About 1,000 Americans die every day from sudden cardiac arrest. Many of them could survive if they immediately received a jolt of electricity, from a machine called a defibrillator, to reset their heart.
Special automated defibrillators, designed for use by laypersons with minimal training, have been available since the early 1980s. Over the last several years, the units have improved to the point where good Samaritans, with no training at all, have used them successfully to save lives.
Virginia is at the forefront of states that are accelerating efforts to take advantage of these technological advances. The national movement envisions that widespread availability of automated external defibrillators, or AEDs, can do for sudden cardiac arrests what fire extinguishers do for fires.
Delegate John M. O'Bannon, R-Henrico, sponsored legislation this year to remove legal barriers to widespread access to AEDs. His bill will give legal protection to untrained people who use the machines in good faith.
The legislation earned the unanimous support of the General Assembly and Gov. Mark Warner has signed it. Warner asked lawmakers to make it effective immediately and the General Assembly will consider his request when it reconvenes in Richmond on Wednesday [April 2] for a one-day "veto session."
Without an emergency clause, the legislation would take effect July 1.
"Widespread access to AEDs will be a step in the right direction," said O'Bannon, a physician. "A thousand deaths a day from ventricular fibrillation are way too many. I think we'll see that number go down."
Unlike heart "attacks," which occur when something blocks adequate blood flow to the heart muscle, sudden cardiac arrests are almost always an electrical problem.
Normal pumping is regulated by electrical signals that stimulate each part of the heart to contract at the right time. When those signals suddenly become chaotic (a condition called ventricular fibrillation), the heart quivers unproductively, and no blood is pumped. With little or no warning, the person loses consciousness and stops breathing; death follows in minutes.
In the October 2002 issue of The New England Journal of Medicine, a team of doctors and experts underscored the scope of the challenge: "Though highly reversible with the rapid application of a defibrillator, ventricular fibrillation is otherwise fatal within minutes, even when cardiopulmonary resuscitation (CPR) is provided immediately."
AEDs are different in many ways from traditional full-function defibrillators -- the machines featured in medical dramas on television and used in real life by highly trained emergency technicians. The full-function defibrillators are complicated and can kill if administered improperly.
Currently, state law tightly restricts access to both full-function defibrillators and AEDs. O'Bannon's bill will lift the restrictions on AEDs, which are specifically designed for public-access use.
Anyone who can find the big green "ON" button, and follow a few simple instructions, can operate a public-access AED. A recording in the machines begins providing clear verbal instructions as soon as the power is turned on. They actually sound quite bossy, but the authoritative voice probably helps rescuers stay focused.
Instead of using bulky paddles, AEDs have self-adhesive, palm-size pads that are connected to the unit by an electrical cord. The person attempting the rescue places the pads on the victim's chest. After the pads are on, the operator does not need to touch the patient unless the AED instructs them to do so.
Several scientific studies have tested the safety and effectiveness of AEDs.
A 1999 research project, for example, timed and evaluated two groups -- sixth-grade children with no prior training, and emergency medical professionals -- as they used AEDs in mock emergencies. All of the children understood and followed the instructions successfully.
When the study was published in Circulation, a medical journal for heart specialists, the researchers made the following conclusion: "During mock cardiac arrest, the speed of AED use by untrained children is only modestly slower than that of professionals."
Many people compare modern public-access AEDs to fire extinguishers, which are so easy to use to save lives that they are found in almost every public place. In some ways, AEDs are even less dangerous than fire extinguishers.
Fire extinguishers are not idiot-proof. If operators point the nozzle at themselves, instead of at the fire, they will be hurt by the blast of chemicals. Fire extinguishers can also be used to cause malicious harm -- by bludgeoning someone, for instance.
AEDs are not idiot-proof, either. Before the unit delivers a shock, it sounds a cautionary warning alarm and issues emphatic orders. "Do NOT touch the patient!"
If operators disobey the defibrillator's orders, they can be hurt.
Unlike fire extinguishers, AEDs would be extremely difficult to use to cause malicious harm. The units refuse to even charge up unless their sensors indicate that they are properly applied to a person who is not breathing and whose heart is in fibrillation.
In 1997, Florida became the first state to enact a law encouraging broad public access to AEDs by trained non-medical personnel such as police officers and firefighters. Currently, all states have taken similar steps.
What makes Virginia unusual is that its law will expand legal protection for purchasers of AEDs and to untrained AED users acting in good faith. Only a handful of states, such as Pennsylvania and Rhode Island, provide such protection from liability.
This protection will be important as AEDs become more prevalent in public places. For example, defibrillators were recently installed at all service plazas along the Pennsylvania Turnpike. And the Illinois Legislature just passed a law requiring golf courses, school gymnasiums and other government-owned physical fitness facilities to have access to at least one AED during hours of operation.
Under current Virginia laws, public-access AEDs (which do not need trained operators) are treated much the same as full-function defibrillators (which definitely do need trained operators).
O'Bannon's bill will update these laws so that:
AED units can be placed in locations where untrained good Samaritans might use them.
O'Bannon said he would be thrilled with even a small increase in the number of cardiac patients who receive emergency treatment in time to prevent irreversible brain damage.
He noted that his bill not only promotes the availability of AEDs but also urges people to get basic life support training.
"The AEDs are great -- no doubt about it," O'Bannon said. "But realistically, there will be many times when CPR and other skills that are taught in basic life support classes will be needed if the patient is to have the best possible chance for a full recovery."