MCHB Conference Webcasts
2005 EMSC Annual Grantee Meeting
April 12-13, 2005
CYNTHIANA LIGHTFOOT: I gotta use the mic. You know I am, because I usually talk without mics, so it's much easier. I'm going to give you a little background on how this program started. In 2000, the AED legislation was put into place in the District of Columbia by one of the council members, Sandy Allen. That was done through the hard work and effort of community advocates. And we basically were just everywhere she went we were there asking her questions in the meeting on when we're going to get this legislation passed because our cardiac rate was so low at the time.
And along with that we needed to do with the legislation was to partnership. We talked about this this morning. Part of that was with the American trial attorneys, to make sure that the law was in place, that it addressed tort issues, et cetera. After that was done, we were able to then educate again the council and other branches and get the law passed.
It was implemented in 2001. DC Fire and EMS took the head of this and decided they were going to run the AED PAD legislation, which Arthur will talk about in a moment. He's getting miked up, it sounds like. What was very important and made a difference was at that time Dr. Daniels was a strong proponent of AED use especially in the school system. He helped develop it and certainly get the funding so that the position would be in place. Arthur Bradley since I knew him used to let me ride along with him was an ideal individual to take ahold of this, because he's such a really friendly family‑oriented kind of guy. So I'm going to turn this over to Arthur.
ARTHUR BRADLEY: Thank you much.
Okay. She's got it now. Okay. I had to get this mic because I gotta use my hands. If I had the mic up here then it will be over here; you couldn't hear me. But I like to say thank you for inviting me, writing a letter to the fire chief. And I'd be remiss without leaving home without saying welcome on behalf of our fire chief, Adrian H. Thompson, and our Acting Medical Director Admit Wadwa to the nation's capital. I hope the visitors get a chance to go downtown, trample on the cherry blossoms and have a good time. For all of you here in the community and citizens in the area, thank you again for inviting me. I hope this presentation will be quite meaningful and you can use the information later on when you depart from here.
That introduction was excellent. I can't say anymore about it. I was wondering who are they talking about? They just do such a great job for you and make you feel so welcome. Thank you so much.
First thing we're going to talk about is what is sudden cardiac arrest, how is it treated, the interventions that take place, where PAD programs are, and then we'll specifically get into PAD programs in DC public schools.
All right? So first thing they told me that most of the people here would be like family members, not necessarily healthcare professionals. So we're going to talk about sudden cardiac arrest. It is a condition in which the heart stops abruptly, usually caused by ventricular fibrillation, or what we call Vfib. That's where the electrical system in the heart usually has a spasm. And it's not the same as a heart attack, and it results in death if not treated immediately.
It's one of the leading causes of death in our country. Some could say it's an epidemic proportion. But the number has been staying steady for about the last few years around a quarter of a million. It goes up a little bit ‑‑ oh, I could take it off.
I thought that was me breathing.
(Laughter)
And I said that I'm not taking a breath; so, Cindy, you know what to do if I go down. We've got a real AED over there. We have some face shields over there. Give me some respirations.
(Laughter)
Even though the median age of a victim is about 65 years old, look at the ages of the individuals that it happens to. Now, I could have put more children in there, but I figured out that it doesn't happen that often in children; and more importantly, children, especially the 13‑year‑old, 12‑year‑old, are always around adult supervision. Okay. So it can happen to them just as well.
The slide here shows it's a public health crisis. Notice, house fires. Fire department, not that many per year. Annual incidents, not that many occur. Car accidents, now, you would think that car accidents would be above 50,000, but it's not. But look at what sudden cardiac arrest is. 250,000 a year. That's amazing. You probably would have thought that the car accidents would have been a little bit higher, but they're not. Ideal treatment in most cases, early access to local EMS system. Call 911, get that ambulance rolling to your facility or your location. Early CPR.
Ms. Lightfoot will do a little demonstration on the CPR and use of AED later on. But what that CPR does, it keeps the blood flowing. Okay? And time is very important. Because once your heart stops, you're not getting that oxygen to the brain. We're going to talk about that a little bit later, and we're going to talk about the Schiavo case, not so much the political or legal ramifications about it, but just talk about it with time and oxygenation or lack thereof going to the brain. Then early defibrillation.
We talked about sudden cardiac arrest not being the same as a heart attack, because usually once a person has a heart attack, they will clutch their chest, I need help, or they'll sit down, a person is going through a heart attack.
