The next person who delivers a lifesaving electrical shock to your heart may not be a doctor or even a paramedic.
It could be a firefighter with less medical training -- but who knows how to use a sophisticated heart machine designed to "think" like a cardiologist.
Yesterday, the Howard County Department of Fire and Rescue Services began using automatic external defibrillators, or AEDs, which analyze the heart and decide whether it needs an electrical shock in order to beat normally.
Other area fire departments began using the devices this year, including those in Baltimore City and in Anne Arundel and Baltimore counties. Some fire departments in Carroll and Harford have bought them, but are not yet using them.
Without AEDs, paramedics must be at the scene to determine whether electric shock is needed. But the machine can make the call on its own.
"Often, the paramedic doesn't arrive at the scene first," said Lt. Dan Merson, the county's emergency medical services manager. "When you're dealing with a cardiac patient, a couple of minutes spent waiting for the shock can mean the difference between life and death."
If a patient's heart is defibrillated within the first minute after it begins quivering uncontrollably, the odds of survival are 90 percent, said Dr. Joseph Ornato, a Richmond, Va., cardiology professor who serves on an AED task force for the American Heart Association.
Each minute after the first, he said, the chance of survival decreases 10 percent.
Paramedics, who receive 800 to 900 hours of training, make up 15 percent of the county's 200 fire and rescue workers. The rest of Howard's career firefighters undergo about 140 hours of training to become emergency medical technicians.
The EMTs will take a four-to six-hour class on using the new equipment.
"All of our personnel feel very confident about using this equipment," Merson said.
When AEDs were designed in the late 1970s, some doctors questioned whether the machines were dependable, Ornato said.
But since the late 1980s, the medical community has seen that AEDs used in cities across the country have increased survival rates among those suffering cardiac arrest.
"It became quite clear that these devices were engineered quite well," Ornato said. "The likelihood of shocking someone who doesn't need it is very remote, and the likelihood of shocking someone who does need it is quite high."
After a conference on AED, the American Heart Association issued a statement in 1994 that supported widespread use of the equipment -- even by laymen.
"If your heart stops, it doesn't matter to you whether a paramedic, a schoolteacher, a police officer or a firefighter delivers the shock," Ornato said.
The Seattle Fire Department was among the first in the country to begin using the AED about 17 years ago. A study conducted by the University of Washington from 1979 to 1982 found that 18 percent of those who required shocks survived when they had to wait for a paramedic, while 38 percent survived when EMTs used the automatic shock machine before paramedics arrived, said Lt. Thomas Walsh, medical services officer at the Seattle Fire Department.
"It's pretty well documented that the earlier you shock them the more lives you save," he said. "Now they're talking about having AEDs in public places like they do fire extinguishers."
Here's how an AED works: Two circular patches, wired to a briefcase-size machine, are attached to the patient's chest. When the machine is turned on, it analyzes the heart's rhythms and says either "shock advised" or "shock not advised."
If a shock is needed, the machine warns everyone to stand clear. The push of a button delivers the shock at one of three levels of intensity, with the level determined by the machine. The shock blows out the heart's irregular activity and restores a regular beat. If the first shock doesn't work, the machine might advise additional shocks.
"It's kind of like a lightning bolt," said Lt. Chris Cangemi, the emergency medical services operating officer.
The department plans to install eight AEDs in ambulances and will distribute 11 others to fire stations. Merson said the money for 19 devices, which cost about $6,000 each, came from the county, state and a Prudential Life Insurance grant.
Pub Date: 8/20/96