Tuesday, July 18, 2000

A Defibrillator Near You? Advocates call for distribution in schools, public areas

By Felice Buckvar.

July 18, 2000 - WHEN JOHN ACOMPORA answered the telephone early June 12 the first words he heard were, "There was another incident on Long Island." Acompora knew exactly what the caller, a doctor friend, was referring to. Another youngster had suffered cardiac arrest from a fatal blow to the chest. This time it was 7-year-old Ryan Blanco of Centereach, hit by a line drive while practicing baseball with his brother.

"Not again!" Acompora exclaimed, immediately reliving March 25 when his son Louis, 14, a healthy, athletic lacrosse player, blocked a ball with his chest during a game, and in front of players, coaches, friends and his parents, walked a few steps, then collapsed. His heart had gone into arrhythmia; the heart was not pumping because the rhythm was chaotic.

With the memory of that day and the sorrow of losing their son still so achingly fresh, the Acomporas have found a cause. "The only known way to reverse a death like Louis' is with a defibrillator," John Acompora said. "It should be readily available. We're on a campaign now to get every school district in Suffolk County, New York State and the United States of America to have a defibrillator program."

In addition to the equipment carried by ambulances, almost every fire truck and police car on Long Island now comes equipped with an automated external defibrillator. Their use is also being expanded in the city. This easy-to-use, lightweight machine is attached with wires to pads placed on a victim's chest and transmits the shocks that can re-establish a viable heart rhythm. But this device usually must be brought to victims after 911 has been called and a vehicle has arrived at the emergency site. The window of opportunity for defibrillation is five minutes or brain damage occurs, and each minute that passes from the beginning of the attack reduces the likelihood of survival by 10 percent.

Suffolk County Legis. Andrew Crecca (R-Hauppauge) agrees with the Acomporas' goals. He sponsored a bill to grant $2,500 to Suffolk school districts to purchase a defibrillator. Discussion on the bill was tabled in a budget committee meeting in June, but Crecca said, "It was more of a monetary issue than anything else. Members liked the idea of getting defibrillators not only into the schools but into other public places." The legislature will vote on the establishment of a task force on the issue at its meeting on Aug. 8.

At a meeting on July 10 in Albany, members of the Community Health and Pupil Services team and others at the state Education Department decided they would send a document as soon as possible guiding schools on proper placement and use of defibrillators, according to Donna J. Kopec, regional manager in eastern New York State for Emergency Cardiovascular Care Programs for the American Heart Association. She attended the meeting, as did school nurses and administrators and a physician-moderator.

"The tone from the state Education Department was very supportive of the concept. They did not have to be talked into it," she said.

In Queens, fire trucks, EMS vehicles, ambulances in the 911 system and police emergency services trucks carry defibrillators. In general, patrol cars do not, but each precinct has at least one defibrillator and staff trained in its use. Some precincts are involved in a pilot program to train officers.

In addition, enterprises such as the U.S. Tennis Association and the Sheraton LaGuardia East Hotel have the devices, with security personnel trained to use them.

One Long Islander who unqualifiedly supports public access to automated defibrillators in schools and elsewhere is Julie Lycksell, an operating room nurse in cardiovascular procedures at St. Catherine's Hospital in Smithtown. In 1998, she collapsed while celebrating her birthday at a Port Jefferson restaurant with her husband. Luckily, all the steps the American Heart Association considers important in its "chain of survival" fell into place.

Among other things that went according to recommendations: 911 was called, early CPR and defibrillation were administered, and she received early advanced care.

Lycksell was later moved to St. Francis Hospital in Roslyn where doctors implanted an internal defibrillator. Since then, she has had no further incidents, and she is back to work.

The majority of victims of cardiac arrest are older than 65. Although a recent brochure from the American Heart Association states that only 5 percent of those who suffer sudden cardiac arrest now survive and predict that 20 percent more may be saved under optimum conditions, even more dramatic results seem to be coming about.

James Sciammarella, a doctor of emergency medicine at Mercy Medical Center in Rockville Centre and volunteer chairman of Operation Heartbeat for the Long Island region, said, "Nine out of 12 who suffered cardiac arrest at Chicago's O'Hare Airport were resuscitated" with emergency treatment that included use of automated defibrillators.

In Nassau County, of 27 uses of automated defibrillators by police in the latter part of 1999, when the program was implemented, there were four positive pulse reactions. Since Jan. 1, 74 uses resulted in 10 positive pulses. The present scenario is usually that the police car is the first responder to a 911 call, followed by an ambulance with emergency medical technicians who take over at the scene after the police have started CPR and defibrillation.

Pearl Logliandro, 81, of Mineola, is a recent survivor. On April 30, she collapsed. "She was pretty much gone," Mary Warnecke, her daughter, said. A registered nurse at Mercy Medical Center in Rockville Centre and a trustee of the village, Warnecke added, "I would say that usually in the community, there is a 1 percent chance of survival when an elderly person suffers sudden cardiac arrest." Warnecke was at work, but her husband, Thomas Warnecke, was with Logliandro in their home. A volunteer emergency medical technician, he called 911 and started CPR. Police on patrol in Mineola arrived quickly and used an automated defibrillator to establish a pulse. They were followed by an ambulance with emergency personnel who took over the procedures. Logliandro eventually required bypass surgery and returned home June 22.

One of the police officers, John Larson of Nassau's Third Precinct, did the CPR while his partner, Michael Walters, set up their automated defibrillator.

Larson said he had been trained in an extensive program on emergency medical techniques and then received additional training in a four-hour course reviewing CPR and adding the use of a defibrillator.

He explained how easy the device is to use: "The machine advises you to shock or not to shock. The machine tells you to stand clear if a shock is going to be administered." In both Lycksell's and Logliandro's cases, the police officers administered the shocks. Increasingly, public access defibrillators are being purchased for use by trained lay persons such as the lifeguards at Splish Splash, a 40-acre water park in Calverton, staff members at the Mid-Island Y Jewish Community Center in Plainview and the security staff of Cablevision Systems Corp. in Bethpage. The latter owns 28 defibrillators, one for each security office and patrol vehicle.

In the Three Village School District Herbert Friedman, director of Health, Physical Education, Recreation and Athletics, plans to "move forward and implement a defibrillator program for the fall," he said.

Meanwhile, in other states, such as Florida and Wisconsin, fund-raising drives by students, parents, businesses and service organizations, with grants for training, have been putting automated defibrillators into schools.

Felice Buckvar is a freelance writer.

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