Usually when you have sudden cardiac arrest, the individual just drops right now. But what happens is your heart usually goes lub dub. Isn't that right? Most hearts go lub dub, dub, dub, lub, dub, lub, dub. When you go into sudden cardiac arrest, usually nine times out of ten your heart goes into what we call early ventricular fibrillation or Vfib. Instead of doing lub dub, the lub being the top part of the atrium and the lower dub would be the ventricle that pushes it out. It won't go through the atrium anymore, so the blood will stop flowing. The person will collapse, become unconscious; they're not breathing. And even though, excuse me, their heart is quivering, it's not pumping blood. So instead of going lub dub, the heart is in a quivering state. That's what we call sudden cardiac arrest. It's going da da da da da da da da da da da.
Now, why is CPR not enough? Because even though you can massage that heart or pump that chest, move or circulate that blood, there's nothing like breathing in on your own, getting fresh oxygen. You're moving around the air, recycling the air already in your system. The other thing it's not addressing that da da da da da da da da da da da. Now you know what happens when you have a computer. You say, well, somebody come fix this. And that's the person doing the CPR. Okay.
But when you both give up, what do you do? Cut it off and cut it back on. And that's what that shock does to this heart. It reboots. Instead of going da da da da, you initiate that shock and it goes da da da da, tick coop, lub dub, lub dub, lub dub. That's the way electrical defibrillation usually works. Usually if you get there within the first two minutes, one shock will usually bring that lady around. Let me tell you how effective it is.
The Schiavo case, that lady was down about at least eight to 12 minutes before she got intervention. I'm talking about CPR use of the AED. We had a 72‑year‑old lady at the Roosevelt Memorial, you know a lot of people come to the Roosevelt Memorial, came down from Pennsylvania with a group of other, from the VFW, Veterans of Foreign Wars. The thing about it, she wanted to come with all the other World War II veterans to see the World War II Memorial. And this is what she told me in the hospital.
I said, "I wanted to see it before I died." A lot of people say that. But what the school did was they paired them up. It was a learning experience for the kids in the high school. One of those kids had just come up here from Florida . So the kid was up here. He was with them. They went on their group, and she was paired with these people. They went to see the World War II Memorial. She got off the bus. And what do you know? She went into sudden cardiac arrest. They hollered for help.
Lo and behold, the park service, U.S. rangers at the memorial, had an AED. They got the AED. Ran to the scene, saw that they were doing CPR on the lady, and what did they do, they said here. So what that 17‑year‑old did, opened up that AED and applied the pads, and administered a life‑saving dose of electricity or defibrillation. Shocked her one time and she came around. She started moving. By the time EMS got to the scene, the lady didn't want to go to the hospital. That's how effective it is.
Now, in children, you know, most of the time I have my little notes up here. Most of the time they think that children don't go into sudden cardiac arrest that much. The school of thought has long been that usually children have respiratory problems and their heart stops and that's it. Instead of going to that da da da, they just go dump ‑ flat line. Nothing. But when I was at the emergency cardiac care meeting in New Orleans , they started to do a little bit more study, and they're thinking that more than not a lot more children are going into Vfib before they go flat line.
What they're also looking at, and the tape was on just a little bit earlier when you all walked in, it talks about the Lou Acaporo story. This was a 15, 16‑year‑old Lacrosse player, normal, healthy guy. And he went to play and then the Lacrosse ball hit him in his chest. And I had my little words right here, and it's called cromotio cortis. That's a condition, when it's just about 2% of when the heart beats, it makes that little wave up, it's a small window of opportunity when that ball hit his chest that disrupted that rhythm and he went into ventricular fibrillation. Now, this happened with a Lacrosse ball, but a lot of people are seeing this with baseball injuries in kids.
The other thing about children is that sometimes that they have the underlining congenital defects or problems in their heart that were not diagnosed. And they go to school, which is the place where they spend most of their time outside of the home, and they have a problem. And we'll talk about that a little bit more as we go along.
Do you have to be a doctor to use a defibrillator? Well, back when they made this thing with the three car batteries in there, you may have had to be one or a genius.
(Laughter)
But, you know, it wasn't practical. You got the screen up here, all of these knobs. I mean it would take a long time to even defibrillate the patient. It probably took a long time for that thing to just warm up.
