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Portable defibrillators increase survival rates Rochester survival rates, one of the best in the nation

By Bill Lisser

Mon, Feb 27th, 2012
Posted in All Health & Wellness

Sudden cardiac death is one of the six leading causes of death in the United States. It can happen unexpectedly in people with no previous history of heart disease. When the initial rhythm of the heart is in ventricular fibrillation, the key to survival for people in this condition is to provide service quickly with the use of the defibrillator. “It makes a huge difference of survival how quickly we can deliver the shock,” said Dr. Roger White of the Mayo Clinic. “It’s very, very important they (Emergency Medical Personnel) get there quickly.”

A time difference of as little as one minute appears to influence outcomes and survival according to a study completed by White and his colleagues. After the delivery of the shock, it’s very important to get right back to CPR, as this is one of the keys to survival for the patient. “This keeps the blood flowing to the heart,” White said. According to White, it took some time for everyone to understand the importance of this step. “We are over that, they’re very efficient now,” said White.

Dr. White has been working with emergency medical services since he arrived at Mayo Clinic in 1970. He is the Co-Medical Director of the Mayo Clinic Medical Transport, Medical Director of the City of Rochester and Olmsted County Early Defibrillation Program while working in association with the Department of Anesthesiology and Division of Cardiovascular Diseases, Department of Internal Medicine and the Department of Emergency Medicine, Division of Prehospital Medicine at the Mayo Clinic. His work has propelled Rochester to the top in comparison with other cities in the country for survival rates for by-stander witnessed ventricular fibrillation.

What happens when an individual suffering ventricular fibrillation is shocked with the defibrillator? The defibrillation process causes the heart to stop fibrillating. When this happens the heart can regain its own rhythm. The fibrillation of the heart causes the lower two chambers of the heart to not function properly and not do their job. That job is to deliver blood to all the vital organs.

In 1990, there were four defibrillators in police cars in Rochester. It was a two year trial period and a breakthrough period for the equipment. “We wanted to see if it would make any difference,” said Dr. White. The program which involved the use of the portable defibrillator and the ability to shock the patient before reaching the hospital showed benefits. In 1994, the program was expanded to more police cars. In 1996, reports showed higher survival rates for bystander witnessed cardiac arrest so defibrillators were added to fire vehicles in Rochester and later they were added to Sheriff’s cars. When defibrillators became portable enough to transport them, Gold Cross vehicles were the first vehicles to get them. The initial equipment weighed 13 pounds and was not easily moved around.

In 2006, a new generation of defibrillators was introduced. A company donated 60 defibrillators to the City of Rochester. The equipment was paying off and showed remarkably good results according to Dr. White. There are defibrillators located in many public locations including schools, malls, and many other businesses. “Many times the police officer can arrive on the scene before people can get equipment ready to use,” White said. “Police officers will tell you that this is the most rewarding thing in their work.” The Rochester emergency response system dispatches police, fire-rescue and ambulance personnel simultaneously. Police and fire-rescue personnel are equipped with automated external defibrillators and advanced life-support is provided by paramedics.

Dr. White captures all details of cardiac events from the time the call comes into the dispatcher until the patient reaches the hospital to evaluate the process and how the procedure was carried out. “We want to know ourselves how we are doing,” Dr. White said. White will review audio, video, and the results of procedures performed on patients as shown on the graphic monitor. He can also review video tape from police cars to get the entire picture of what took place. There have been cases where emergency personnel have repeated the process of CPR and defibrillation for 96 minutes in one case, and 63 minutes in another. Both individuals survived and are living normal lives today.

The dispatcher sometimes gets called into action to help someone performing CPR that is not totally familiar with it. The dispatcher would tell them to push the chest hard and fast. Let the chest come all the way up between pumps. Count out load so I can count with you.

With Rochester already at the top of the list with successful outcomes, I asked Dr. White what would need to happen to improve on that success. “The major impact on survival in our city and county would occur by more bystanders knowing how to do CPR; CPR buys time while the emergency personnel are en route. Defibrillators (AEDs, automated external defibrillators) are becoming smaller and lighter, which increases their portability and ease of use. But the most critical determination of survival in our location is performance of skillful CPR by witnesses or bystanders.”

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