As reported in newspapers across the country on Friday, Sept. 13th. 1996:

On Wednesday, September 11th. 1996, the F.D.A. approved a smaller, less expensive automatic defibrillator that can be used by first responders to re-start the heart in cardiac arrest. As many as a third of the 300,000 Americans that suffer from fatal cardiac arrest could be saved if emergency workers had delivered an electrical shock to the heart in the first critical minutes.

Paramedics carry defibrillators that can do that, but they are bulky, complicated and expensive and requires significant training to operate. Most first responders like police and firefighters do not have this vital equipment that can change the outcome of a "full arrest' in the first few minutes. "Time to Shock" is the term we use as paramedics. Cardiologist are demanding the smaller more affordable units for all emergency workers. They should be placed in all first aid boxes.

The first new system to be approved is the "ForeRunner" from Heartstream Inc. It only weighs 4 pounds and is the size of a book. It will cost between $3,000.00 and $4,000.00. It has a computer screen that displays the rhythm so the operator can see if the patient is responding to the shocks. Less than 25% of all emergency vehicles carry the older automatic defibrillator units. And, less than 1% of police cars have them.

In a pilot program in Rochester, Minn. the survival rate for cardiac arrest is 50%. The average rate nationwide is less than 5%. They were placed on 12 police cars. Anyone with minimal training required for emergency work can operate them. A voice and computer screen prompts the user. The unit also has a recorder inherent that maintains a complete record for the cardiologist and E.R. doctors.

Airlines carry the larger auto-defibrillators but the F.D.A. did not approve the new machine for use on planes as there is no data to indicate if altitude has an affect on its performance.

Time to Shock:

Auto defibrillators became a useful tool in the emergency setting in 1987 when fire companies used them to evaluate and shock the "life threatening" rhythms. This in some cases while the paramedic unit was still en-route. V-Tack and V-Fib can be stopped with the shock and the internal electrical impulses from the heart can regain control and activate a normal and viable heart rhythm. However; the heart will eventually become less stable and the irritable area of electrical tissue and muscle will again disrupt the electrical sequence.

The physiologics of this event called Cardiac Arrest:

In V-Tack the heart is beating too fast to refill between beats, so less fluid is pumped out. This is called decreaed cardiac output or decreased "stroke vollume." In V-Fib the cardiac muscle is beating irregularly and uncontrolled and quivering. In this case there is no cardiac output. Unconciousness will occur almost immediately in V-Tack and immediately in V-Fib. We call this "clinical death" as the pump has failed and the dynamics of life has ceased. Death is eminent and "biological death" begins in 4 to 6 minutes. Conscious V-Tack does occur and presents the emergency worker with a challenge as the patient needs to be shocked while they are alert. We administer Valium to create an amnesiac affect prior to the countershock.. Lidocaine and other "cardiac electrical desensitizing drugs" must be given immediately or as soon as possible to prevent this from re-occurring. We call this reccurent or refractory V-Fib or V-Tack. Prior to going into Asystole, or "Flat Line," the heart will begin to beat irregularly and then very fast and unproductive. Eventually Ventricular Tachycardia will ensue and then Ventricular Fibrillation. This is the time to shock and turn the inevitable outcome around. Even in Asystole (no contractions or electrical function), drugs like Epinephrine and Atropine can generate an impulse and then possibly a contraction or V-Fib, V-Tack which could then be converted to a viable rhythm.

Someday, maybe the national survival rate could be as great as the study in Rochester.

by Mitch Mendler E.M.T. ParamedicFireFighter

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