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.)

'True Miracle' Saves Driver's Life

April 27, 2006

Mary Blome and Steve Earle join Carolyn Holt
to talk about "miracle" life-saving
(CBS/The Early Show)
"The first thing I remember is waking up in
the intensive care unit of the hospital and
people saying to me, 'what do you remember?'
 And I said, 'Nothing.'"...Carolyn Holt

[Click here to watch "The Early Show" (CBS) interview]

(CBS) Luck was on the side of a Missouri woman who went into cardiac arrest while driving.

Carolyn Holt was alone in her car on Friday, driving in St. Charles, Mo., when her heart stopped beating. She drifted across several lanes of traffic and then crashed into a guard rail. Other drivers stopped to help and by sheer luck, two of them were nurses and one was a defibrillator salesman — who happened to have a defibrillator in his car.

A truck driver used his trailer hitch to smash through a window and pull Holt out of the car. The nurses performed CPR and then used the defibrillator to shock Holt back to life. She spent the week in the hospital and is expected to be released April 27.

Holt joined two of her good Samaritans, Mary Blome, the nurse, and Steve Earle, the salesman, for an interview with The Early Show Thursday morning. She told co-anchor Julie Chen she has no memory of those terrifying moments on the road.

"Everybody finds it hard to believe, but the first thing I remember is waking up in the intensive care unit of the hospital and people saying to me, 'what do you remember?' And I said, 'Nothing,'" Holt told Chen. "So they started telling me the story about my very helpful friends."

Earle, who was driving with his wife to pick up their daughter, described the moment when he realized someone was in trouble. "We basically saw traffic slowing down, and Carolyn's car coming across the center line very, very slowly," he said. "At that point when I sort of swerved to go around her, I looked over and realized there was definitely something wrong. She looked to be unconscious at the wheel, and that's when we, along with several other cars, pulled over, and went over to see what was wrong."

Blome is a registered nurse and she jumped into action. "We went over to knock on the window. We thought this was just a small vehicle accident, and realized that Carolyn wasn't responsive. So the other man that is not with us today smashed in the window of the vehicle, and the gentleman got Carolyn out, and the other nurse and I assessed her and realized that she was in big trouble and we started CPR, compressions and breathing," she said. "Then Steve came with the defibrillator. It was a true miracle that evening."

As a salesman, Earle says he always carries defibrillators in his car — but it was unusual to be in his car at that point during the day. "It was strange luck that day because when we finish up work for the day, a lot of times we'll get in my wife's car and take it out to eat or to pick my daughter up. We just happened to get into my car for some reason."

Holt was full of thanks for her saviors and said, considering the amazing luck she's had, she might just buy a lottery ticket when she's released from the hospital.

©MMVI, CBS Broadcasting Inc. All Rights Reserved.

'Our Hero': School Nurse Saves Life With Defibrillator

April 13, 2006

Gary Bissaillon and Susan Decker
performed CPR on Marcellus school
psychologist Hans Smid, second from left.
At far right is school nurse Debbie
Bowman, who used the defibrillator,
which is on the table.

Debbie Bowman has been a nurse at Marcellus Middle School , 10 miles southwest of Syracuse , for 16 years. On Jan. 23, she learned she hadn't seen everything yet.

At 8:15 that morning, school psychologist Hans Smid was attending a routine meeting at Marcellus Elementary School when the unthinkable happened — his heart stopped.

The 38-year-old Smid collapsed from cardiac arrest. It would be another 15 minutes before the elementary school nurse would report to work. As one colleague dialed 911, another placed a frantic call to Bowman at the middle school.

Gut feeling

"I just dropped everything and ran," Bowman explained. "You just have a gut feeling about things sometimes."

Fortunately, the elementary, middle and high school are on the same campus. Bowman was at the scene in less than a minute.

School principal Gary Bissaillon and elementary teacher Susan Decker already were performing cardiopulmonary resuscitation on Smid, thanks to a program in which district nurses train school personnel throughout the year on life-saving techniques.

The bad news was that the emergency crew had not yet arrived and Smid was not coming around. Fortunately, the school was equipped with an Automated External Defibrillator.

A state law enacted in 2002 and backed by New York State United Teachers requires defibrillators in all public schools and at scholastic events.

The law has already saved several lives, including that of a 16-year-old student from Naples , near Rochester , in November. Teacher Courtney Conrad of the Naples TA and two colleagues used an AED after the student collapsed. Marcellus has had the AED devices since the legislation was passed, Bowman said.

"I screamed, 'Someone get me the AED!' and I had it within seconds," Bowman recalled. "You just go into tunnel vision."

AEDs read heart rhythms and will provide shocks only if they are necessary. The AED advised administering a shock and then a second one. After the second shock, Bowman said, the AED reported no further shocks were necessary.

Still, Smid remained unconscious. Bowman continued CPR and mouth-to-mouth resuscitation, aided by the building principal.

Several seconds later, Smid took a deep breath — and so did Bowman. Smid was breathing on his own and showing signs of regaining consciousness when the ambulance arrived.

