Posted: 4/23/2009 10:58:52 PM EDT
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Hi, This question is for EMT's and anybody else that might have an opinion.
I re-certified myself, and my assistant coaches in CPR yesterday, and AED instruction was part of the course. I hadn't heard of this device before, but it makes sense. I spent much of the day reading up on this device, and am trying to decide if it's worth the cost. I run a program with about 300 kids between the ages of 3-16, and there are also many parents and grandparents that are there on a given day. I can't seem to find one anywhere for less then 1000.00, and need to justify the expense to the board, IF its a good idea to have at all. Thoughts? |
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they are handy to have around, but they're not an instant quick fix either. good, effective CPR until the ambulance arrives would be more valuable, in my opinion. but, if you've got the extra cash, sure. Thanks. I'm trying to decide if "handy" is worth the cost. We are all trained in CPR etc, and the response time here is about 5 minutes. I can make it happen if it's worth it to buy one. I'm just trying to figure that part out. |
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they are handy to have around, but they're not an instant quick fix either. good, effective CPR until the ambulance arrives would be more valuable, in my opinion. but, if you've got the extra cash, sure. Thanks. I'm trying to decide if "handy" is worth the cost. We are all trained in CPR etc, and the response time here is about 5 minutes. I can make it happen if it's worth it to buy one. I'm just trying to figure that part out. Well, the possibility of saving someone with it vs losing them without it is a very real one. Also, consider that even with defibrillation, ambulances, hospitals, CPR, cardiac drugs, dead chicken voodoo and everything else, a person going into cardiac arrest has a very poor chance at survival. less than 20% if memory serves me. If you have the cash available to spend to give yourself that much more of a chance to be the person who makes that 20% work, then i support that 100%. if not, having everyone trained on CPR and ensuring that they know what to do when the time comes is pretty damn good too. I like it when i have a couple extra set of hands on scene that can perform exceptional CPR when i arrive, to free my partner and i up to do other things. i say this as someone who works on an ambulance as my full time job. plain and simple, the AED is an effective device on people that are in v-fib or pulseless v-tach. assuming that there are not other complicating factors, and that you've got good CPR in progress. i can't say whether or not it's worth it to you. |
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If I remember the numbers correctly, a patient in V-fib is 7 times more likely to survive CPR if it is augmented by an AED. Ok, how often would that be an issue with 3-16 year olds? I can get this approved, but have to have a reasonable argument as to how it would be advantageous in my work setting. |
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With 3-16yo's? I'd guess it would be essentially a non-issue. For mom/dad Granny/Gramps it would be a pretty big issue. Early Defib is the third link in the "chain of survival" http://www.chainofsurvival.com/cos/Early_Defibrillation_detail.asp From the link: When CPR and defibrillation are provided within eight minutes of an episode, a person's chance of survival increases to 20%. 1 When these steps are provided within four minutes and a paramedic arrives within eight minutes, the likelihood of survival increases to over 40%. 1 ETA: Also, look into grants. There are a bunch of them floating around. |
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With 3-16yo's? I'd guess it would be essentially a non-issue. For mom/dad Granny/Gramps it would be a pretty big issue. Early Defib is the third link in the "chain of survival" http://www.chainofsurvival.com/cos/Early_Defibrillation_detail.asp ETA: Also, look into grants. There are a bunch of them floating around. Thanks. I spent the day reading about this. Day to day it's just the kids there. Parents, siblings are there too. Competitions easily have 1000 people, many of them friends and grandparents. I'm really leaning towards having this on hand, and hoping we never need to use it. |
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If I remember the numbers correctly, a patient in V-fib is 7 times more likely to survive CPR if it is augmented by an AED. Ok, how often would that be an issue with 3-16 year olds? I can get this approved, but have to have a reasonable argument as to how it would be advantageous in my work setting. 3-16 year olds have parents................. If parents get to watch the activity, or grandparents, or you have refs or other officials, you could save one of them. Also AED's seem to be getting more common, and people are starting to expect them in facilities where groups gather. |
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Look around, there are a bunch of associations and charities that promote their use and availability in public places. Somebody might have a grant or a donation for you. If I can get on point, and have a good argument as to why we need one, I'm sure the board will buy one. |
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If I remember the numbers correctly, a patient in V-fib is 7 times more likely to survive CPR if it is augmented by an AED. Ok, how often would that be an issue with 3-16 year olds? I can get this approved, but have to have a reasonable argument as to how it would be advantageous in my work setting. 3-16 year olds have parents................. If parents get to watch the activity, or grandparents, or you have refs or other officials, you could save one of them. Also AED's seem to be getting more common, and people are starting to expect them in facilities where groups gather. The competitions have many hundreds of people attending, including happy, smiling grandparents. OK, point was made. I'll go to bat with my BOD. |
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I suppose it depends on who we are, what we do, and who we work for.
