AED Effectiveness and Cost --> RE: Preparing for Office Emergencies

[Guest guest]

Kathy,

I suspect the AEDs actually work quite well for V-fib - see article below.

The question for our offices is --> is the expense of having one on hand worth the rare occurence in a solo/small practice.

Even at O'Hare, Midway, and Meigs, they only had 21 cardiac arrests over a 2 year period. So the chances of that occuring in our office are much smaller.

Of those 21 arrests -- 18 had V-fib and 11 saved with AED -- 3 remained in V-fib despite AED and 4 didn't have an AED nearby, these 7 died.

So, in my mind the question isn't whether the AEDs work for V-fib, but does the frequency/cost match up.

Also, they aren't helpful for unstable Tachy or unstable A-fib since it won't recognize the rhythm as shockable.

BTW, the costs on these things are coming down -- $800-$1,300 on ebay.

If one could get together with others in the building, the cost would come down.Or perhaps put a jar out front in the office saying the office will pay for 1/2 and donations will pay for 1/2.

What if the AED cost $500 for your practice -- would you get it?

$250? $100? $50?

What is our cut-off for being able to treat V-fib?

I'm not sure what my cut off is.

In our 3 person group (before it dissolved), we made the decision to buy one to have on hand.

That AED then went to a doc in the same hallway as me after the group split.

He has offered to share it in case of arrest.

Below is some futher info.

Locke, MD

Public Use of Automated External Defibrillators

Sherry L. Caffrey, E.M.T.-P., a J. Willoughby, D.O., M.H.P.E., E. Pepe, M.D., M.P.H., and Lance B. Becker, M.D.

ABSTRACT

Background Automated external defibrillators save lives when they are used by designated personnel in certain public settings. We performed a two-year prospective study at three Chicago airports to assess whether random bystanders witnessing out-of-hospital cardiac arrests would retrieve and successfully use automated external defibrillators.

Methods Defibrillators were installed a brisk 60-to-90-second walk apart throughout passenger terminals at O'Hare, Midway, and Meigs Field airports, which together serve more than 100 million passengers per year. The use of defibrillators was promoted by public-service videos in waiting areas, pamphlets, and reports in the media. We assessed the time from notification of the dispatchers to defibrillation, survival rate at 72 hours and at one year among persons with cardiac arrest, their neurologic status, and the characteristics of rescuers.

Results Over a two-year period, 21 persons had nontraumatic cardiac arrest, 18 of whom had ventricular fibrillation. With two exceptions, defibrillator operators were good Samaritans, acting voluntarily. In the case of four patients with ventricular fibrillation, defibrillators were neither nearby nor used within five minutes, and none of these patients survived. Three others remained in fibrillation and eventually died, despite the rapid use of a defibrillator (within five minutes). Eleven patients with ventricular fibrillation were successfully resuscitated, including eight who regained consciousness before hospital admission. No shock was delivered in four cases of suspected cardiac arrest, and the device correctly indicated that the problem was not due to ventricular fibrillation. The rescuers of 6 of the 11 successfully resuscitated patients had no training or experience in the use of automated defibrillators, although 3 had medical degrees. Ten of the 18 patients with ventricular fibrillation were alive and neurologically intact at one year.

Conclusions Automated external defibrillators deployed in readily accessible, well-marked public areas in Chicago airports were used effectively to assist patients with cardiac arrest. In the cases of survivors, most of the users had no duty to act and no prior training in the use of these devices.

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From: [mailto: ] On Behalf Of Kathy SaradarianSent: Friday, February 08, 2008 5:57 AMTo: Subject: RE: Preparing for Office Emergencies

I agree with almost everything but the AED. I think the need for AEDs have been created by the maker of the machine. And with all the recalls I get notice of every month, I wonder how many actually work. Correct me if I am wrong (I know you will) but I thought AEDs only shock identifiable V-tach, that’s the “A” (Automatic) in AED. I don’t believe that happens all that often, even in hospital witnessed arrests. I wonder how many AED prevented deaths there really are out there/year.

I don’t keep IV solution for several reasons: 1) I have not found a source to buy just one and they expire frequently, same with the needles, 2) I almost never start IVs now that I am not a resident and am terribly out of practice, 3) we have pretty quick EMS response time and for the chest pain and the SVT I have had to call in EMS they were there in minutes.

I do encourage potential emergencies to just go to the ER and skip my office.

I have a receptionist and a biller in the office with me, so it would be difficult to do more than support someone while waiting for EMS. The receptionist is good at calling 911 so I don’t need to be on the phone.

I do keep aspirin, NTG, epinephrine (not the pens as very expensive and expire in a year, the vial is dirt cheap and I write the dose on the box so I don’t need to read when panicking, I mean excited. This is for 911 emergencies.

I have always had a nebulizer and use it a lot. Not only for asthma and bronchitis but to do spirometry. I keep O2. I have gauze, tape and dressing supplies should a bleeder ever walk in. I have steroid because epi wears off quickly so if ever a severe allergic reaction I feel starting the next phase of treatment is beneficial. I also keep Tylenol because parent will bring their kids in with high fevers so “you can see it”.

And don’t forget the chicken soup, or juice or cookies for that vasovagal person who tries to or does pass out on you.

I used to get Rocephin samples but they have always expired on my shelf so I won’t buy it.

My thoughts.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing