In 2008, the Sudden Cardiac Arrest Foundation honored Roman Matlaga with its first-ever People Saving People award for saving the life of a fellow basketball player who had collapsed during a game.
After Matlaga administered CPR and one AED (automated external defibrillator) shock, the stricken man awoke and asked, "Did we win?" Although Matlaga is an emergency physician, he stressed that it doesn't take a doctor to save a life. "Any one of my teammates could have taken charge of the situation," he said.
Luckily for Matlaga and his fallen teammate, the elementary school gymnasium had an AED onsite. In 1997, Florida was the first state to enact a broad public access law regarding equipping public facilities with AEDs. As of 2001, all fifty states had enacted defibrillator laws or adopted regulations regarding the use of AEDs, according to a report by the National Conference of State Legislatures.
Many states allow a "Good Samaritan" exemption from liability for any individual who renders emergency treatment with a defibrillator. In 1998, President Clinton signed the Aviation Medical Assistance Act, which states that air carriers and individuals "shall not be liable for damages" in attempting to obtain or provide assistance on airplanes. In 2000, Clinton signed similar legislation regarding the placement of AEDs in federal buildings and providing civil immunity for authorized users.
Federal momentum supporting AEDs continued under President Bush, who signed legislation in 2002 authorizing millions of dollars in federal grants to purchase and place AEDs in public places, as well as to train first responders in life-saving care. The bill also encouraged private companies to purchase AEDs and train employees in CPR and emergency defibrillation.
“Good Samaritan” laws are worth noting, particularly because current AEDs can easily guide non-medical personnel through the process by audible or visual prompts. The American Heart Association notes that at least 20,000 lives could be saved annually by rapid use of AEDs by bystanders, and up to 50,000 lives saved annually with broad deployment of AEDs among trained responders.
Once the patient’s heart is shocked back to rhythm, it’s up to the community to ensure the patient has access to the best care. A recent report by Rokos et al in the J ournal of American College of Cardiology: Intervention found that highly specialized STEMI networks are able to coordinate care to allow door-to-balloon time in less than 90 minutes in 85 percent of patients. Once thought unlikely, such coordinated efforts, particularly involving EMS personnel, are now being touted as the gold standard.
The key is the ability to perform a pre-hospital EKC, determine if the patient has STEMI, and alert the nearest qualified hospital to activate the cath lab. “This is an important demonstration project. It can no longer be argued that it is impossible to establish an integrated EMS and hospital system to provide faster primary PCI,” wrote Christopher B. Granger, MD, in an accompanying editorial. Despite a 24 percent rate of false positive STEMI calls from EMS personnel, STEMI networks are the “wave of the future.”
More importantly, this study shows that “reperfusion with primary PCI can be provided more rapidly if EMS is placed in its rightful position as the front line for integrated STEMI care. “Expansion of what these 10 networks have done on a national scale—refined and coupled with better EMS support, data collection and feedback—will improve care and save lives,” said Granger.
On these or any other topics, feel free to send me comments.
Chris P. Kaiser