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7.6. SR 12-16-1996 From: iver Date: Police Department Subject: Memorandum ITEM 7.6. Mayor and City Counoil Thomas D. Zerwas, Chief of Police December 9, 1996 PORTABLE DEFIBRILLATORS FOR POLICE VEHICLES At the December 2, 1996, City Council meeting, there was a presentation on ambulance services for the City of Elk River. One of the topics was defibrillators for people in cardiac arrest. It was mentioned that some police departments have equipped their police vehicles with these devices, aiding in reviving patients who have gone into cardiac arrest. Generally speaking, a majority of the time, Elk River police officers are the first ones on the scene of medicals. I recently read an article that I am forwarding to you about the Rochester, Minnesota, Police Department's use of these devices. As the article indicates, Rochester has had very good success with these devices. As a result of this, I would recommend that we look into purchasing three(3) of these devices to enhance our responses to medicals where someone has gone into cardiac arrest. It is estimated that cardiac defibrillators would cost approximately five thousand dollars ($5,000.00) each. If you are interested, I will pursue this by first obtaining quotes. After obtaining quotes, and if approved, funding would come from the Capital Outlay Reserve fund and the proceeds from the sale of old squad cars. If you have any questions or concerns, give me a call. TDZ/kma 13065 Orono Parkway · P.O. Box 723 · Elk River, MN 55330 · (612) 441-2324 · Fax (612) 441-8937 Cover Story: Rochester Police Early Defibrillation Program by John Sibley How many of us that live in this Northern climate have experienced the problem of a dead battery in our vehicle in the middle of winter? It would proba- bly be safe to say that almost all of us have been faced with such a problem at one time or another, some perhaps a number of times. And how does the average motorist deal with the problem? Some may call for a towing or starting service, which often takes quite a while and costs more than they want to spend. More likely, the majority of us carry those simple, inexpensive devices called jumper cables. We hook one end of them up to the dead battery and the other end to the good battery from a friends car, and before you know it we are on the road again. Pretty simple ... right? Well, what if someone told you that, of the more than 250,000 Americans who die each year of sudden cardiac death, 20 to 25 percent of them could survive if a device were used by folks like you and me, that is almost as simple to use as the good old jumper cables. As it happened, about six years ago, that very message was presented to mem- bers of the Rochester Police Department. A proposal is made In the fall of 1990, Dr. Roger White, of the Mayo Clinic, came to the Rochester P.D. with a rev- olutionary idea. Dr. White is with the Mayo Department of Anesthesiology, and is a long- time medical director of the Gold Cross Ambulance firm of Rochester, specializing in cardiac arrest response. His theory was relatively simple. Since police squad cars are out and about in the neighborhoods and areas of the city, twenty four hours a day, 4 THE MINNESOTA POLICE JOURNAL there is high probability that a police officer will arrive on the scene of a cardiac episode signifi- cantly sooner than an ambulance that would be responding from a fixed location. His analysis of response times in cardiac inci- dents over previ- ous years clearly showed that, in a significant num- ber of cases, the police squads were arriving on the scene of med- ical emergencies two to three min- utes or more before the ambu- lance crews, even though they are simultaneously dispatched via a joint link-up between the 911 center and Gold Cross dis- patchers. About 65 to 70 percent of all cardiac arrest victims are in a state of ventricular fibrillation or tachycardia during the early minutes following the arrest. In the former, the heart has uncoor- dinated electrical activity and cannot pump blood effectively. In the latter, the heart rate is sim- ply too fast to permit the ventri- cles to refill with blood and sus- tain consciousness. In either case, if normal rhythm is not restored, the patient will not sur- vive. Fortunately, the rhythm can be restored by means of early defibrillation ... delivery of an electrical shock that reverses these most common forms of car- diac arrest. In the past, the use of a defibrillator to deliver such a shock was considered best left to paramedics or those in the med- ical profession. Now, however, with the advances that have been made in battery and microchip technology, new portable defibrillators have been developed that require only a "Since police squad cars are out and about in the neighborhoods and areas of the city, twenty four hours a day, there is high probability that a police offwer will arrive on the scene of a cardiac episode significantly sooner than an ambulance that would be responding from a fi. red location." minimal amount of training To use. Dr. *vVhite's