But in the '70s Roy and Johnny came on the scene. I don't know if you all remember that, Emergency. They call the doctor and say, hey, we have this patient and you know ‑‑ it gave ‑‑ "Clear" took on a whole new meaning. They had the pads and they shocked the person. This is what we're at today. Light weight, portable. Safe. Unless that person's heart is in that Vfib rhythm that we talked about doing that ga ga ga ga ga, it won't shock them. All right. You got the lub, dub, lub, dub, or if it's flat line, won't administer a dose of electricity.
They made it so easy now, that what we call the LAY, you don't have to be a healthcare provider in order to use these. You're starting to use these all over the place. Especially all those who came by air, usually they try to have them at least two minutes apart. When I say two minutes apart, that anyone who sees a victim down or a person who suffers from sudden cardiac arrest, can go, grab the AED, bring the AED back, place it on the patient and administer a shock within two minutes.
In DC, we have all over the place the Smithsonian, Library of Congress, Union Station, a couple of the schools, and we'll talk about those a little bit later.
This is why it's so important. The chances of survival from sudden cardiac arrest diminishes seven to 10 percent with every minute after collapse. Okay. Because your heart is not going to go ga ga ga ga forever. It is going to stop. And, remember, CPR will circulate in the blood but not necessarily addressing that da da da da issue.
Let's make it real. We know that the chance of survival goes down about 10% with each minute. But when responders come, the national fire protection agency standards, this is about five to eight minutes. But how do we measure the five to eight minutes? From the time the person collapses, from the time we receive the call. It's usually the time we receive the call. Now, I know we're in an age with cell phones and technology sort of reduces the time that the person collapses and the time we receive the call but nevertheless on the average it's around here, one to two minutes before we get that call.
Now, one to two minutes before the person actually calls? No. What happens is even the person goes to the phone most of your calls are routed through the police before it gets to the fire department. But now if you had an AED, you probably could apply that AED before you even made the call for the dispatcher to dispatch the engine company and the ambulance to your facility or location. Five to eight minutes is about the norm. But the time doesn't start here. It starts when we get the call, such as in the Schiavo case. They came between I think five or ten minutes. But nevertheless they got to her around here.
Now, even though you're revived, what's the quality of life afterwards? Okay? So just keep that in mind. Even though we can get there quickly, usually the time that we calculate is the time we received the call. Now, some jurisdictions, depending on where you are, they calculate it from the time not that the fire department received the call, but the particular engine company received the call. So you're adding seconds onto that. And that's very important when every minute counts.
Just a testimony to their effectiveness. You can see American Airlines are using AED on its aircraft 89 times in the last seven years and saved 50 people. Now probably those 50 people probably wouldn't be alive today if it wasn't for the AED. 56% survival. That's pretty good given the numbers we talked about a little earlier today.
7% survival rate, typically. We think that 30% or more could survive in community settings. But 20% is probably realistic for right now. Now, these are the survival rates. Of course, you're in a cardiac rehab center, chances are pretty good. But look at this. If you're in the airport, remember those AEDs are two minutes apart. The casino study, if you ever go into a casino to gamble, that he got cameras all over the place. Security men and all the security guards are usually trained how to use the AED and know where they are.
But now let's go a little bit further, Rochester , Minnesota , 45%. We're starting to look at Seattle with 34%. Now, they don't necessarily have AEDs in all of the locations like the, that short distance apart like the airport and the rehab center. But the population has changed. Is trained. They have a high level of people trained in CPR in the use of AED. When we started looking at some of the data, we noticed that places that had high save rates had a high level of training. Most of the population was trained.
National average again, 7%. DC is around 17%, as Ms. Lightfoot said earlier, International Association of Fire Chiefs, before we started the program, we were at less than 1% in 1999. So we've come a long way. We still haven't met our target of 20%, but we're well on our way.
Let me talk about some cost‑effectiveness. Everybody wants to talk about cost. How much does it cost. Now, according to the National Center for Defibrillation, medical intervention costs per year of life saved. Now, for children, it's going to be a little bit, the numbers won't be as high as this, because children probably live longer. Okay? But chemotherapy is up there. But look at this. Cholesterol lowering drugs, 50,000. And then let's go down to this one. Hypertension screening and treatment. 20,000. And you know how medications aren't getting cheaper. Okay? Now, look at defibrillation, less than 5,000. And like I said with children, it will probably be cheaper than that.
