Portable Defibrillators Can Save The Lives Of Young Athletes

Automated external defibrillators (AEDs):

Are new, portable, computerized devices that use defibrillation (electric shock) to restore a regular heartbeat after cardiac arrest caused by Commotio Cordis and heart attacks due to undiagnosed heart problems.

Interpret the victim's heart rhythm, differentiate rhythms that require a shock from normal rhythms, and guide the rescuer through the procedure of shocking the victim by the use of voice messages and visual prompts.

Are suitable for use by trained lay personnel. Such use is permitted in all 50 states; “Good Samaritan” laws protect the rescuer, the owner of the device and the medical director who oversees the program.

Are relatively inexpensive (less than $2000).

Are simple to operate. One study demonstrated that 6th grade students who received a brief orientation to the device could safely administer a shock in a time only slightly longer than highly skilled paramedics. It only takes about 4 hours of training to learn to operate an AED.

Can prevent the death of young athletes, such as Louis Acompora if used within the first few minutes of collapse.

Is it safe to use an AED?
The AccessAED is simple to use, and most importantly, safe and reliable. Easy-to-follow voice and screen prompts guide lay rescuers through the proper use of the device. Multiple, built-in safeguards and warnings protect the rescuer and patient alike. For example, the device is automatically programmed to deliver a shock only when it detects ventricular fibrillation or ventricular tachycardia. Also, the operator must intentionally push the "shock" button, thereby guarding against accidental current release. Still, basic training on safety issues and maintenance is recommended.

What safety considerations do lay rescuers need to remember?
There are important safety considerations to keep in mind while operating the AED. These include not using the AccessAED on a patient who has a detectable pulse, is breathing or conscious. Avoid motion when using the device; do not use the device in a moving motor vehicle. Apply defibrillation pads to the patient’s chest carefully so as not to trap air pockets between the skin and the gel. Also, it is best not to use the device in the vicinity of flammable agents, or in oxygen-rich or wet environments.

Can you use an AED safely on patients with implanted heart devices?
It is safe to use the AED on patients who have implanted devices, such as implantable cardioverter defibrillators (ICDs) or pacemakers, but be sure not to place the pads directly over such devices. Check the patient’s chest for a scar or bulge that signals the location of such a device. Also, avoid placing AED defibrillation pads directly over trans-dermal medication patches.

Can you use an AED safely on children?
Do not use an AED on a child who is under age 8 or weighs less than 55 pounds (or 25 kilograms).

Can the person operating the AED near water ever get shocked?
There is a remote chance of shocking yourself or bystanders if there is water under the patient or pooled nearby. If possible, move the patient to a dry area, remove any wet clothes, and be sure the patient’s chest is dry before applying the defibrillation pads. Also, as you press the "shock" button, do not touch or let anyone else touch any part of the patient.

Are metal surfaces dangerous to bystanders and AED users?
No. As long as you don’t touch the metal surface or patient as you push the "shock" button, there is no shock hazard.

Why does the AED shock the cardiac arrest patient so frequently?
The patient does not always respond to AED treatment immediately. Sometimes it takes more than one shock to stop the fibrillation. Also, once a patient has been successfully defibrillated, the heart can refibrillate, necessitating further shocks.

If AEDs are easy to use, why is basic training necessary?
The AccessAED is very operator friendly, but lay rescuers should be trained to recognize the signs of sudden cardiac arrest, when and how to initiate the chain of survival, and how to administer CPR. Basic training on the AccessAED ensures that the operator is familiar with how to use the device successfully and safely should an emergency arise.

Can a life-threatening error be made using an AED device?
The AccessAED has a very high level of accuracy in determining what action should be taken for a patient in cardiac arrest. The device’s built-in computer uses a sophisticated algorithm to detect if a shock is necessary and if it is, selects the pre-programmed amount of energy. The AccessAED exceeds all industry standards for sensitivity and specifically for rhythm detection. It is very rare for an AED to shock inappropriately.

QUESTIONS CONCERNING AEDS, CPR AND THE RESCUER'S ROLE

Why must you stop CPR as you position the AED defibrillation pads on the patient and wait for analysis?
In order to ensure accuracy of rhythm analysis, the patient must not move while the AED analyzes the heart rhythm. After the AED delivers a shock to the patient, do not restart CPR. Allow the device to reanalyze the patient’s heart rhythm. The AccessAED display will then let the rescuer know if another shock is necessary or if CPR should be initiated.

Once the emergency medical services (EMS) professionals arrive, should the lay rescuer continue giving CPR to the patient?
Yes, the lay rescuer should continue giving CPR to the patient as the EMS professionals arrive on the scene and set up their medical equipment. When the EMS responders are ready they will take over CPR, assess the patient, and provide further emergency care.

After using the AED on the patient, what actions should the lay rescuer take?
The lay rescuer should brief the emergency medical professionals about the resuscitation effort and rescue attempt. If the patient is transferred to an Advanced Life Support AED device, such as the AccessALS‰, the lay rescuer should give the AccessAED’s removable data card to the EMS professionals. The data card can automatically record all ECG wave forms and voice information, the time elapsed from the start of resuscitation, and the number of shocks delivered.

Other than using the AED, how else might a lay rescuer help a sudden cardiac arrest patient?
The lay rescuer may be asked to call 911, get the AED, assist with CPR, offer direction and support to bystanders, family and friends if needed, and stand by to assist EMS professionals with patient information and other duties.

If a responder knows how to operate an AED, why is formal CPR training still necessary?
Along with the AED, early CPR is an important step in the chain of survival. AED operators must know when, why and how to perform CPR, either before using the AED or when the device prompts the rescuer to use CPR instead of shock.

Is the AED so important that it will eventually replace CPR?
No. Using an AED is one critical step in the lifesaving chain of survival; early CPR is another. Both may be important to ensure survival when sudden cardiac arrest strikes.

QUESTIONS PERTAINING TO LIABILITY ISSUES

As a lay responder, can I make things worse for the patient by using the AED device?
Built-in safeguards and warnings protect both the patient and the rescuer. The AccessAED’s sophisticated, internal computer automatically analyzes the patient’s heart rhythm, determines if defibrillation is necessary, and if so, instructs the rescuer to deliver a pre-programmed electrical current through the defibrillation pads and chest wall to stop the heart’s abnormal electrical activity. The device is automatically programmed to deliver a shock only when it detects an irregular heartbeat. Also, the operator must actually push the "shock" button, thereby guarding against accidental current release.

As a lay responder operating the AED device, am I at risk for liability issues?
If you are a licensed and trained medical first responder, you must follow an established standard of care. If you operate within those guidelines you are protected under the law. If you are a lay rescuer trained in the use of AEDs, then you are protected under Good Samaritan laws. As long as you act in good faith, you will be free of liability.

What if the patient has a pulse, but I can’t feel it and use the AED device?
The device will be able to detect whether or not the patient requires defibrillation after analyzing the patient’s heart rhythm. You should follow the text and voice prompts to guide you in the correct use of the device. If the patient has a pulse, they will not have a rhythm that requires defibrillation and the AccessAED will identify the rhythm as non-shockable.

QUESTIONS PERTAINING TO THE AccessAED AND AccessALS

What is the difference between the AccessAED and the AccessALS?
The AccessALS can be used both as an AED and as a manual mode defibrillator. Only someone qualified in Advanced Cardiac Life Support would use the manual mode of operation. The AccessALS turns on as an automated external defibrillator but can be overridden by an advanced user.

DATA CARD

Is the use of a data card optional? If there is no data card or the data card is full, can the device still be used?
The user has the option to use a data card for rescue event data collection. The AccessAED is also able to function without a data card or with a full data card, allowing some information to be temporarily stored in the device, and retrieved only prior to turning the device off. The user must install a data card in order to collect and evaluate full rescue event data. Data cards are available from Access CardioSystems and are recommended.

How can the data be reviewed if there is no data card installed in the AED?
The user can review limited event data on the screen of the AED. If a data card is installed, users can review the event data via the Access Data Management Software (DMS) on a PC. DMS is available from Access CardioSystems.

How can the recorded data be downloaded? Can it be downloaded via the IR Port or only through a PC-based card reader?
Data can only be downloaded to a PC using a USB card reader. The IR port is for manufacturer’s testing only.

POWER AND BATTERIES

How is the AccessAED powered?
The AccessAED is powered by a disposable Lithium Manganese Dioxide battery pack. A new battery has the capacity for two hours of monitoring and at least 10 full energy defibrillation shocks, or 30 full energy shocks without monitoring. Monitoring for less than two continuous hours will allow more than 10 shocks, up to a maximum of 30, to be available. "Replace Battery" warning indicates the battery is low and needs to be replaced immediately. Once the battery is placed into the device, the AED will perform automated self-tests every 24 hours. The battery must be replaced after each use.

What is the total life of the battery?
The total life of the battery is five years. While left in the device the shelf life will be two years.

Can the batteries be changed during use of the device, i.e. "hot-swapped"?
Yes, the battery can be briefly removed and changed during use. If the device is off for less than one minute, the AccessAED will continue the same rescue sequence. If the battery remains out or the device remains off for more than one minute, the AccessAED will assume that a new patient rescue has begun.

What is the normal working life span of the AED?
The normal working life span of the AccessAED, not including the pads and accessories, is five years. The Operator’s Manual should be referenced for specific warranty information.

How can I be sure the AccessAED will be ready to use whenever I might need it?
The AccessAED will conduct a self-check every 24 hours. A flashing green light in the front of the AED means the device has passed its most recent self-test and is ready for operation. A flashing red light indicates the device has failed its self-test; the battery should be replaced immediately. The AED should be checked for the presence of the green light on a daily basis.

MAINTENANCE

What is the recommended maintenance for the device?
The Operator’s Manual should be read for detailed instructions on maintenance for the AccessAED.

The device should be visually inspected on a daily basis to ensure the device’s green indicator light can be seen. Every month, all supplies, accessories, and spares should be checked to be sure they have not expired, are not damaged, and are clean. Expired supplies should be replaced and additional replacements should be ordered. After each use, the battery and defibrillation pads should be replaced. If signs of damage are visible, contact Access CardioSystems as soon as possible. The device is chemically resistant to most common cleaning agents, and cleaning is simple.

 

Commotio Cordis

Commotio Cordis is the medical term for a rare disruption of the heart's electrical system resulting from a blunt impact to the chest that leads to cardiac arrest. There are many other pieces of information that youth sports parents may be interested in knowing about.

Has been documented in over 128 cases in the four years since the formation of the United States Commotio Cordis Registry in Minneapolis, Minnesota in 1998, although the true number of deaths is unknown because of underreporting and misclassification.

Occurs most often in baseball. But aside from baseball and lacrosse (three deaths of players from New York in two years; one near death of a player at a Massachusetts prep school), commotio cordis has stricken those playing hockey, softball, soccer and karate. In the fall of 2000, two football players died from blows to the sternum delivered by a helmet. In one case, a young boy reportedly died after his father poked him in the chest.

Is largely the result not of the force of the blow but from an incredibly timely blow contacting the chest directly over the heart at just the wrong time -- the precise millisecond between heart contractions that throws the heart into a lethal abnormal heart rhythm called “ventricular fibrillation” or VF, which causes a useless quivering of the heart that results in a complete cessation of circulation instantly depriving the brain and other vital organs without circulation and oxygen. The blows usually causes no identifiable structural injury to the ribs, sternum or to the heart itself.

Occurs most often in healthy young athletes, who are especially at risk because the pliability of their chest walls. In a study of 55 cases of sudden cardiac arrest, 90% were 16 years of age or younger, 25 were playing in organized athletic events such as baseball, softball, and ice hockey. The remaining 30 children were playing informal sports at home, school or on the playground. None of the children showed evidence of any heart defect or diseases.

Cannot be completely eliminated through the use of protective equipment. Chest protectors do not appear to protect against it: athletes have died wearing chest protectors while playing baseball, lacrosse, hockey and softball. Studies have shown that the use of softer, lighter baseballs may reduce the risk of commotio cordis. Softer, heavier (so-called Reduction In Force or “RIF”) baseballs may actually increase the risk of commotio cordis.

Has a survival rate that declines by approximately 7 to 10% for every additional minute that passes without defibrillation. After 12 minutes, the time Emergency Medical Service (EMS) paramedics typically arrive, it is usually too late (the national survival rate from sudden cardiac arrest (SCA) is a dismal 5%. In some cities it is as low as 1 to 2%.

Requires community-based programs using Automated External Defibrillators (AEDs) if the survival rate is to be increased. When defibrillation is delivered in one minute, the reported survival rates can be as high as 90%. For defibrillation within 5 minutes, the survival rate can be as high as 50%.

Requires community-based programs using Automated External Defibrillators (AEDs) if the survival rate is to be increased. When defibrillation is delivered in one minute, the reported survival rates can be as high as 90%. For defibrillation within 5 minutes, the survival rate can be as high as 50%.

To prevent deaths from Commotio Cordis it is necessary to train coaches, bystanders and other sports personnel in the recognition of this event and the timely response. Basic life support training and access to AEDs are crucial to achieve this goal.