New guidelines suggest schools have defibrillators

By ANDRE PICARD
Friday, April 27, 2007

Every school with a competitive athletics program should put a series of measures in place to ensure that athletes who suffer cardiac arrest have a fighting chance to live, according to newly published medical guidelines.

The recommendations, published in this month's edition of the medical journal Heart Rhythm, say that all high schools, colleges and universities should have a readily accessible automated external defibrillator at sporting venues, as well as students and staff trained in cardio-pulmonary resuscitation and a practised plan for summoning help.

Jonathan Drezner, a physician at the University of Washington in Seattle, and lead author of the guidelines, said that while sudden cardiac arrest is rare in young people, it is still the leading cause of death in young athletes.

Having defibrillators _ easy-to-operate heart-shocking devices _ at sporting events is also a great benefit to spectators, coaching staff and other personnel, he said.

When the heart stops, due to trauma or an underlying heart problem, quick action is imperative. When the heart is restarted within one minute, the survival rate is 90 percent; at 10 minutes, it is less than 10 percent.

"The most important factor in survival is the presence of a trained rescuer who can initiate CPR and who has access to early defibrillation," Drezner said.

In North America, an estimated 400,000 people a year suffer sudden cardiac arrest, and survival rates are dismally low, in large part due to slow response.

Most people whose heart stops suddenly are older. But the new guidelines shine a light on young people.

Joel Kirsh, a staff cardiologist at the Hospital for Sick Children in Toronto, agrees. "We should have AEDs in every school," he said in an interview. "It's technology that's been proven to save lives."

Kirsh said that just as schools are equipped with smoke alarms, fire extinguishers and practice fire drills, they should also have defibrillators on site and train staff and students to use them.

"You're about 100 times more likely to die of cardiac arrest than in a fire, so where you have a fire extinguisher you should have a defibrillator," he said.

An automated external defibrillator is a device containing sophisticated electronics used to identify cardiac rhythms, and to deliver a shock to correct abnormal electrical activity in the heart.

AEDs will only deliver a shock if the heart is in a rhythm that can be corrected by defibrillation, meaning the machines are basically idiot-proof.

However, responders need to be trained to identify cardiac arrest (which is different from a heart attack, a stroke or fainting), where the AED is located and how to use it quickly, along with complementary skills like CPR.

Sandra Clarke, executive director of the ACT Foundation, a charity whose mission is to train all high-school students in CPR, said AEDs are a great add-on.

The foundation has begun a pilot project in Ottawa where it trains students and teachers in defibrillation as well as CPR.

Clarke said that "schools are, increasingly, public places, so it's a great idea to have AEDs in place." But she said the greatest barrier is funding.

Defibrillators cost about $3,500 each and, with all sorts of public institutions clamoring for them, the priority is on placing them in high-traffic areas such as hockey arenas, football stadiums and community centers. Schools don't always have the money to follow suit.

"We think that defibrillators should be in schools, but we don't want them cutting books and breakfast programs to pay for them," Clarke said.