We didn't even talk about the quality of life, if you get the defibrillator to that person and get them revived quickly. But in the District of Columbia , we have what we call the Heart Safe Community Program. As Ms. Lightfoot said earlier, the Defibrillator Act came about in 2000. We started working on it, really enacted it in 2001. Promote the use of AEDs, establish the criteria for having a public access to defibrillator program. In the district of Columbia . Expands the Good Samaritan Law.
In order to make this thing work, we really didn't have any money, so we went out and got some partners. Partners are always good. DC Chamber of Commerce, whoa, they helped us promote the program with the private organizations; the American Heart Association, American Red Cross helped us with a lot of the training, as you could see some of my bags say American Red Cross over there and Medtronic Physio Control helped us with a lot of the products. I must say we do not endorse any products in the District of Columbia . We do use the Medtronic Physio Control brand, and they are part of our partners but we don't have any sponsorship or thing like that.
And the program is administered by the Emergency Medical Services Continued Quality Improvement Unit, fire and EMS department. The ultimate goal is the chain of survival to save more lives.
We go one step forward and basically what we do is promote healthy lifestyles. A lot of people have healthy choices of food. If you're in a business, promote exercise. You know, allow people to have lunch hours where they can eat healthy, like the 20 minute lunch. You are just asking for a disaster if you give people 20 minute lunch, then you have candy machines, soda machines. Unless people bring in their lunch to work. So give them a good lunch hour. If they don't eat lunch, you can have time to walk, de-stress and enjoy eating your meal.
Educate the public on early warning signs. I think we did a pretty good job of this and increased training and CPR and the use of AEDs and finally promote the placement of AEDs where people work, congregate. And a big thing right now is recreate. Working with the District of Columbia schools. We started this in 2003. It was the last school year we had to select the schools to participate.
Cordoza was our big one. We looked at the data. It's 2003. So that doesn't go back to '98. Five cases of sudden cardiac arrest, include three children, two adults over the past three years. Two of the kids, or one on the basketball court, one on the football field, one standing at the bus stop. The adults: One was a teacher. That teacher was saved. We got a teacher back. And the other one was a contractor working in the boiler room.
Meetings were held with key personnel from DC Department of Health, American Heart Association, DC public schools, Medtronics and DC Fire and EMS Medical Director, Dr. Fernando Daniels at the time. This is basically his baby.
Number of civics contacted including organizations such as the masons. Who would have thought the masons. But you never know who in the community will be able to champion your program and help the wheels of legislative politics turn a little bit smoother.
Key people: Director, Department of Health. In the District of Columbia , politics is real big here. So some of these positions, you know, they go through and you know you think you've got something going and then people change. The private sector says this is transient. We're in a transient location. So the director of Department of Health that we were working with wasn't director that we had when we started the program and still is not the same director that we have now. The same thing with the medical ‑‑ excuse me, it's not ‑‑ the medical director of DC public schools, everything was you, doc. Fire and EMS chief and medical director. We still had the same chief but different medical director. Superintendent of schools. It's not the superintendent we had. And the American Heart Association, those key players down there, stable.
Community stakeholders were always willing and able to expand if we get the opportunity. We got buy‑in from the Department of Health. A lot of instructor support. The fire and EMS chief and the medical director, they ensured that we had medical oversight and it was usually one of the assistant medical directors that provided the oversight. The bulk of the instructor support we took on, we supplied all the equipment and we assisted the schools in establishing the PAD program.
American Heart Association provided all training materials necessary to train about 500 people via the Phillip Graham fund. We spend that grant, spend that grant, we got three times the training out of it by linking that with some other training initiatives that we had.
Medtronic ensured us we had media coverage for our kick‑off and that they supplied our AED trainers and helped us with instructor support. And they donated the first AED through DC public schools which is Cordoza. We'll talk about that program because seems like a good program in DC. They're also going to donate another AED to Dunbar . And that will probably be done during EMS week.
The superintendent of DC public schools, we facilitated the MOU between the American Heart Association and us and has helped us to navigate the legal issues pertaining to teaching children and utilizing their likeness to promote the program. And I'll tell you, I didn't know that there were so many legalities dealing with children, especially going into the public schools trying to set up what they call space lease agreements and such. And so we had a real eye‑opening experience there.
Howard University came and provided us with instructor support. Even the Air Force Reserves came about. This group over at Andrews Air Force Base, they gave us the audiovisual equipment. PowerPoint presentation, large screens, brought in instructors and administrative personnel to make sure the program succeed. All these people I'm talking about, they don't cost us any extra money to put this training event on.
