Santa Cruz County Grand Jury • 1999-2000

Improving the Odds with Automated External Defibrillators

Published: October 17, 1999 14 pages
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Findings 28 findings

F1
The 911 system for most of Santa Cruz County is administered through the Santa Cruz Consolidated Emergency Communications Center, commonly called Net Com. Additional public safety answering points for the 911 system are in Scotts Valley and at the University of California’s Santa Cruz campus.
F2
Net Com is an up-to-date, modern facility. Dispatchers have access to computer- aided dispatch systems that allow them to rapidly send police, fire, and medical assistance when needed. For medical calls involving a person not breathing, such as sudden cardiac arrest, Net Com was able to dispatch Emergency Medical Service units within 60 seconds 92 percent of the time in 2006.
F3
The Emergency Medical Services Integration Authority (EMSIA) — consisting of the Aptos/La Selva Fire District, Central Fire District, Scotts Valley Fire District, City of Watsonville Fire Department, and City of Santa Cruz Fire Department — provides first responder Advanced Life Support (ALS) medical services to the urban areas of the county.
F4
The remainder of the county receives first responder Basic Life Support medical services from a variety of smaller fire departments and the California Department of Forestry.
F5
American Medical Response (AMR), a private ambulance service, coordinates with the EMSIA agencies for first responder ALS service and through its contract with the County of Santa Cruz is the sole provider of medical transport in the county.
F6
EMSIA fire agencies are able to provide a paramedic to a medical emergency within eight minutes of dispatch 90 percent of the time in urban areas.
F7
AMR is able to provide an ambulance to a medical emergency within 12 minutes of dispatch 90 percent of the time.
F8
A fire department paramedic is the first one to arrive at a medical emergency about 60 percent of the time.
F9
The expectations of service are carefully listed in the emergency services’ contracts issued by the county to American Medical Response. AMR coordinates its services with the EMSIA to ensure the best possible service to the citizens of Santa Cruz County. AED Distribution and Training
F10
Manual defibrillators, such as those carried by fire department and AMR paramedics, are expensive and complex and require significant training and experience to be effective. Conversely, automated external defibrillators (AEDs) are reasonably priced and simple to operate by anyone with a minimum of training. - 4 Surviving Sudden Cardiac Arrest
F11
Santa Cruz County does not have a comprehensive policy regarding the distribution and installation of AEDs in public locations.
F12
AEDs are carried in police patrol cars in Scotts Valley. No other law enforcement agencies in the county require AEDs in their vehicles.
F13
The locations of AEDs in the county are not available to Net Com dispatchers.
F14
When AEDs are deployed in public buildings, they are often not visible and therefore not accessible when needed.
F15
CPR classes, including training in the use of AEDs, are available through a variety of sources in the county. Need for AEDs
F16
While immediate CPR can buy valuable time for a sudden cardiac arrest victim, defibrillation is the only treatment that can save the victim’s life by restoring the heart’s spontaneous rhythm.
F17
People of any age may suffer sudden cardiac arrest and die suddenly.
F18
Sudden cardiac arrest is different from a heart attack although coronary artery disease may reduce heart circulation and eventually result in SCA.
F19
Often the first sign that a person is vulnerable to ventricular fibrillation is an attack that results in sudden cardiac arrest and death.
F20
In Santa Cruz County, approximately 250 people per year are victims of out-of- hospital sudden cardiac arrest. From October 2004 through September 2006, more than half of these victims (51 percent) were not candidates for resuscitation, mostly because too much time had elapsed before emergency medical services could be activated.6
F21
Some common causes for sudden cardiac arrest include asphyxia due to drowning or other oxygen deprivation, congenital heart conditions, sudden blows to the chest, electrocution, and coronary artery disease.
F22
The worst combination for cardiac arrest survival is if patients collapse without witnesses, and when discovered, receive no bystander CPR while emergency services personnel are en route. In a two-year period in Santa Cruz County, only two of 215 patients in this situation had their hearts begin to beat again, and neither survived. When sudden cardiac arrest was witnessed and immediate CPR was administered, nearly a quarter of the victims regained pulses and 10 percent survived. The survival rate jumped to 19 percent when EMS professionals witnessed cardiac arrest and could begin treatment immediately. There were 16 EMS-witnessed cases in the two-year period, and three of those were found to be 6 SCA Audit, p. 6. Surviving Sudden Cardiac Arrest - 5 in ventricular fibrillation (as opposed to those with no electrical activity or pulse). All three were successfully resuscitated with defibrillation only.7
F23
Some experts believe that a connection may exist between the use of ‘Tasers’ by law enforcement and sudden cardiac arrest in some individuals.
F24
To improve the survival rate of victims of out-of-hospital cardiac arrest in Santa Cruz County, the Emergency Medical Services Integration Authority recommends “promulgating citizen CPR programs, Public Access Defibrillator (PAD) programs, and continued rapid EMS response using all the latest AHA (American Heart Association) recommendations for CPR, defibrillation, and advanced life support care.”8 Laws related to AEDs
F25
Effective July 1, 2007, the State of California will require all health clubs to be equipped with AEDs on site and establish a program of training, maintenance, and record keeping.
F26
Good Samaritan laws protect most citizens from liability if they take action in a medical emergency, which includes using an AED. Conversely, lawsuits have been filed against organizations such as amusement parks and airline companies for not having AEDs readily available.
F27
AEDs are now required at FAA governed airports and on all commercial airliners.
F28
The Federal Cardiac Survival Act of 2000 (Public Law 106-505) directed the Health and Human Services Department to establish guidelines for evaluating and installing AEDs in federal buildings. Conclusions:

Recommendations 9