I picked up my AED cert from a DAN conference for two basic reasons. The more I know, the more valuable I am to other people (and being able to help others falls into that category). Secondly, conferences for me usually cost a pretty penny in travel, fees, hotels and I want to make sure I get everything I can out of them. But there is a concern in one direction. In the non police world, not so much, but in the police world, there is the question of putting someone such as a crook in that situation, such as with a round to chest with someone wearing body armor; is the officer then legally obligated to go to that person's aid? That, on a side point, is a bitter legal pill for while it seems like it would make sense to have deputies cross trained as EMT's for the populace, it generates a conflict issue when the person in need was the offender who was shooting at you a moment ago. Of course, in the non police world, that conflict is less or doesn't exist. But then, there is another stand point of the coin if one is in a leadership position. That is, if something goes wrong and there is an investigation, what will it show in preparation, even if the devices weren't used? The more resources one has under the belt, the easier the jury might be on them. Hence, I get what medical training I can when I can. About the individual unit? Well, if someone else was buying, that's one thing, but I think it is a little bit out of my pocketbook for what I do. Now, if I was a sports trainer, I might think differently. Which brings up an interesting point. What is the possibility for one of those kids to squarely hit another one in the chest and send them into fibrillation? I would hope low; children should be allowed to be children, be allowed to play. However, this article might suggest a decent possibility. It may be the reason you are looking for though I do not know about its accuracy. __________________________________________________________________________ ("You done got a double dose of rock salt, right in the ole tit. Now not havin tits as fine or as big as yours, I can't even imagine how bad that sh** stings."––Budd to The Bride, (w,stte), "Kill Bill Vol: 2") |
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Almost everywhere around here in terms of schools and programs has AEDs on site. I've even heard of a push to make them mandatory in certain public buildings like airports, etc.
They are RETARDEDLY simple to use. A braindead, blind monkey with one hand can use one. And they can REALLY help. Early (within 5 minutes of a witnessed collapse) can SAVE people's lives. Check with your local EMS system, fire department or police department. They may be aware of grants, cooperative agreements, etc, or they may be about to phase out an older one. You could easily source a donation of a used unit and upgrade later on. A local physician here has a program where he secures funding and provides the AED's and training so that the jail, all the police cars, other public buildings, etc all have AED's. I highly recommend it, and it could be an excellent PR point for your program. Of course (insert dark humor) if you do get one, and end up making a 'save', you can count on the fact that the next 5 AED's will be provided through generous donations by family members! ETA - do you have water on site? IIRC, children involved in near-drownings who are defibrillated have a huge chance of survival. I may be mixing up my facts but I distinctly remember some connection between children, near-drownings, and AEDs. Very handy talking point with as many kids as you've got in your program. |
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they are simple to use and work. We have one in each of our squad cars, so if a cop can make it work right then anyone can. We have used them and saved some people with them. As for cost I second looking for charities, grants etc to help pay. All of our (I think we have 20 between the road and station house AED's) were purchased with money from local charities.
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| Absolutely you should have one, especially if you have a bunch of children playing sports. Look up 'commotio cordis' on wikipedia. While not common, it CAN happen. While effective CPR is necessary, someone in ventricular fibrillation NEEDS to be de-fibrillated. It is also generally the first heart rhythm seen in cardiac arrest. By the time I (paramedic) get there with my fancy drugs, the patient usually has already moved on to another heart rhythm. The patients with the greatest chance of surviving are the ones that receive both effective CPR and early de-fibrillation prior to the arrival of EMS. |
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Get the AED.... Do whatever you can to have it cause trust me they work.
People are right in that they aren't the save all, but if the pt does need to be defibrilated the earlier its done the higher the chance it will work. I've seen them used on young and old. |
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Look into your local resources. PAD (Public Access to Defibrillation) programs are popping up everywhere as the availability of an AED in places where people gather in numbers are more often becoming required rather than nice to have. These public agencies like the local Department of Health or Emergency Medical Services may have a pricing-plan in place with a manufacturer or distributor that might make one more affordable for your organization. Many people have made the excellent suggestion of looking for a grant, also look at some of your local civic/fraternal organizations like the Lions Club, Ladies Auxiliary, etc. If all this fails and you need justification for the Board for the expenditure, one life saved will outweigh the purchase price of an AED at even 10 times the cost. Could they afford the legal expense of being sued by an angry family who can't believe that something that is so common place at almost every school, library, and restaurant in the United States wasn't available to save their loved one?