Phillips Medical System, they donated an AED to Aniacosta High School and also provided instructor support and Zohn Medical Corporation donated an AED to Coolidge High School and provided instructor support. And Carol, bless her heart, made sure we had extra instructors at all our events.
This is truly a lay rescuer program. You can't take a program into a school and expect the school nurse to do the work for you. Added to her duties. There are some contract agreements and some other legal issues that you have to navigate through before that can become a reality. So you must obtain buy‑in from the staff and the faculty at the school. And I don't think one of the key players is up here, but that was the principal. If you've got the buy‑in from the principal, he can make it happen. We had the buy in from Cordoza's principal. He's the same principal when we first started and he's still there today. And they have an outstanding program.
Thank God they never had to use the AED, but still they have a nice program at the school.
The other key players, the medical oversight physician and the AED PAD program coordinate. Medical oversight position must be licensed in the District of Columbia, responsible for overseeing all aspects of the PAD program, includes training, making sure everybody receives training from a nationally recognized training facility or organization, tracking the training, like know how many people are trained, when they're due, develop deployment strategies; and for a school, it's pretty simple.
The same deployment strategy you use if a child is sick, except in case of sudden cardiac arrest, you grab the AED and you go. They already had those things in place. They just had to add the AED portion. Equipment maintenance: Equipment maintenance is pretty easy now because all you have to do, and we'll talk about that a little bit later, is look at this little piece that says it's okay and write it down on a little piece of paper and you can keep it with the machine. He performs a QA function. A lot of people say what's the QA function.
These machines are really recording the ECG. Some of them record voice, but most of the part they just record the ECG. What happens is they download that, put it to a computer, and then the physician can look and see what type of wave form this person was in prior to us shocking, after we shock them and how deep the compressions were. So he can get feedback. Because sometimes what will happen is a person will die. They may use the AED and a person may not come back.
And the people will say, what, we got the AED and it didn't work, what's wrong? When you look at it and, you see that this person went flat line. That was the case at the Commerce Department. We looked at that, explained to them what a flat line was, nonshock rhythm. AED did CPR. We started talking to the people at the hospital, when it's time for you to go, it's time for you to go. But most people it's not their time to go.
We were able to give them valuable feedback on what was happening. If the person is in defib; we use Ms. Clements as a perfect case. We go, find Ms. Clements heart, you could see, she was da da da da. The machine shocked her one time ‘tshctump’ and she goes back lub dub, lub dub. During the transport she goes back da da da da. The machine shocks her again. Lub, dub, lub dub. When you see this, you can actually see the wave form that reinforces the training and what you've been doing.
Okay. The coordinator. The coordinator, they do most of the stuff. They're the people at the facility who make sure that the program runs. All right? Now, good candidates are the custodians. Who would have thought. The secretaries? Who have thought? The counselors at Cordoza, it happens to be a counselor. Mr. Cryton. And he's the counselor for the difficult to manage students. But he runs this program. And he wants to become CPR AED instructor. So when students have to stay with him in detention, he said that's what he's going to start teaching
(Laughter)
Major duties. Again, monitor the training, the maintenance, deployment strategies and maintain the records up above. Notify the physician if you use it make sure the information is extracted if you use it. In the Columbia if you have any AED compatible to ours take to it the firehouse that he can down load it and that I can make sure the PAD application is renewed every four years. You say why register these programs. Wherever you are there's usually a registration process.
The only state I know of that do not have a registration process is Virginia . You get the AED. Now, there's still an FDA class 3 device, medical device so you still have to get a physicians's scrip but you don't have to register the program. Here it expands the Good Samaritan Law, look who is covered, the facility, the owner of the building AED coordinators or any other entity that provides training and oversight and individuals who use the AED in good faith and extends to the owners managers and supervisors of the facility.
So everybody is covered under that law. Schools that we train. Now Balu, we only did faculty and staff. We didn't train any students at Balu. But the other ones we trained more students than we did faculty and staff.
And out of them Cordoza, has AED and (inaudible) we're going to get one for Dunbar , so the other two schools on our list. Where are we today? We're working with the Reagans and DC public school superintendent to rewrite the memorandum of understanding. The problem is the American Heart Association, can we still get that money? You know the program does take some money and we still need that money. So they said if we come up with something similar to what we had, they may be able to kick in, make the money.