proposal was to place a number of these portable automatic units in Rochester P.D. squad cars for the purpose of conducting a clinical study over a two year period. With close coordina- tion between the officers, the ambulance per- sonnel and the 911 dispatchers, data would be collected that should tell us whether police officers carrying and using defib- rillators will significantly increase a cardiac arrest patient's chance of survival. Chief Pat Farrell and his administrative staff discussed Dr. White's pro- posal and decided to give it a try. We would be the first police department in the country to participate in such a study. Naturally, there were more ques- tions than answers at this point. A journey into uncharted waters Once the decision was made to proceed with the project, things started to move quickly. A com- pany near Seattle, SpaceLabs, Inc., had recently developed a new portable defibrillator appro- priately named First Medic 510. They offered to loan the project four units at no charge, for the duration of the study. The units arrived in early October and training was conducted over the next couple of weeks. All patrol personnel were trained by Dr. White and Gold Cross Ambulance paramedics. Since all officers were already certified as "first responders," the training (continued on next page) block required was only three .ours, of which a fair amount of time was spent on reviewing CPR techniques. They learned the proper placement of the elec- trode pads on the upper and lower chest. Then, as soon as the pads are in place and the unit activated, the computer microchip begins its analysis of the patient's heart rhythm. In a matter of seconds the unit will determine if the rhythm is irreg- uiar, and if it is one that can be terminated by an electrical shock. If the nature of the patients condition is one that electrical shock cannot reverse, the audible voice command will announce that a shock is not indicated. On the other hand, if a reversible condition exists, the voice command tells the officer that a shock is indicated. "Do not touch the patient" is the audible prompt the defibrillator uses while it analyzes the rhythm. During this short period of time the machine has been building a charge of direct current that is sufficient to "stun" the heart. When that charge is sufficient, the audible prompt tells the offi- cer to deliver the shock by press- ing a button, and the high energy shock is sent from one electrode pad to the other, pass- ing through the patient's heart. In some cases only one shock is needed to return the heart of normal rhythm, where in others, multiple shocks may be required. In either event, the device will not allow a shock to be delivered unless the patient's condition requires it. For lack of a better term, it is about as close to fool- proof as you can get. As one might expect, during this initial training there was a fair amount of skepticism and concern expressed by some offi- cers, and rightly so. After all, this was all new, and there was no experience from other law enforcement agencies to refer to, one way or another. All in all however, in the finest pioneering spirit, they mostly agreed that, "If it has a chance of saving more lives, we're willing to give it our best shot." While training In the finest pioneering spirit, they mostly agreed that, "if it has a chance of saving more lives, we're willing to give it our best shot.~ was taking place, decisions were made as to the deployment of these initial units. It was deter- mined that placing one of the units in squad cars in each of the four city quadrants would allow for the greatest likelihood of one being closely available when a cardiac episode occurs. Dispatchers were briefed on the importance of getting a defibril- lator equipped unit rolling on any suspected heart attack calls. A system was devised for keep- ing the battery packs charged and replacement of batteries at shift change time. As soon as possible after each incident, a debriefing would take place between the officers involved and Dr. White. By November 1 the program was ready to start. Evidence begins to build Statistics show that, nation- ally, of the out-of-hospital car- diac arrest incidents that occur each year, the average survival rate is presently in the range of five to ten percent. In Rochester, before the defibrillator program began, the survival rate was already at 28 to 30 percent, much higher than the national average. Several factors probably contributed to this higher than average rate, such as, the prox- imity to the Mayo medical com- plex, the degree of competency of the ambulance paramedics, and the amount of on-going training provided to the police as first responders. Even so, the firm belief was that this figure could be much higher if Dr. White's theory was correct. By the end of 1992, even though the total num- ber of incidents was not high, the figures seemed to support the theory. Of the 14 patients with iventricular fib- rillation that the units had been used on, seven regained their pulses after shocks were delivered by