Device to Revive Heart Attack Victims Will Get Wider Usage

Impending changes in state regulations will allow California police officers, firefighters and lifeguards to use a new generation of computerized electric shock devices to revive heart attack victims. The change is expected to save hundreds of lives annually.

The new rules will allow public safety officers who are not now permitted to use defibrillators, as the electric shock devices are called, to do so after four hours of formal training in addition to instruction they already receive in basic first aid.

Draft regulations implementing the change, officials said Thursday, have been approved by the California Emergency Medical Services Authority and will become effective in January.

Dr. Bruce Haynes, the agency’s director, said wording must still be accepted by the state Office of Administrative Law, but the approval is expected to be routine.

“At a minimum, I think there will be hundreds of lives saved each year,” Haynes said.

Existing rules permit only paramedics and specially trained emergency medical technicians to use defibrillators. The machines pass a high-voltage current through the chest cavity to restore a normal beating pattern to people whose hearts have gone into a deadly rhythm disturbance called ventricular fibrillation.

California would be the first state to permit defibrillation by so-called first-responder personnel, according to the National Clearinghouse for Emergency Medical Services Information. Most states do not permit defibrillation by anyone but extensively trained paramedics or emergency medical technicians.

Currently, about 9,000 of the state’s 55,000 firefighters are permitted to use the defibrillator. The rule change would make the remaining 46,000 eligible.

Defibrillation has been restricted until now because recognizing ventricular fibrillation requires advanced skills and administering the shock to someone who is not suffering from the rhythm disturbance can be fatal.

But within the last several years, a new generation of equipment has been developed that combines automated electrocardiogram analysis with the shocking capability. The machines determine the victim’s rhythm by computer and administer a shock only if defibrillation is appropriate.

Defibrillaton advocates, noting that there has never been a reported incident in which a machine delivered a shock inappropriately, have urged that automated defibrillators be placed in office buildings, restaurants, airliners and other locations where people congregate.

Disenchantment With CPR

Development of automated defibrillators has occurred simultaneous to growing disenchantment with traditional cardiopulmonary resuscitation programs. CPR is incapable of correcting electrically caused, fatal changes in the heartbeat, which are the cause of most fatalities in heart attacks that occur outside hospitals.

“We’ve found in recent years that the time frame to save someone is very narrow,” Haynes said. “It is only three or four minutes. So shortening the time between when someone collapses and when they can be shocked will have a substantial impact and a large number of lives will be saved.”

Haynes noted that in Hollister, Calif., where the private ambulance company serving Hollister and surrounding areas of San Benito County added automated defibrillators earlier this year, two of four victims on whom the equipment has been used so far have survived to be discharged from the hospital.

In 1986, Haynes said, Hollister reported no saves of heart attack victims who collapsed outside the hospital. He said the Hollister experience is indicative of save rates that may be possible statewide.

Haynes said that while most large counties and cities in California have good paramedic systems, adding automated defibrillators to equipment carried on most fire engines and in some police cars could dramatically increase the number of heart attack victims who survive.