's vascular care committee.

Both Dr. Hickey and Dr. Vincent Mosesso, associate professor of emergency medicine at the University of Pittsburgh School of Medicine and medical director for UPMC prehospital care, support CPR training for coaches.

More likely to survive

The doctors say cardiac arrest victims who receive CPR while awaiting defibrillation are much more likely to survive. Also, quick access to defibrillation increases survival. The doctors say survival rates decrease by 10 percent for each minute without treatment.

Dr. Hickey, who coaches his children's soccer teams, said he believes "most coaches would be in favor of learning CPR if you made it available. Coaches are, in general, people who want to give help."

The problem, he said, is that most coaches are parents who are taking care of their families, working and coaching teams several nights a week. "We need to find an efficient way to do this."

One way is with a self-directed learning program that can be ordered via the Internet and comes in a box with a mannequin and instructional DVD. Dr. Hickey said the kits, developed in part by the American Heart Association, can teach CPR in about 30 minutes.

More information can be found at www.cpranytime.org.

Dr. Mosesso said adolescence is the time that undetected heart ailments arise, and vigorous exercise appears to be a trigger.

An article in the Annals of Emergency Medicine in January 2004, to which Dr. Hickey contributed, said: "Many of these conditions will not be detected during routine screening for school physicals or sports activities, so sudden cardiac arrest may be the first sign of these problems."

Dr. Mosesso said young athletes may experience symptoms they might not recognize as signs of a heart problem.

The symptoms

The symptoms to be alert for during or after exertion are: heaviness or pressure in the chest, shortness of breath that is out of the ordinary, breaking into a cold sweat, a feeling that your heart is racing or beating irregularly, dizziness or light-headedness or any collapse or loss of consciousness.

The incidence of cardiac arrest increases at the high school and college levels, Dr. Mosesso said. Most occur to football players. Basketball produces the second highest number of deaths from sudden cardiac arrest, said Dr. Mosesso, who recently returned from a conference of the National Athletic Trainers Association.

While Dr. Mosesso and Dr. Hickey support CPR training for coaches at all levels, they stop short of insisting that AEDs be required at all athletic events because of the cost, which can be $2,000 or more.

Dr. Mosesso said he recently worked with the Upper St. Clair Athletic Association to install AEDs in the concessions stands at the fields at the municipal center and at Morton Field, two of the township's larger athletic complexes.

Getting AEDs, training

Joseph DeMarco, former president of the Upper St. Clair Athletic Association, which operates most of the community recreation leagues in the township, said Dr. Mosesso helped the group to get grant money for the AEDs.

In addition, Dr. Mosesso volunteered his time to teach CPR to all of the youth football coaches in the township league in recent years, said Mr. DeMarco, a commissioner of the Upper St. Clair youth football league.

Likewise, coaches in the athletic association's basketball program received training through the township recreation department in the use of AEDs, which are available in district schools where the basketball program operates.

"There was a lot of willingness to learn not only for the kids but also for the people in the stands," Mr. DeMarco said.

In Bethel Park, Assistant Municipal Manager Judy Miller said the municipality last year purchased six AEDs for community sports teams to use. The devices are kept at the municipal building, where they can be checked out by coaches to take to games.

The problem is they are not checked out as much as municipal officials had hoped.

"We sent a letter to the sports leagues and it's up to them. We can't force them," Ms. Miller said. "I think a lot of people are intimidated by the whole idea of doing CPR and using one of these on someone. But they are designed to be used even by someone with no training."

Ms. Miller said the municipality purchased the AEDs because of reports of young athletes dying from sudden cardiac arrest in other parts of the country.

"The chances of it happening are remote, but this whole thing with Sam really brings to light that it can happen here," she said.

Mr. Coffield, the neighbor who saved Sam's life, is a Bethel Park municipal employee who took advantage of the free CPR training the municipality offers its employees annually. This year's training will be offered in Bethel Park tomorrow.

Mr. Coffield said he's known CPR for about 10 years, but the first time he used it was on Sam.

"I hope I never have to do it again, but I'd be willing to if I had to. It was certainly worth it."

Sam has returned to school and most of his normal activities. But his participation in sports in on hold for now, his mother said. His implanted defibrillator shocked him once recently when he "was running around," his mother said.

"Right now he is under a restriction with athletics until they can figure out how to control things," Mrs. Nicholson said. "But we are hoping that he will be able to get back to it at some point because he really loves sports."

(Mary Niederberger can be reached at mniederberger@post-gazette.com or 412-851-1866.)