Most adults who need CPR are suffering from a problem cardiac in nature, most children from a respiratory problem (IE: Choking, Submersion, etc.). However, when dealing with sports-related incidents where children are struck in the chest, an AED is invaluable. The external force applied to the chest caused a sudden, rapid compression of the heart - which in turn generated an electrical impulse, a natural property of heart muscle is the ability to generate it's own electrical impulses, this is what is seen on an EKG. Anyway, if at the 'wrong' time during the heart's normal electro-mechanical cycle (the naturally occurring electrical impulses trigger mechanical contraction of the heart muscle) an errant impulse is generated, it may disrupt the heart's normally ordered rhythm. The most commonly encountered of them are Ventricular Fibrillation and Ventricular Tachycardia, both loosely termed as rhythms of Cardiac Arrest (no blood circulation). Ventricular Fibrillation AKA V-Fib is a quivering of the large chambers of the heart. Chaotic electrical impulses are stimulating the heart in such a disorganized fashion that the muscle cannot contract as a group, which is how the heart pumps blood. Ventricular Tachycardia or V-Tach (pronounced Vee-Tack) is a rapid stimulation of the heart that causes the muscle of the large chambers to contract as a group but very rapidly, too rapid to allow the heart to fill with enough blood to circulate and generate a pulse in this case. V-tach can occur where the rate isn't too fast to allow filling of the heart, this type will also allow a pulse to be generated. Therefore, there are two types of V-tach; Pulseless V-tach and V-tach with a pulse. I know, they really reached with those names, right? Anyway, an AED will recognize and 'shock' both V-Fib & V-Tach, which is why it's important to be sure the person affected is actually in cardiac arrest and does not have a pulse. An AED will shock someone in V-Tach with a pulse because the EKG looks exactly the same as Pulseless V-Tach, the only difference being the presence of a pulse, which AEDs don't measure (Yet, anyway). So, the AED is connected to the patient by peeling and sticking a set of electrode pads to the chest and then turned on, some will power up when you open their case. It will analyze the EKG and determine if a shock is indicated, meaning the victim is in one of the two rhythms above, and it will act accordingly. Some require you to press a flashing button to deliver the shock and some will do it automatically after playing a warning alarm or voice recording telling everyone not to touch the patient. When this shock is delivered, it causes a complete discharge of all the electrical activity in the heart, stopping it, in the hopes that it's naturally ordered rhythm will begin again. Just keep in mind that AEDs are generally made for use on adults, you usually need specially designed supplies for use on children. Make sure that whatever you purchase has the ability to 'step down' the Joules (energy) setting for use with small children, most often just a set of pediatric electrode pads are all that's needed. Good luck and I hope you can get the funds together, it's for the children. LOL! American Heart Association - AED/PAD Programs ETA: I'm a Critical Care Paramedic/Educator with over 18 years in EMS. I've seen first hand what good CPR and timely use of an AED can accomplish. Again, good luck. |
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I was also going to recommend finding a PAD program in your area. Been running on an ambulance for almost 16 years but I teach mostly now for a Level I Trauma Center & Academic Hospital. American Heart Association Guidelines are to attach an AED to any unresponsive patient over the age of one year who has no spontaneous respirations and no pulse. There has not been enough data on the effectiveness of AED use in patients less than one year old. Lay rescuers are taught to attach one if there is no response and no spontaneous respirations (no pusle checks). Given that your population includes parents/grandparents I think it would be worth the money to purchase an AED. Our clinics that don't have advanced care practitioners have these monitors becuase the pads interface with what local EMS agencies are using: Zoll AED Plus The Phillips FR2 is also a good machine. Found some of those on Ebay for around $1000. |
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Quoted: With 3-16yo's? I'd guess it would be essentially a non-issue. For mom/dad Granny/Gramps it would be a pretty big issue. Early Defib is the third link in the "chain of survival" http://www.chainofsurvival.com/cos/Early_Defibrillation_detail.asp From the link: When CPR and defibrillation are provided within eight minutes of an episode, a person's chance of survival increases to 20%. 1When these steps are provided within four minutes and a paramedicarrives within eight minutes, the likelihood of survival increases toover 40%. 1 ETA: Also, look into grants. There are a bunch of them floating around. What he said. I'm a big fan of AED's as witnessed arrests due to shockable arrythmia's are some of the people who can actually make a full recovery (if they don't die from it first). Like Zack said, the percentage of cardiac arrest survival sucks - but these patients who go into V-Fib or V- Tach are some of our greatest opportunities as far as "saves" go. We had an off duty FF save a visiting man at Port Columbus a few years ago. The man wasn't aware he had a heart condition (until he woke up in the hospital after being defibbed on the airport floor). I personally defibbed a 34 y.o. man at a restaurant a few months ago with no cardiac history. So yeah, you might get one and never use it - but what if you use it just ONCE and it works.  |
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If I remember the numbers correctly, a patient in V-fib is 7 times more likely to survive CPR if it is augmented by an AED. Ok, how often would that be an issue with 3-16 year olds? I can get this approved, but have to have a reasonable argument as to how it would be advantageous in my work setting. 3-16 year olds probably very rare to require the AED, but if their parents or grandparents are routinely on the premises (or even adult staff, for that matter), the AED may be the valuable step in emergency response care that prevents death. Your insurer may provide you with a rate cut for having one available. Check with them to find out. I test for my AED cert next week. 
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| In our state there is a law requiring AED's to to be installed in public builds, child sports events and health clubs. I just purchased 6 AED's last week for several members of our team. Check with your local or state CTC to see if they have a discounted program. |
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ETA - do you have water on site? IIRC, children involved in near-drownings who are defibrillated have a huge chance of survival. I may be mixing up my facts but I distinctly remember some connection between children, near-drownings, and AEDs. Very handy talking point with as many kids as you've got in your program. Yes. Blunt trauma isn't an issue where I work, but drowning certainly is. It's never happened, and we are very careful, obsessively so...but that it the most likely cause of a child being injured where I work. |