"We didn't leave them much work to do," Bowman said.

Smid, who has a history of heart problems, is back at school. Whether he would have been so fortunate without the AED is debatable.

Unafraid

"You can't be afraid of the AED," Bowman said. "You're not going to hurt anyone. It won't let you."

For Bowman, Jan. 23 was a day of firsts. It was the first time she ever had to use an AED on school grounds, and it was the first time she had ever met Smid, a fellow member of the Marcellus Faculty Association.

"Debbie is our hero," said MFA President Terry McSweeney.

— Kevin Hart

NYSUT.org. Copyright New York State United Teachers. 800 Troy-Schenectady Road, Latham, New York, 12110-2455. 518.213.6000. www.nysut.org.

Port Authority Expands Award-Winning Defibrillator Program at Facilities

Nearly 10 years after the Port Authority pioneered the use of automated external defibrillators (AEDs) within its police department, the agency will greatly expand the program with the purchase of 1,200 new AEDs for use at its airports, PATH rapid-transit rail system, tunnels, bridges, bus terminals and port terminals in New York and New Jersey.

Getting to the heart of athletes' silent killer: Medicine tries to get a grasp on athletes' heart problems

PATRICIA ANSTETT (online@rgj.com)

DETROIT FREE PRESS

February 28, 2006

Are athletes engaged in intense training or competitive sports at risk of suddenly dropping dead from heart problems? Highly publicized cases over the years -- the latest involving Detroit Red Wings defenseman Jiri Fischer, 25, whose promising career might have ended after he collapsed on the bench with heart problems during a November game -- have triggered parental and public concern.

They raise these and other questions:

· Who needs to worry about sudden heart death?

· What are the warning signs?

· Should all competitive athletes be screened for heart problems starting in high school?

· What kinds of tests should they undergo?

· Can athletes with serious heart problems be treated and return to active sports?

For players, parents, coaches and fans, we've culled through the research and talked to half a dozen specialists in heart disease and sports medicine. Here is a summary of the problems, the warning signs, the treatments and prevention issues.

The Problems

A range of heart problems can affect athletes. Hypertrophic cardiomyopathy, a disease of the heart muscle that causes it to enlarge and weaken, has gotten the most attention. It is usually hereditary and relatively rare, occurring in one in every 300 to every 500 people. It is the most common cause of sudden heart deaths -- those that occur within one hour of initial symptoms -- among people under age 30 in the United States.

So what happens? Under a microscope, heart muscle cells appear disorganized, not parallel and neatly arranged as they should be. This molecular disorganization, most likely caused by genetic mutations passed along in a family, interrupts transmission of the heart's electrical signals, often causing the heart to beat irregularly.

The most dangerous type is ventricular arrhythmia, which occurs when the heartbeat races to as many as 300 beats a minute, compared with 50 to 80 beats a minute in a normal, resting heart. That's believed to be the type of heartbeat irregularity Fischer experienced when he collapsed and nearly died before he was shocked back to life with a rink-side automatic external defibrillator.

Other things that can cause sudden cardiac death in athletes include high blood pressure, diabetes, high cholesterol, obesity, smoking, inherited diseases such as Marfan's syndrome, heart valve defects and other heart abnormalities, steroids and recreational drugs.

Intense training can trigger a condition called athletic heart syndrome, which causes a thickened heart muscle. Up to now, most experts considered the condition rather harmless. If it does cause problems, they tend to be less dangerous heartbeat irregularities that can be easily fixed with medicine or minimally invasive operations. Detroit Lions quarterback Joey Harrington, for example, underwent such a procedure in March 2003 and later returned to NFL play.

Experts also thought athletic heart syndrome was relatively benign because muscle thickness often reverted to normal once the athlete stopped engaging in intense exercise. Although that often may be true, "it may not be all that simple," says Dr. Archie Roberts, a former NFL quarterback with the Cleveland Browns and Miami Dolphins who became a heart surgeon after his retirement from sports.

Some heart muscles don't automatically reduce in size on retirement from sports, says Roberts, who directs the Living Heart Foundation, a nonprofit New Jersey organization involved with heart disease research. The increasing size of some athletes, the absence of conditioning in retirement and joint pain from lifelong sports activities might limit an athlete's ability to exercise and maintain a heart-healthy lifestyle, he says. "What is apparent physically, like large body size or obesity, may be the tip of the iceberg in retired athletes," Roberts says.

Warning Signs and Testing

Athletes with these signs should see a doctor:

· Family history of heart problems before age 50, particularly sudden heart death.

· Heart murmur detected in an exam.

· High blood pressure.

· Fainting or dizziness.

· Shortness of breath during exercise.

· Diabetes or high cholesterol.

Pre-participation physicals required for high school and college sports vary. Parents and athletes need to take these physicals seriously and report any warning signs to doctors, says Dr. Steven Karageanes, sports medicine specialist for the Henry Ford Health System.

