Let's Talk About Sudden Cardiac Arrest

If someone has a heart attack in a public place, will you know what to do? The most common action is to dial 9-1-1. When you call an emergency operator, they in turn contact first responders, who will then transport emergency personnel to the location you’ve provided.

All of that takes time. And, time is a killer.

The first five minutes after a person suffers a major heart attack is critical to the patient’s survival. To provide the average citizen with the best opportunity at survival, Automatic External Defibrillators or AEDs are now positioned in many places where they may be useful.

Today, you’ll find an AED in many public places, including hotels, libraries, restaurants, the Los Angeles Airport (LAX), as well as many office buildings and other facilities. There is substantial evidence that using an AED within the first three to five minutes after someone suffers cardiac arrest, the survival rate of those individuals will increase substantially.

IMPORTANT NOTE: An AED is NOT to be used when someone has a pulse, or on an individual who has been physically injured (trauma), or on a small child (under 14 months of age).

How does an AED work?

Externally, an AED is a pretty simple looking device. And, like the name implies, it is automatic in operation. The job of the AED is to shock the heart back into a status where it can pump blood to the brain and the body. More technically, the AED can determine if the patient’s heart is pulseless - referred to as being in ventricular fibrillation (v-fib). If so, the AED will send a shock to the heart, attempting to restart it.

Why does the heart stop pumping blood?

The human heart is a remarkable organ. To discuss it in detail here would take many pages and hyperlinks. So, let’s focus on one simple aspect of the human heart: there are conditions in which the heart will stop functioning as intended. That is what is referred to as sudden cardiac arrest.

When the human heart stops pumping (and there may be many reasons for this), it will continue to receive nerve impulses from the brain. These impulses may create additional “confusion” or “chaos” for the heart, due to the rate these impulses are fired and the “status” of the heart. Think of an individual who stutters when they speak. They are trying to say something, but the words won’t come out as they’d like. When the heart is involved, this means it cannot beat - or expel enough blood to keep the patient’s circulatory system (and the oxygen carried in the blood) functioning. No blood = no life.

A person’s brain cells will begin to die after being deprived of oxygen for between four and six minutes.

Did you know the LAFD organizes their fire station "first in" districts based on the time it takes to get to a patient in cardiac arrest? More than 84% of the department's calls are EMS, or medical-related. Getting to a patient within the first crucial five minutes is a key initiative of the LAFD.

Learn how the Los Angeles Fire Department responds to an emergency, such as sudden cardiac arrest: Click Here.

The heart will twitch in an uncoordinated manner (moving but not pumping) until one of two things happens: it no longer receives nerve (electrical) impulses from the brain (and then stops altogether), or it is shocked back into a “rhythm” - and that’s where the AED becomes so valuable. Using an external electrical shock, the AED can interrupt the brain instructions momentarily with a strong electrical pulse, allowing the nerve impulses that have been chaotic in delivery to resume a more organized interaction with the heart - and as a result, the heart can resume beating again.

The patient may be extremely ill and in need of extensive medical treatment. The key is to keep the heart in rhythm until physicians at a hospital and intervene and provide the medical care the patient may require.

What should you do when someone falls over, suffering from apparent sudden cardiac arrest?

1. CALL 9-1-1: If someone falls over and is obviously in need of medical attention, call for medical assistance. Be certain to provide accurate instructions on how to find you, and if asked, stay on the line and provide the medical dispatcher with any information they may ask of you. Note that in the City of Los Angeles, all dispatchers are sworn LA City Firefighters - and as a result, are also Emergency Medical Technicians (EMTs). As a result, they may try to gain additional information about the patient, so the minimal amount of time will go by pending the arrival of paramedics or other first responders.
2. ABCs for Life: It’s very important to check the patient’s airway to ensure it isn’t blocked. Next, check person’s respirations. If there is no pulse, it’s very important to begin CPR - and there are a number of places where anyone can learn how to properly do CPR. Chest compressions can be an effective alternative to an AED, but only pending the arrival of medical professionals.
3. AED Support: Look about, and if there are other people nearby, have someone assist you in searching for an AED. They are typically in white boxes mounted on a wall, with black and red lettering to identify them. Keep delivering CPR to the patient and do not stop until the AED is ready to analyze the patient, or medics arrive. (NOTE: If the patient is bleeding, that is a fairly strong indicator that the patient has a pulse.) If there is a pulse, an AED should NOT be used. It’s important to have a team of people coordinating this support. The LAFD always dispatches a number of firefighters, as each one can perform a specific job. If medics are not on-scene, try to partner with someone: one person to perform CPR and another to operate the AED and communicate via phone with the emergency dispatcher.
4. AED Awareness: (NOTE: This information should not be considered instruction on AED use, but rather, information about how it is used.) Most AED devices have adhesive pads. These are applied to a bare chest and to the AED device. Most AED devices have instructions that highlight how these adhesive pads are used. Do not improvise when using an AED. They are automatic in use and as such, the only thing you should worry about is following the directions on the device (and hopefully the training you’ve undertaken). Typically, the positive pad is attached to the patient’s left chest near the side (axillary line) just below the nipple and pectoral muscle. The negative pad is attached to the victim’s upper chest wall, above the nipple. Maintain CPR while the AED leads are being attached. Turn on the AED. Stop CPR (this is required for an accurate analysis regarding the need to apply a shock). It will analyze the heart rhythm of the victim and indicate if a shock is appropriate. NOTE: A shock will only be applied if the heart is in ventricular fibrillation. If a shock is indicated, move away from the patient (do not touch him/her), indicate “CLEAR” verbally and press the SHOCK button. If a NO SHOCK indication is made by the AED, it will typically mean one of the following things: The victim has a pulse; the victim is without a pulse, but is not in a shockable rhythm.
5. Cycles for Survival: The process described above may need to be repeated in a series of cycles. The American Heart Association and the Red Cross have varying methods for instruction regarding CPR and use of an AED. Typically, you will perform CPR for five cycles of 30 compressions to two breaths (NOTE: This technique varies, and we would stress that some basic life safety education is appropriate for every person living in L.A.). After two minutes stand clear and let the AED determine if the victim is in need of a shock. If the AED tells you that it is not appropriate to shock, re-check the victim’s airway and if required, continue CPR and respiration support until first responders arrive at your location.

Every AED is made to the manufacturers specification and as such, there may be differences in how they function. Overall, the AED is a very important life safety device. With some basic education, you can participate in helping to save someone’s life in the event of sudden cardiac arrest.

ADDITIONAL RESOURCES:

Online CPR instruction: International CPR Institute

AED instruction: American Red Cross AED Course

Various CPR, AED, EMT, and related training: LifeSaver Education

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