Imagine this: you’re driving down the street thinking about your plans for the day when you see a panicked pedestrian waving you down to an unconscious man laying on the ground not breathing.
In this situation, most people wouldn’t know what to do or they would panic. It’s not something anyone wants to think about, but it happens way more often than people think. Cardiac arrest is the leading cause of death in America and more than half occur outside of a hospital setting with less than a 6% survival rate. Being prepared is how we save lives and prevent the worst from happening. Something as simple as an Automated External Defibrillator (AED) can completely change a horrible situation. However, the majority of Americans don’t know what an AED is or how it works.
The AED is a simple machine that usually only requires a push of a button and to follow prompts. It is used to detect a pulse and decide whether or not to deliver a shock to those suffering from a cardiac arrest. There can be some better design to the machine itself, but the most important part of the AED is the knowledge of them and the accessibility to the machines. It’s important for people to be comfortable with how to use an AED, especially in a high stress environment like that of an emergency situation. The more comfortable someone is with using something, the more likely they are to be of help. Educating people about the AED and how it’s used is fundamental in getting them comfortable with them.
CPR and AED training is not a common practice, especially the training combined is even more rare of an occurrence. They should both be taught in school and everyone should know how to utilize both like they know addition and subtraction. A cardiac arrest victim needs to be attended to within the first minutes of the arrest in order to have the best chance of survival. CPR is very important in keeping the heart pumping, but an AED is the most important in getting the heart beating on its own again. AED use within the first 5 minutes of a cardiac arrest almost doubles the survival rate. Comprehensive education on AED use to the public will prepare bystanders to act as soon as possible and in turn increase survival rates.
However, education doesn’t solve the entire problem. There is a great lack of accessibility to AEDs. The machines cost almost $1500 a piece, which is astounding for something that is the difference between life and death for more than a third of our country. With greater education and access to AEDs, thousands of lives can be saved every year. Think about having an AED like a spare tire in the car prepared and ready to go when it’s needed the most. Instead of panicking when you get waved down, you’ll be ready to do everything you can to save someone’s life.
Sec. 12. Use of an automated external defibrillator; exemption from civil liability for emergency care. As provided in Section 30 of the Automated External Defibrillator Act, any automated external defibrillator user who in good faith and without fee or compensation renders emergency medical care involving the use of an automated external defibrillator in accordance with his or her training is not liable for any civil damages as a result of any act or omission, except for willful and wanton misconduct, by that person in rendering that care.
In all 50 states of the United States of America there is some form of the Good Samaritan Law. In Illinois there is a subsection that directly relates to the use of automated external defibrillators (AED) as can be read above. This law protects those that provide care for others in emergency situations with the stipulation that they are providing non-negligent or non-reckless care.
Though the Good Samaritan Law is common in the United States, it is not customary in other countries. One specific example is Italy, which is considered by the World Health Organization to have the second most efficient public healthcare system next to France. The public healthcare system may be extremely efficient in Italy, but this lack of a Good Samaritan Law reduces the public use of AEDs. This reduction in usage also correlates with a reduction in survival rates of out-of-hospital cardiac arrests.
In order for a person to utilize an AED in Italy, they are required to hold a certificate for its usage. With this law, AED use in Italy was disproportionately lower than where the Good Samaritan law exists. Overall the reduction in use outweighs the pros of what holding a certificate entails. It may help to improve comfortableness with using the AED and also knowledge on the AED itself and what it does; however, the AED is already very simplistic. The design of the AED is made for any person to understand.
In America there is a general lack of knowledge of what the AED is, but with the Good Samaritan law people may be more inclined to at least try to help. However, those in Italy have the added pressure of possibly being penalized for trying to help someone suffering from a cardiac arrest. This law is a huge hindrance in the survival rate of out-of-hospital cardiac arrests.
The integration of a certificate program and a Good Samaritan law may be a possible answer to increasing survival rates for cardiac arrests. The certificate would not be required, but would be a recommended program that is regularly publicized by the government. A recommended program would increase awareness of AED use and knowledge of the design of the AED, which in turn should strengthen the public comfort in emergency situations. Also, the Good Samaritan Law will reduce the fear of being penalized for helping in an emergency situation with an adverse outcome.
While Italy and the United States may have advanced health care systems and emergency medicine structures, other countries like Peru and Madagascar face a different story. In Madagascar specifically, there is a major lack of infrastructure in general. Their healthcare system relies heavily on homeopathic methods that have been passed down generationally and minimally on local allopathic clinics. Peru has a higher level of healthcare infrastructure, but their emergency medicine programs and response is very newly implemented.
Emergency medicine has been formally recognized since the 1960s within America. One of the most common complaints and emergent issues that presents outside and inside the emergency room is chest pain. Because of this, the American Heart Association (AHA) has created what is called the Out-of-hospital Chain of Survival, which outlines the most important steps when responding to a cardiac emergency. While this guideline has been around since 1983 in America it was only just adopted in 2010 in Peru. In this Chain of Survival, one of the most important steps is rapid defibrillation, which is provided by an AED
One case study in Peru followed the use of public AEDs in public facilities and commercial and residential facilities. Within one year, the study showed an 11.6% usage of an AED in a public space at least once in these facilities. There is no existing data on the mortality rates from cardiac events within Peru, but it is known that cardiovascular disease is the second leading cause of death in the country. This fact shows the importance in gathering that mortality and other data and researching more on this issue within Peru.
Peru seems like they are taking steps to further their emergency medicine infrastructure and response with the implementation of the Chain of Survival, but other countries like Madagascar lack the ability to execute plans like what the AHA created. During my time in Madagascar and also my research afterwards, there was little to be found surrounding the topic of emergency medicine and AEDs. One thing that I found was the single AED on campus at the American School of Antananarivo. With that being said, time is the most essential factor in a cardiac emergency or any emergency. There is only one AED on the entire campus and the health clinic is 10 minutes away from an ambulance service, not even a hospital.
The infrastructure of Madagascar doesn’t allow for an effective emergency medicine system. Seconds make the biggest difference in a cardiac emergency. Someone having a heart attack can’t wait 10 minutes for an ambulance to then drive half an hour away to the nearest hospital. They can’t even wait for someone to run and go get the AED that’s all the way across campus. Emergency medicine is important, but it’s not simple. There’s a lot of structural change outside of medicine that needs to happen in order to have an effective and efficient general and emergency medical system.
