Today, it would be unthinkable to construct a building without smoke detectors or fire alarms. These devices save lives, and we consider them essential. But there is another killer lurking in our communities that takes even more lives than fire, and it too is preventable with a simple electronic device that’s easily installed in public facilities.

Sudden cardiac arrest (SCA) kills 1,000 people a day — or one person every two minutes. It is a leading cause of death in the United States. According to the American Heart Association, as many as 7,000 children and more than 450,000 adults die each year from SCA. It can happen without warning at any time to anyone. An estimated 95 percent of its victims die before they can get emergency help.

Without emergency help, SCA results in death within minutes. Victims can be saved if an automated external defibrillator (AED) is immediately available to deliver an electrical shock through the chest to restore the heart to its normal rhythm. When a person suffers from SCA, each minute that passes without defibrillation decreases their chance of survival by 10 percent.

In October 1999, a healthy, athletic friend of mine was participating in a 10K race when he collapsed from SCA. Two respiratory clinicians, who also were running in the race, immediately started CPR. The ambulance that had been assigned to the race with an AED had been called away moments earlier to a non-emergency event.

My friend was transported to a hospital where he was pronounced dead. He was 56 years old. If an AED had been available at the race, his chance of surviving would have been dramatically improved.

Sudden Cardiac Arrest Is Not a Heart Attack

In SCA, the heart abruptly and unexpectedly ceases to function normally. It is an “electrical problem” caused by a heart rhythm disorder called ventricular fibrillation. When SCA strikes, the heart is no longer able to pump oxygen-rich blood to the rest of the body.

SCA is not a heart attack or myocardial infarction (MI), which is a “plumbing problem” where a blood vessel blockage interrupts blood flow to the heart, causing an infarct (an area of dead heart muscle). It is possible, however, for a person to suffer SCA in conjunction with a heart attack.

Project Heart Beat Improves the Odds

After my friend’s tragic death, I set out to make AEDs as readily available as fire extinguishers. In October 2001, working with his widow and the San Diego Fire-Rescue Department, I helped launch San Diego Project Heart Beat. The program’s initial goal was to increase the survival rates for SCA victims by placing at least 250 AEDs throughout the county before the Super Bowl in January 2003. We exceeded that goal by nearly 550 AEDs, and the program has been growing ever since. As of October 2007, we installed more than 4,000 units in San Diego County. We have a 71 percent “save” rate in cases where an AED is deployed and have now saved 45 people who likely would have died without access to one.

Project Heart Beat was designed to offer all agencies, businesses and organizations the opportunity to implement these life-saving programs affordably, easily and successfully. The project has developed a comprehensive life-saving program that provides training and assistance with implementing, managing and maintaining AEDs.

The project’s ultimate goal is to ensure that AEDs are as accessible as fire extinguishers throughout our county and state, thus maximizing SCA survival rates. We also want every high-school student in California to graduate with experience and certification in CPR and AED so that they, too, can help save lives.

Liability Issues Addressed

Early on in San Diego’s Project Heart Beat, property owners and businesses expressed concerns about liability related to using an AED. They wanted to make sure they wouldn’t get sued if something went wrong following an AED deployment. In response, I worked with then Assembly Member Juan Vargas (D-San Diego) to sponsor AB 204, the AED Good Samaritan Law. It provides legal coverage for property owners, landlords and others concerned with potential liability.

Maureen O’Connor, a San Diego emergency medical technician who has been with the program since its inception, offers some interesting observations. “Today, we are finding more businesses and building owners who are concerned over liability if they do not have an AED,” she says, “a complete reversal from our early experiences.”

O’Connor adds, “If you talk to firefighters, they will tell you that in any public venue they end up using an AED more than a fire extinguisher, and most of those who have used an AED have never deployed a fire extinguisher.”

Thanks to Project Heart Beat, AEDs can be found almost everywhere in San Diego, including office buildings, hotels, public parks, swimming pools and libraries.

Making AEDs Part of the Municipal Code

I recently proposed new municipal code language that will require AEDs to be installed in new construction in San Diego. The intent is to create a citywide program that will establish AED protocols and create a system for tracking usage data. Specifically, the draft code will apply to all new buildings of more than three stories or 10,000 square feet, including office and commercial buildings, medical, dental and outpatient clinics, hotels, motels, restaurants and common areas of residential condominiums and apartments. AEDs would also be required in places of assembly with capacity for more than 300 people, and educational facilities with 200 or more students. The code will require new construction to be pre-wired on all floors with dedicated wall mounts for the AED system with self-acting alarms. Owners would be required to register their AED equipment with the Fire Rescue Department, test it annually and notify the department each time the device is used. Eventually, I envision AEDs becoming mandatory in all public buildings — just like fire extinguishers.

The County of San Diego is partnering with Project Heart Beat to get AEDs in public facilities. Recently, San Diego County Supervisor and League Past President Greg Cox led the effort to install AEDs in every public school throughout his south San Diego County district. And in the San Diego Unified School District, the state’s second largest school district, a fundraising drive is under way to install AEDs at each of the 265 school sites in the district. In fact, the district has adopted a plan to install three AEDs at each high school, two in each middle school and one in each elementary school.

Over the past several years, a number of cities have made AEDs available in public facilities — yet surprisingly, we have a long way to go before AEDs are as common as fire extinguishers.

Does Your City Have a Program?

Creating a public access defibrillation program is something your city may be considering. The staff and volunteers at Project Heart Beat offer support and technical assistance to help other jurisdictions set up such programs, and they can help your city as well. For more information, visit the San Diego Project Heart Beat website at www.sdprojectheartbeat.com.

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This article appears in the December 2007 issue of Western City
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