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block required was only three
<br /> .ours, of which a fair amount of
<br />time was spent on reviewing
<br />CPR techniques. They learned
<br />the proper placement of the elec-
<br />trode pads on the upper and
<br />lower chest. Then, as soon as the
<br />pads are in place and the unit
<br />activated, the computer
<br />microchip begins its analysis of
<br />the patient's heart rhythm. In a
<br />matter of seconds the unit will
<br />determine if the rhythm is irreg-
<br />uiar, and if it is one that can be
<br />terminated by an electrical
<br />shock. If the nature of the
<br />patients condition is one that
<br />electrical shock cannot reverse,
<br />the audible voice command will
<br />announce that a shock is not
<br />indicated. On the other hand, if a
<br />reversible condition exists, the
<br />voice command tells the officer
<br />that a shock is indicated. "Do not
<br />touch the patient" is the audible
<br />prompt the defibrillator uses
<br />while it analyzes the rhythm.
<br />During this short period of time
<br />the machine has been building a
<br />charge of direct current that is
<br />sufficient to "stun" the heart.
<br />When that charge is sufficient,
<br />the audible prompt tells the offi-
<br />cer to deliver the shock by press-
<br />ing a button, and the high
<br />energy shock is sent from one
<br />electrode pad to the other, pass-
<br />ing through the patient's heart.
<br />In some cases only one shock is
<br />needed to return the heart of
<br />normal rhythm, where in others,
<br />multiple shocks may be required.
<br />In either event, the device will
<br />not allow a shock to be delivered
<br />unless the patient's condition
<br />requires it. For lack of a better
<br />term, it is about as close to fool-
<br />proof as you can get.
<br /> As one might expect, during
<br /> this initial training there was a
<br /> fair amount of skepticism and
<br /> concern expressed by some offi-
<br /> cers, and rightly so. After all,
<br /> this was all new, and there was
<br /> no experience from other law
<br /> enforcement agencies to refer to,
<br />
<br />one way or another. All in all
<br />however, in the finest pioneering
<br />spirit, they mostly agreed that,
<br />
<br />"If it has a
<br />chance of saving
<br />more lives, we're
<br />willing to give it
<br />our best shot."
<br /> While training
<br />
<br />In the finest pioneering spirit, they
<br />mostly agreed that, "if it has a
<br />chance of saving more lives, we're
<br />willing to give it our best shot.~
<br />
<br />was taking place, decisions were
<br />made as to the deployment of
<br />these initial units. It was deter-
<br />mined that placing one of the
<br />units in squad cars in each of the
<br />four city quadrants would allow
<br />for the greatest likelihood of one
<br />being closely available when a
<br />cardiac episode occurs.
<br />Dispatchers were briefed on the
<br />importance of getting a defibril-
<br />lator equipped unit rolling on
<br />any suspected heart attack calls.
<br />A system was devised for keep-
<br />ing the battery packs charged
<br />and replacement of batteries at
<br />shift change time. As soon as
<br />possible after each incident, a
<br />debriefing would take place
<br />between the officers involved and
<br />Dr. White. By November 1 the
<br />program was ready to start.
<br />
<br />Evidence begins to build
<br /> Statistics show that, nation-
<br />ally, of the out-of-hospital car-
<br />diac arrest incidents that occur
<br />each year, the average survival
<br />rate is presently in the range of
<br />five to ten percent. In Rochester,
<br />before the defibrillator program
<br />began, the survival rate was
<br />already at 28 to 30 percent,
<br />much higher than the national
<br />average. Several factors probably
<br />contributed to this higher than
<br />average rate, such as, the prox-
<br />imity to the Mayo medical com-
<br />plex, the degree of competency of
<br />the ambulance paramedics, and
<br />the amount of on-going training
<br />provided to the police as first
<br />responders. Even so, the firm
<br />belief was that this figure could
<br />be much higher if Dr. White's
<br />theory was correct. By the end of
<br />1992, even though the total num-
<br />
<br />ber of incidents was not high, the
<br />figures seemed to support the
<br />theory. Of the 14 patients with
<br />iventricular fib-
<br />rillation that
<br />the units had
<br />been used on,
<br />seven regained
<br />their pulses
<br />after shocks were delivered by
<br />police officers, and all seven were
<br />survivors. The other seven
<br />needed additional paramedic
<br />treatment, and three of these
<br />patients survived. Thus, 10 of
<br />the 14 patients initially treated
<br />by police officers survived. These
<br />two year outcomes were pub-
<br />lished in a medical journal in
<br />1994. Ironically, one of those
<br />patients who was saved was
<br />recently retired Rochester P.D.
<br />Captain Clark Tuttle, who had
<br />collapsed during one of his regu-
<br />lar daily walks. Thankfully,
<br />because of the ability of the offi-
<br />cers to deliver that early shock,
<br />Clark is still enjoying his daily
<br />walks.
<br /> With these early successes, the
<br /> decision was made to continue
<br /> the program, and to expand the
<br /> number of units available. By
<br /> early 1993, four additional
<br /> FirstMedic 510 units were pur-
<br /> chased, and again deployed
<br /> equally in the quadrants of the
<br /> city. The collection and analysis
<br /> of incident data was beginning to
<br /> receive recognition from medical
<br /> authorities around the country.
<br /> It was decided that this data col-
<br /> lection would be continued indef-
<br /> initely and shared through arti-
<br /> cles published in medical jour-
<br /> hals. By the spring of 1995,
<br /> another manufacturer of defibril-
<br /> lators that had become aware of
<br /> our program expressed interest
<br /> in having us field test some of
<br /> their units. Survivalink
<br /> Corporation of Minneapolis had
<br /> developed a unit that was about
<br /> half the size and weight of the
<br /> earlier devices, and added even
<br /> (continued on next page)
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<br /> DECEMBER, 1996 5
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