hydrangea blossoming

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Sunday, December 30, 2012

We Bought them, But Why?

One of the many purchases announced by the new fire chief at the last meeting is a quartet of artificial external defibrillators.  My understanding from previous conversations with the chief is that there were already four such AED's on the Point, including at Lighthouse Park and the Community Center.  The purpose of the AED is to improve the survival chances of an individual suffering an out-of-hospital cardiac arrest: it's essentially a portable electric shock to the heart machine in order to restore a stable rhythmn.  In such a situation, the first thing to do is call 911, then begin CPR and then after a series of CPR cyles, use the AED.  The AED won't work with all cardiac arrests: only if the cause is ventricular fibrillation or ventricular tachycardia.  But, in those instances, it can be helpful if 8 minutes haven't already passed before it is applied.

Now, the unfortunate fact is that chances of survival in an out-of-hospital cardiac arrest are not very good, regardless of what is done.  That's largely because if emergency treatment is going to work, it needs to be done within 8 minutes.  Alas, 85% of all cardiac arrests occur within private homes and its easy to imagine (especially here) that those 8 minutes might pass pretty quickly before an emergency response is on the scene.

When the AED's were first put on the market there was a lot of enthusiasm for them, but over time, research has shown that their effectiveness is pretty limited.  If you put them in the hands of trained EMTs or paramedics or nurses in clinics, they're reasonably useful, pretty cost-effective.  They're not terribly expensive: about $1,000/unit, but you have to train all the individuals who are likely to be using to use them, you have to maintain them, etc.  All time, and thus money consuming items.

Over the past ten years, with a lot of experience, the technology assessment researchers have made it pretty clear where these devices should be placed in the public arena: only at public sites with large populations (where it is likely that the device will occasionally be needed).  For example, they site sports arenas and casinos as examples of such places.  They do not suggest that local libraries, or small unattended parks, or local grocery stores (where one of our newest AED's is destined to call its home) are good locales.  In fact, they specifically say they are not.

Strangely, the cumulative judgment of our past and present fire chief is that there should be such devices at the Community Center, the International Marketplace, and Lighthouse Park.  How about the Wellness Clinic?  Tiny population, but at least people who might be trained to use them.  I'd be interested in knowing what was the rate of cardiac arrest at the clinic in its ten years of existence.  The Sheriff's Deputies are to have them: are they responding to 911 cardiac arrest calls instead of the Fire Dept. EMT's now?

Where is the responsibility for good judgment in such decisions?  With the Fire Commissioners who seem only to rubber-stamp the Chief's already-made purchases by approving the warrants?  With the Chief who is doing the planning and buying?  Got me.  Maybe nobody.

If you are interested in reading the Province of Ontario's Technology Assessment of the appropriateness of AED's, it's here.  Maybe the Commissioners and the Fire Chief should be the ones reading it.  Is the effectiveness of all the technology that is available to them an issue in their decisions about how to spend public funds?  Or is the only relevant fact that such technology is around to be bought, is fun to have, and sounds good when they describe it:  "Life-Saving," for example.  Maybe not so much.  Just money spending.

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