I told you about Dunbar . Tentatively we plan to train a thousand students and families and friends. Of course, families and friends course is basically finish, we show it on the screen. It's not too much practice. But you have a clue how to use the AED and the AEDs are so simple they can walk through. It doesn't take as much time as a full blown course this year to train a thousand students of family and friends during EMS week. And we've got one more student we're going to honor here Georgetown day school the guy saved his dad. He performed CPR on his dad.
What happened was cardiac arrest had occurred. He went in there. He got his mother to call 911. He's down in Georgetown , and the unit had to come all the way up Tinley Circle . It's long distance to get to him. The ambulance, he's down in Georgetown DC , had to come from Bethesda (inaudible). So that tells you that sometimes even though you can go down, you think the ambulance is going to come quickly, especially in a large metropolitan area. The ambulance or units may not be available. That's where the CPR and the AED available, it comes into play.
This kid knew the CPR. He starts CPR on his dad. He kept performing CPR until the engine company got there. Because he's performed good CPR, they put the AED, according to the report. They shocked him. One shock. (and he) came back around. Dad is living today. We'll be honoring them at Georgetown Day School , I think that's about the 16th of August. How did he learn CPR and use AED? It's part of his curriculum at school. So we've got something for the lady who started that program as well.
But that's where we are. And we always put this in, because you know you always hear such bad things about the city sometimes. We won the 2004 Heart Safe Community award, an international award. I tell everybody we had the best program in the world.
(Chuckling)
But it's probably here just in the United States . This is where I got the information from. These are the sites. I think that this whole thing, like I had to submit this thing like a week in advance. I think they said they'll give it to everybody. So you have the information right here if you need additional information. Bobbie was so kind as to put my picture up here.
(Laughter)
And that's my phone number. And you know you can't go anywhere without thanking the people who allow you to come here. Sergeant Austin, putting all this together. Sergeant Covington, she packs my bag. I don't know how I'm going to get it back in there. She's packs my bags and I'm ready to go. And of course you can't do anything without saying thank you to the boss.
Do you have any questions for me? Yes?
UNKNOWN SPEAKER: You go to schools they have a machine, the fire department, can you just explain that?
ARTHUR BRADLEY: Now, it's a thing right here speaker session being recorded. Please repeat audience questions if possible. You said that now ‑‑
UNKNOWN SPEAKER: You made reference to the capability of schools to down load the (inaudible) from their AED. Could you explain that process.
ARTHUR BRADLEY: To down load the AED, every time you use it it's recording like the ECG. It's a micro chip. There's a couple of ways to transfer that information. Some have adapters where you connect to a phone line so like a modem and you transfer that information electronically. And what we're looking for, and it's basically just the ECG. But then it has some words like AED applied here. It tells you when the AED was turned on. It tells you when it was applied. Tells you when it was shocked. So you get a little time line, also.
And the fire department, if you have one of these, we have down load capability and we're in the process of updating our system. We've got new software, makes it easier to use. We had these three programs. You had to go to this one and that one and come out and do another one and send it. And now it's all in one program. As soon as we get that done then they can just come in and send it to us. But the reason why we allow you to do it, we have the technology. It's just sitting there, and all they do is give it to the firemen and it's an adapter that sits in the computer similar to this. He'll go in and follow the instructions on the machine and he'll send that to us.
Now, by law all of that has to go to the District of Columbia Fire Department, we're supposed to be the repositories of all that information. Does that answer your question?
UNKNOWN SPEAKER: Yes. And are you using that for QA purposes?
ARTHUR BRADLEY: Yes, ma'am, it goes to the continued quality improvement unit.
UNKNOWN SPEAKER: Do you report back to the schools?
ARTHUR BRADLEY: Yeah, we could, we could give them. It goes to me and the medical director, usually everything is pretty much good and we'll give the school a pat on the back. But one thing we like to do is to know who performed CPR, especially in the case of a save, even if the person didn't come around, what we do is everybody who made that, we give them a certificate, you know, to say thank you, your valiant efforts, a letter from the fire chief, that type of thing. If they do save somebody. See the pen I have? We give them one of these and we make a big to‑do about it.
Yes, ma'am.
UNKNOWN SPEAKER: What grade level (inaudible).
ARTHUR BRADLEY: Right now we're targeting, when we started out, we wanted to do the high schools, anybody in high schools. But the schools themselves wanted to target the ninth graders because that way they'll have them at least another two years. When we go, we usually don't make that target but I know right now we're not going to be in elementary school. We had the pads here for that, but usually right now if we can just get to the high schools, we'll be happy.