Those showing signs of heart trouble typically undergo a thorough medical history, an electrocardiogram, or EKG, and possibly an echocardiogram, an ultrasound test of the heart. Some countries, notably Italy, require heart screening and EKGs for high school and other athletes, but U.S. experts say that with as many as 15 million people involved with competitive sports, the costs would be too great for the few cases they might detect. Adults who begin sports or intense training at 40 and older also should consider heart screening tests, experts say.

Treatments

Drugs for heartbeat irregularities might help, but some athletes are reluctant to take the medicines because they fear the medicines decrease performance, doctors say. Athletes with less serious heartbeat irregularities could need a minimally invasive procedure, radiofrequency ablation, to correct the rhythm. It often cures the problem and the athlete no longer needs to take heartbeat medicines.

Implantable internal defibrillators help prevent sudden cardiac death from serious heartbeat irregularity problems, but the American Heart Association, does not recommend that athletes with the devices engage in intense sports because they can misfire or be disconnected during aggressive physical contact.

Athletes who have died from heart-related deaths:

-- Jim Fixx, 51, runner, author, heart attack, 1984

-- Len Bias, 22, all-American college basketball player, cocaine-related heart attack, 1986

-- Pete Maravich, 40, Hall of Fame NBA star, heart attack due to congenital defect, 1988

-- Hank Gathers, 23, Loyola Marymount basketball player, cardiac arrhythmia, 1990

-- Reggie Lewis, 27, Boston Celtics, cardiac arrhythmia, 1993

-- Flo Hyman, 31, Olympic volleyball player, heart attack due to Marfan's syndrome, 1986

-- Florence Griffith Joyner, 38, Olympic track and field athlete, heart seizure, 1998

-- Sergei Grinkov, 28, gold medal-winning Russian pairs skater, early-onset arteriosclerosis, 1995

-- Darryl Kile, 33, St. Louis Cardinals, heart attack due to arteriosclerosis, 2002

-- Sergei Zholtok, 31, Nashville Predators, cardiac arrhythmia, 2004.

-- Jason Collier, 28, Atlanta Hawks, abnormally enlarged heart, 2005.

Athletes diagnosed with heart problems:

-- Robert Traylor, Cleveland Cavaliers. Open-heart surgery for bad aorta in mid-November. Inactive.

-- Juwan Howard, Houston Rockets. Heart infection. Out six months; now active.

-- Eddy Curry, N.Y. Knicks. Heart arrhythmia episode last spring. Refused to take DNA test from Bulls. Active.

-- Joey Harrington, Detroit Lions. Irregular heartbeat in December 2002. Catheter ablation procedure corrected problem.

-- Mario Lemieux, Pittsburgh Penguins. Irregular heartbeat. Retired.

-- Jiri Fischer, Detroit Red Wings. Heart stopped in game Nov. 21. Out indefinitely.

-- Ronny Turiaf, L.A. Lakers. Surgery in July for enlarged aortic root. Inactive.

-- Fred Hoiberg, Minnesota Timberwolves. Surgery in June for enlarged aortic root. Inactive.

Source: Free Press research

http://news.rgj.com/apps/pbcs.dll/article?AID=2006602280316

Machebeuf JV Coach Collapses at Game

By Neil H. Devlin

Denver Post Staff Writer

Cherry Hills Village - (2/17/2006) Tom Young, the junior varsity boys basketball coach at Bishop Machebeuf, suffered what appeared to be a massive heart attack Thursday while his team was playing at Kent Denver.

He was taken to Swedish Medical Center, where a spokesman said he was in serious condition. Julie Lonborg also said doctors were attempting to confirm the reason for Young's collapse. Kent Denver varsity coach Todd Schayes visited Young late Thursday and said he was alert.

Young collapsed on the Buffaloes' sideline with 4:23 remaining in the fourth quarter and his team trailing 40-30. It devastated the players, coaches, fans and officials at Kent Denver's Black Field House, some of whom immediately rushed to Young's aid.

A plea for a doctor was answered through happenstance by Jonathan Branch, the father of Bishop Machebeuf varsity player Nick Branch, and a male nurse at Walter Reed Hospital in Washington, D.C., who recently traveled to Colorado to watch his son compete.

The elder Branch performed CPR and used a portable defibrillator that helped to revive Young. After several anxious moments, local EMTs arrived and took Young by ambulance to Swedish.

Jonathan Branch, who received thanks from several crowd members for his quick action, said Young "probably suffered a heart attack."

Through Lonborg, Young's wife, Joanne, said, "I'm terribly grateful for everyone's help."

Fans prayed out loud while Young was being treated, and Buffaloes players, many of whom refused to go to the locker room, were cheering for their coach to come out of it.

"I'm extremely proud of the kids and fans who witnessed this and handled it," Kent Denver athletic director Scott Yates said.

The rest of the junior varsity game was canceled. A decision on the postponed varsity game, which was to be the Class 3A Metropolitan League finale of the 2005-06 season, may be made today, Yates said.

All contents Copyright 2006 The Denver Post or other copyright holders.