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Automatic Defribrillators
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Automatic Defribrillators

Many states now have laws mandating the storage of and the training in use of so-called "automatic defribrillators".

In nursing homes and senior centers they must be present if the center is to operate.

These devices enable a lay person, with little medical training, to apply an electrical countershock to convert ventricular fibrillation to normal sinus rhythym. A software algorythm analyzes the rhythym to ensure a shock is not given inappropriately. Prior to the introduction of these devices a medical professional was required to evaluate the rhythym.

Now comes the problem...

I recently witnessed an elderly gentleman develop signs of a myocardial infarct at a senior center. Cold sweats, palor, thready pulse, and pain down the left arm.

The automatic defibrillator was not in the assigned case on the wall near the door. Because it was "expensive" the staff had it locked up in an office.

Furthermore they refused to bring it out to be near the patient because "his heart had not stopped".

Well... it was true his heart had not yet stopped.

The fact is every seconds delay diminishes the probability of a sucessful rescusitation.

(1) If such a device is located on your premises it should be brought near the patient, with a person trained to use the machine whenever there is a suspicion that venticular fibrillation may develop.

This brings us to point two. Not all ambulances that respond will have a defibrillator. There are basic life support ambulances and advanced life-support ambulances. But the senior centers are reluctant to allow their defibrillator to leave the premises "for legal purposes". In the military there used to be a term for this. Sideways thinking. Very popular.

(2) Thus, if a patient in a center with an automatic defribrillator appears likely to go into cardiac arrest, and an ambulance without a defribrillator arrives, the center defribrillator should accompany the patient to the hospital, along eith a person trained in it's use.

Related Discussions
Well it's obvious that the staff hadn't been properly trained in the use and purposed of an AED, thus they had it locked in the office.  This is just a blatant example of the fact that they care more about $$ than they do their residents.  Also, one of my co-workers is a paramedic and I asked him about your observation on ambulances and your poing #2.  He has never seen an ambulance without a defibrillator.  Even BLS trained EMT's have AED training.  It doesn't have to be an ALS crew in order to have an AED.  That is why a lay person can receive AED training along with CPR.  Also, there are many legal ramifications to your suggestion of sending an AED along with a patient and someone trained to use it that isn't on the ambulance crew.  
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