Yes, ma'am.
UNKNOWN SPEAKER: Do you have an idea about how to implement this in an area where the athletic fields are not directly contiguous to the school, inside an out door mounting and how you go about obtaining a (inaudible).
ARTHUR BRADLEY: That's a good question. Now, what they have right now, we have, when you register them, you don't have to have them fixed. They can't be mobile, like the police, they're mobile, they're in the units. The trainers, DC public school trainers, they do have them and they're mobile units and they take them to athletic events so the person will take them with them. So they're not always at a fixed location. So if something happens, like mine, mine is mobile. I take it with me. I'm here at this event and will use it if it need be.
UNKNOWN SPEAKER: Makes sense in a single event. In my town we have eight fields kids are playing baseball, younger kids.
ARTHUR BRADLEY: Yeah, same as DC public schools. They don't have just one AED they have about 12 of them. It's 12 people because every time you send them or put them somewhere, you have to have at least one person trained. So that person who is trained is the trainer. And you have in DC public schools at least one trainer at each event. And that way they each have one at each event.
UNKNOWN SPEAKER: But in the district of Maryland they have seven or eight and we're trying to (inaudible) across, maybe track and field. Presently we also have legislation in the district that we hopefully will piggyback on to the budget in which we require all buildings of 100 or more persons also have (inaudible) that would be paid by the (inaudible).
ARTHUR BRADLEY: That would be government buildings with 100 and private buildings with a thousand occupants. Yes, sir.
UNKNOWN SPEAKER: I know that Phillips, I believe, did receive approval from the FDA for their machines to be over the counter. Do you anticipate the other vendors that you showed going that way as well?
ARTHUR BRADLEY: Yes, sir, doctor. As a matter of fact, we were down in New Orleans when it happened and they were scrambling right then. But that's the only machine you can buy it over the counter, that one Phillips brand, that one model. But the other ones they're clamoring to have one also.
UNKNOWN SPEAKER: Is this individual use or does it pertain to a school, I mean a public entity, a public or private entity rather than the individual?
ARTHUR BRADLEY: Okay. That's a good question. Does it apply to just the individual. Yes, that's just an individual, because now once you take that and put it in a public place, it becomes a PAD program. Now, if you, yourself, take it outside of your home and say, for instance, we have a case where a lady teaches aerobics, and she takes her AED wherever she goes. It still becomes a public program, right, because it's outside of her house. Even if she had a business. Unless she's a doctor, you still have to have medical oversight, AED coordinator. She can be the coordinator but it's still a PAD program because this is a public place.
UNKNOWN SPEAKER: So the expectation then that individuals who do purchase AEDs over the counter need to register, then register them with the local PAD program?
ARTHUR BRADLEY: Yes, sir, except for if you're in Virginia they don't have any registration requirements. But here if you're not going to use it for just your family, yes, sir.
UNKNOWN SPEAKER: Then they have to have medical oversight.
ARTHUR BRADLEY: Yes, ma'am.
UNKNOWN SPEAKER: And PAD and (inaudible) program and (inaudible) school program it must be confined (inaudible).
UNKNOWN SPEAKER: Who pays for ‑‑
UNKNOWN SPEAKER: The program?
UNKNOWN SPEAKER: The good graces of the taxpayer and the school district.
ARTHUR BRADLEY: Did they get 'em in all the schools yet? Because at the ECC there was still some contention about that.
UNKNOWN SPEAKER: As far as we know (inaudible) yes.
ARTHUR BRADLEY: That's great. Yes, ma'am.
UNKNOWN SPEAKER: Now?
ARTHUR BRADLEY: Yes, ma'am. I thought they had the mic. Are you picking up the questions?
UNKNOWN SPEAKER: Will you repeat them?
ARTHUR BRADLEY: What happened to the other one?
UNKNOWN SPEAKER: Can I use the mic first?
ARTHUR BRADLEY: I don't have it.
UNKNOWN SPEAKER: Okay.
ARTHUR BRADLEY: Where is the other one?
UNKNOWN SPEAKER: Then I'll speak into his chest.
(Laughter)
This is not a question. This is a testimonial. I had an aborted sudden cardiac death at age 16. I had a sudden cardiac death at age 30. So what he was referring to as far as genetics, even though the numbers may seem low to you, approximately 4,000 children between the ages of 0 and 18 lose their life every year to sudden cardiac arrest.