police officers, and all seven were survivors. The other seven needed additional paramedic treatment, and three of these patients survived. Thus, 10 of the 14 patients initially treated by police officers survived. These two year outcomes were pub- lished in a medical journal in 1994. Ironically, one of those patients who was saved was recently retired Rochester P.D. Captain Clark Tuttle, who had collapsed during one of his regu- lar daily walks. Thankfully, because of the ability of the offi- cers to deliver that early shock, Clark is still enjoying his daily walks. With these early successes, the decision was made to continue the program, and to expand the number of units available. By early 1993, four additional FirstMedic 510 units were pur- chased, and again deployed equally in the quadrants of the city. The collection and analysis of incident data was beginning to receive recognition from medical authorities around the country. It was decided that this data col- lection would be continued indef- initely and shared through arti- cles published in medical jour- hals. By the spring of 1995, another manufacturer of defibril- lators that had become aware of our program expressed interest in having us field test some of their units. Survivalink Corporation of Minneapolis had developed a unit that was about half the size and weight of the earlier devices, and added even (continued on next page) DECEMBER, 1996 5 more automatic features. .another attractive .Feature That the o~cers liked was that the batteries only required recharg- ing once a month. They agreed to place four of these devices in our squads for the next year, bring- ing our total deployment to twelve. By July of 1995 the sur- vival rate for patients whose hearts were in a treatable condi- tion and who received defibrilla- tion initially from police officers, had risen to 58 percent (18 of 31 patients, 13 of whom regained pulses after shocks only). These data are published in the November 1996 issue of the med- ical journal Annals of Emergency Medicine. What lies ahead? Over the past year, some of us involved with this program have spent some fair amount of time working with yet another com- pany that has developed an Automatic External Defibrillator (AED). This company, HeartStream, also from Seattle, has developed a unit called the ForeRunner. It is a biphasic AED, meaning that it uses a The ForeRunner by HeartStream. 6 THE MINNESOTA POLICE JOURNAL waveform previously reserved for medically implanted internal defibrillators used for victims of prior cardiac arrest. The device received Food & Drug Administration approval in mid- September for marketing in the United States. Again, more downsizing and weight reduction are evident in this A.ED, and its operational features are all but totally auto- matic. The device is about the size of a '~By the beginning of the twenty- first century, a majority of law enforcement agencies in this country will have seen the benefits to be gained by adding these devices to their inventory of equipment necessary to best serve their community." hardcover book and weighs only four pounds. It features a dispos- able, yet recyclable lithium bat- tery pack that can deliver up to 100 shocks and has an expected standby life of approximately one year. Other available features include clear and concise voice prompts that walk the user through each step of the process, and an electrocardiograph (ECG) screen that shows the user the heart rhythm throughout the process. These units are expected to cost in the range of $3500.00 to $3800.00 depending on extra features desired. HeartStream will be placing 12 of these units in Rochester P.D. squad cars for field testing beginning in mid- November. If this first six years of experi- ence is any indication of what the future may hold, we can probably expect th AED to become even smaller, lighter and less expen- sive in years to come. In terms of its ability to offer the hope of survival to so many more victims of the num- ber one killer in the United States, the price is already incredibly low. There is very little doubt in our minds that, by the beginning of the twenty-first century, a majority of law enforcement agencies in this country will have seen the benefits to be gained by adding these devices to their inventory of equipment nec- essary to best serve their com- munity. With our project receiv- ing national attention via televi- sion network exposure, the word is now spreading rapidly. In addition, through the on-going efforts of the American Heart Association and concerned pro- fessionals like Dr. Roger White, we will likely begin seeing more and more of these AED units in places where lives can be saved. These locations might include apartment complexes, retirement homes, sports complexes, shop- ping malls, airplanes and air- ports, just to name a few. Anyone desiring additional information about our experience in the use of the AED is encour- aged to direct your inquiry to: John Sibley, Rochester Police Department, 101 - 4th Street S.E., Rochester, MN 55904-3761, or call 507-285-8262.