NYC Is In For A Shock

by Nadia Aguilar

At 11:34, a call comes in for a 77-year-old man in Flatbush who is complaining about dizziness. Yosef Simha and his partner buckle their seatbelts, and their ambulance shudders to life, pulling into the street, siren bleating twice. But the drive into Flatbush is smooth and controlled, the ambulance weaving through traffic like a windsurfer catching the breeze.

"If you want to see screeching tires and wailing sirens, go home and turn the TV on," Simha says. "The most important thing is for us to get there safely."

In his 14 years as a paramedic, Yosef Simha has delivered more than one hundred babies. He has packed severed limbs on ice. And he has restarted countless hearts.

But some he has been unable to restart. It is the heart attacks that used to disturb him the most. "One of the hardest things to learn at first is that you can't save everybody," he says Simha. "Eventually you disassociate. You'll go home and puke the first time you see someone die from a heart attack. Everyone does, especially when you were the one doing the chest compressions."

A quarter of a million people die from sudden cardiac arrest each year in the United States. In the first eight minutes after the onset of a heart attack, the hearts of most of these patients will be in a state of what is called ventricular fibrillation, which means the heart has started to beat irregularly. It is possible to shock some of these irregular beats back into regularity with the use of a device known as a defibrillator. There have been great technological advances in professional defibrillators. Emergency response time has quickened as well. But too often Emergency Medical Service personnel like Yosef Simha still arrive too late to use defibrillators with success. This is why there is a national push for "early defibrillation." And this explains the beauty of Automated External Defibrillators, or AEDs, or simply "smart defibrillators," which require no medical training to operate.

They are about the size of a SuperNintendo. A child of ten may be taught to use them. They are already in most major airlines and are appearing in increasing numbers in places around the United States. Congress recently required that they be placed in all federal buildings. And now they may help to save thousands of lives in New York City, after Mayor Giuliani's announcement in his final State of the City address that the city will spend $4 million to purchase 2,000 of them, and place them in public places like city office buildings, courthouses, performing arts centers, train stations, theaters, museums and stadiums. So excited was the mayor about them, in fact, that he spent more time on them during his address than on anything else, even enlisting a startled aide for a demonstration.

Automated External Defibrillators, or AEDs, are machines that analyze a heart attack victim's heart rhythm and deliver electrical shocks to stimulate heart muscle into a regular rhythm. Two studies recently published in the New England Journal of Medicine reveal that the installation and use of these devices in public places such as airports and public buildings may help to save the lives of over half the people who suffer from heart attacks outside hospitals.

"It's a very simple machine to use. It's virtually idiot-proof," Simha says. "Even a child or someone who is frightened to death at witnessing a heart attack for the first time will be able to use it."

In chaotic emergency room scenes on shows like E.R., harried doctors place the block paddles of the defibrillator on the patient's chest amid the mayhem of tubes and bleating machines and shouted medical jargon. The lay person's semiautomatic Automated External Defibrillators, the type that will be installed in New York City, is a much simpler and less frightening device.

Instead of the paddles, semiautomatic AEDs have two thin, oval-shaped plastic adhesive pads, which are applied directly to the chest. After these monitoring-defibrillation pads are attached, a monotone digital voice typically issues a series of commands:

ANALYZING HEART RHYTHM NOW.
SHOCK ADVISED.
PLEASE STAND CLEAR OF THE PATIENT.
DELIVERING SHOCK NOW.

Semiautomatic AEDs do not require special medical expertise. While manual defibrillators used by medical professionals depend on the doctor or paramedic to determine when to shock, which heart rhythms to shock, and how many Joules to deliver, semiautomatic AEDs contain an internal computer that determines all of these factors.

"That makes it incredibly simple for the lay person," says Simha, who teaches a course in the use of an AED to corporations, schoolteachers, summer camps and students.

Simha is confident that with proper training, anyone can be taught to use an AED, and their use by the lay person should not interfere with the paramedic's course of action upon arrival at the scene. When using semiautomatic AEDs, the protocol is to deliver two sets of three shocks each. Shocking beyond this, without specific medical expertise, can result in irreparable damage to heart muscle.

"However," Simha says, "machines today are so easy to use, that it is unlikely for people to make mistakes.

"I think that the AEDs will be received very well. They're going to make a big difference. It has been proven that early defibrillation saves lives. They already have defibrillators in a lot of other places, and now New York City will be catching up."

Click to see Councilmember James Oddo's story

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