Mine was identified as Long QT. I went with CPR, effective CPR for eight minutes until 911 came. And three shocks later I was semi revived, taken to a hospital. I was in a coma for three days and pretty much my husband at the time I had six‑month old twins. My husband was told that I wouldn't survive. Okay. I normally do this rather well because I am very pro advocate of AEDs.
My children who are 13 today, the twins, also have the same condition. One of them has an implanted defibrillator. I have an implanted defibrillator. We have an AED at home. The subject is very near and dear to me. And I encourage you to get AEDs in all the schools.
ARTHUR BRADLEY: Okay.
(Applause)
That's great. Well, I guess we got ‑‑ we have a life save today. Even though we give the pins to the people who save the life, we give the life savers as well. So there's yours.
(Applause)
Thank you. I hope I didn't mess your mic up. Do we have any more questions?
UNKNOWN SPEAKER: How do we register?
ARTHUR BRADLEY: Register, we have over 700 AEDs at the city at 150 registered locations. The federal government has a lot more and they're coming and they're starting to register them a little bit more but some people in the federal government figure we don't have to do that, we're the Feds. But we're trying to have them register their AEDs too because when you register your AED, say, for instance they have one in this building someone will call from this building, use one of these phones.
They'll come up on our screens and say you have an AED third floor, fifth floor, sixth floor, what floor are you on. If you're on such and such a floor go to the elevator lobby buy north wall get the AED and go back to the patient. They can walk you through the steps. Because when you're trained when emergency strikes, especially for the first time you're like what do I do? And sometimes you just need that calm reassuring voice on the other end of the phone.
We have another question. Yes, ma'am?
UNKNOWN SPEAKER: It's really kind of a compliment. I really liked what was said about the detention teacher, utilizing that in a positive way educating students. I was hoping, one of my pet projects, I work with MCHB, HRSA, get people and others, we need CPR in every school and we really need to, I think, force the AED is so important. It's always important to participate in education and CPR. I think it's really great. I hope you're spreading the word and he is too to his colleagues, using it positively for kids at school for detention and others.
ARTHUR BRADLEY: Was it you? Was it you? Yes. What happened to the other mic?
UNKNOWN SPEAKER: Back to the comments. I actually think that AEDs are ‑‑
ARTHUR BRADLEY: I'll cut it off.
UNKNOWN SPEAKER: ‑‑ are fairly fashionable right now. It's a great opportunity to take it because schools want it, like in St. Louis the grade schools (inaudible) CPR. So I think that you can use it to really enhance what is available at schools in terms of health related issues that are important to you.
UNKNOWN SPEAKER: I just wanted to ‑‑ it's not going to work unless he turns his off. I wanted to offer some suggestions on how you might fund these. And our school system, the principal had an issue with her husband's health. So she found some extra money. She said you know this would be a good thing to have here. And the next year they had a child come to school that had a heart condition, and they actually used it and saved the child's life.
After that, the other schools saw the need in the area and it was, of course, in the paper and all of that. When Liz went back to school last year, her math teacher said we don't have enough AEDs in here. You're on this floor, they're over there. So the teachers themselves started to say, okay, this group of teachers will fund an AED. So there's lots of different ways other than the state doing it.
ARTHUR BRADLEY: How does this work? (Inaudible).
(Laughter)
You know, she brought up a very good point. And I'm glad you did that. That reminds me of emergency management and Homeland Security. Funding is available. Just think about it. You know especially when you're in the grant game. Where do people go congregate in the event of a emergency, the aftermath. You go right to the schools and the funding is available for those. Also you can contact those websites, the center for early defibrillation and the AED foundation and there's one more, the Medtronic Foundation and some funding is available now.
You probably won't be able to get enough to adequately cover a school, but, you know, at least they'll give you one where it will put you on your way. Let me cut this off.
UNKNOWN SPEAKER: One more website to add to your list of websites would be www.sads.org. It stands for Sudden Arhythmic Death Syndrome. They deal with young people, children and adolescents that die of sudden cardiac death and they have a new packet of information out for school nurses that talks about AEDs and CPR. I was fortunately invited to Scotland in July to talk about AEDs and sudden cardiac death in children.
So I would refer to that website. It's excellent. It was started by Dr. Michael Vincent, who actually was the first physician to recognize Long QT, and the other genetic causes of heart disease