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Stories from the heart

For Anne Efron, this Valentine's Day is about more than boxes of chocolate and long-stemmed roses. This year, the holiday is truly a celebration of the heart. The one that's beating in her chest.

In late January of last year, Efron, a project administrator with the Center for AIDS Research at the Johns Hopkins University, was at home in Ruxton, planning dinner with her husband, David, the chief surgeon with Hopkins Hospital's division of acute care surgery.

They planned to grill but discovered they were out of propane, so David went to the store, leaving home for about 15 minutes. When he returned, Anne was lying on the sofa. "I thought she was sleeping," he says. "But I went to wake her, and she was blue."

Even with his medical training, David concedes that he experienced "a short round of panic." But he quickly moved Anne to the floor, started cardiopulmonary resuscitation and called 911. He continued CPR for the next 10 minutes, until the Baltimore County paramedics arrived with an automated external defibrillator and additional medical technology.

Anne was initially taken to University of Maryland St. Joseph Medical Center in Towson, then transferred to Hopkins. On Friday, Efron will celebrate the one-year anniversary of her release from Hopkins, after several weeks of treatment for sudden cardiac arrest.

Stories like the Efrons' are not uncommon, although they don't always have such happy endings. The American Heart Association estimates that in 2014, about 4,000 Marylanders will experience an out-of-hospital sudden cardiac arrest; 88 percent of cardiac arrests occur at home. Of those patients, only 9.5 percent are likely to survive. According to the association, that number would be much higher if, like David Efron, more people knew and were able to administer CPR in the critical first moments after sudden cardiac arrest begins.

"We have external defibrillators in public places," says David Efron. "Those are about $1,500 a pop, but they make a huge difference. But CPR is so important. You can do it for 15 minutes on somebody and have this kind of outcome."

The quick and confident action of a loved one and early CPR were also instrumental in saving the life of Steve Haffner. In May of last year, he experienced sudden cardiac arrest at home in Hunt Valley, where he was caring for his partner, Helene Darling, who was in the final stages of pancreatic cancer.

Haffner did not immediately realize he was having a heart problem, but after a few minutes of watching him try, unsuccessfully, to cool off and manage his pain, Darling called 911. Haffner credits Darling and the three first responders — Charles Watson, Amanda Prosser and Amy Backhouse — with saving his life. "The way the EMS crew approached me, their efficiency and proficiency was unbelievable," he says.

Following initial care in the ambulance, Haffner underwent immediate surgery at St. Joseph and was released the next day, happy to be home to care for Darling until she passed away on June 30th.

Following their heart health scares, both Efron and Haffner have been moved to publicly praise first responders and to enact programs that spread the message that early CPR can save lives.

To promote CPR education, Haffner is donating three loanable CPR training kits, in Helene Darling's name, to the Baltimore County Professional Firefighters Local 1311. "The kits are big duffel bags containing a rubber dummy, videos and materials," he says.

"He wanted to do something that immortalized Helene Darling's memory," says Steven Adelsberger, an EMS shift commander with the Baltimore County Fire Department, who is working with Haffner to coordinate the donation. Adelsberger says he hopes groups including home-schooled children, church members, recreation and park programs, and businesses will use the kits to learn how to perform CPR.

Learning CPR is much easier than it was a decade ago, says Anne Efron. "It used to be that you had to do different beats per minute depending on age," she says. "But now, except for babies, it's 100 beats per minute." Plus, CPR recommendations are now "hands-only" — mouth-to-mouth resuscitation is no longer required.

Anne Efron has become involved with the American Heart Association, advocating for state Senate Bill 503, which would make CPR and defibrillator training a graduation requirement in Maryland public high schools. She believes learning the skill is a life-or-death proposition and will also help boost students' confidence.

"CPR is a simple lifesaving skill," says Efron, explaining that she believes it would give even high school-aged children a "feeling of empowerment. A sense they could step in if needed and not stand by helplessly. A confidence of knowing what to do in an emergency. This has the potential to trickle into other aspects of their lives."

Senate Bill 503 will be discussed in several sessions this month, which is American Hearth Month, says Michaeline Fedder, director of government relations for the American Heart Association.

William Reinhard, a spokesman for the Maryland State Board of Education, notes that many schools currently teach CPR and provide defibrillator training. "At the same time," he says, "the Maryland State Board of Education will likely oppose the legislation, not because of its worth but because the state board has historically served as the educational policymaking body in the state, as set up in the [Maryland] Constitution."

Reinhard also notes that current Maryland standards include a required health course. One of the objectives of this course is to "demonstrate skills related to CPR" and using defibrillators.

Fedder said that while CPR training is part of the curriculum, there is no requirement that it must be taught. According to a 2013 heart association survey, 37 percent of Maryland school districts are teaching CPR in every one of their high schools. The association believes that the way to increase that number is to make CPR training a graduation requirement, via the proposed legislation.

For Anne Efron, passage of the law will make the policy more than "one person's cause that fades away. It becomes durable," she says.

Handling a sudden cardiac arrest

When someone experiences sudden cardiac arrest, immediate action can mean the difference between life and death.

Organizations like the Maryland Resuscitation Academy, a group that trains first responders and the public in cardiopulmonary resuscitation and automatic external defibrillator use, boil down the action to three easy-to-remember steps: check, call, compress.

Check: When you see someone who might have experienced a sudden cardiac event, first check for responsiveness. In a loud voice, ask if the person is all right and rub his/her sternum with your knuckles. No response means they might have experienced cardiac arrest. It is not necessary to spend time trying to check for a pulse or clearing the airway (if there are no other signs of choking).

Call: Ask someone to call 911 or do so yourself. The faster emergency responders arrive, the better.

Compress: "Hands-only CPR" is recommended. This involves chest compressions, using enough force to compress the chest about 2 inches, at a rate of 100 compressions per minute. Continue until emergency responders arrive.

If a defibrillator is available, turn it on and follow the instructions to use.

For more information and to learn how to become certified, visit the Maryland Resuscitation Academy website at ramaryland.org.

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