One Emergency
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Two potentially different outcomes
By Paul Duffy
On a hot summer day, a woman collapses near a baseball field. Bystanders jump into action and quickly realize she isn’t breathing and has no pulse. Someone calls 911 and others begin CPR. The dispatcher asks if there is an Automated External Defibrillator (AED), but no one knows.
Seeing the commotion, employees at a food stand say they have a defibrillator, but it’s locked up. They begin frantically calling the manager, who, of course, isn’t working at 7 p.m. on a weekend. The ambulance and first responders arrive 10 minutes later and take over CPR. Those 10 minutes can seem like a lifetime when you’re trying to save a life. And those are common response times, from the biggest cities to some of the smallest rural communities across the country. But more important is that early CPR and defibrillation in those 10 minutes can dramatically change the outcomes for victims.
Take Two
This story plays out almost daily across the United States, but it doesn’t have to end the same way. Let’s see how it can play out differently.
The same woman collapses by a baseball field.
When a bystander calls 911 to report a cardiac arrest, the dispatcher asks about their location in the park.
Dispatcher: “Ok, help is on the way. I need you to go to field R2. There’s a bright yellow box by the dugout with an AED in it. Tell me when you get there.”
911 Caller: “I’m here.”
Dispatcher: “Ok, push 1789 into the lock box code, take out the AED, and bring it back to the victim.”
Within five minutes of the woman collapsing, the defibrillator is attached and a shock is given.
Five minutes later, the ambulance arrives. There are 10 minutes for both scenarios, but potentially dramatically different outcomes for the victim.
Sad But True
There was a time when the first scenario was common. I served as both an assistant and head of a municipal recreation department for 29 years. I ran a golf course and marina, and ultimately ended up in Westerly, Rhode Island, where I operated two town beaches and summer playground programs, and worked with the sports leagues to help run their programs. Between 50,000 and 70,000 people per year participated in the programs.
Each spring during lifeguard and staff orientation, I said that, no matter what we did to prevent it, somewhere along the five-mile stretch of coastline known as Misquamicut, at least one person’s life would end. It might be someone in a beach chair who suffers a stroke or has a heart attack. Or it may be someone who is caught in a rip current.
In most of those emergencies, staff members were the first responders. That’s why we always stacked the lifeguard ranks with EMTs and paramedics. As the years went on, lifeguard supervisors and captains returned each season, and with it my anxiety level lessened, but never completely abated. I have learned we have the ability to improve the odds of survival by involving the public and making lifesaving equipment available to all.
An Eye-Opening Conversation
In 2016, I received a call from David Hiltz, a local resident and emergency-care specialist with Code One Training Solutions, headquartered in East Hartford, Conn.
He asked me two questions:
“Do you have an AED at all of your recreational facilities?”
I was able to answer that question confidently in the affirmative. Then came the one that stumped me.
“Where do you store them?”
I knew the leagues all had AEDs, but I didn’t know where they were stored when the leagues weren’t present. Reflecting, I assumed they were in the storage closets. But I never considered how someone could get into that locked space to access the AED at other times. Then Hiltz inquired about access to AEDs at the two beach facilities. I knew that, when we were open, we not only had immediate access to an AED, but also trained emergency medical staff. But when the beaches closed at 6 p.m., the AEDs were locked away while thousands of patrons were still on the beach for several more hours.
The conversation I had with Hiltz opened my eyes to the huge gaps in access to emergency equipment and services within the department. We were providing accessibility to resources when we were there, but emergencies don’t follow our hours. As in most communities, we have an amazing team of first responders, but we knew we could do better to help our citizens before the responders arrived.
Safe And Secure
We set out to install accessible AED cabinets at all of the athletic complexes and at the two town beaches. The goal was to provide the easiest access to the best available equipment. But we didn’t want to have this expensive equipment easily stolen. The cabinets keep the AEDs in an easily accessible location, but secure behind a locked door. When cabinets are placed in a community, the local 911 center is given the locations and access codes so that information can be quickly relayed to callers. This also ensures 911 is activated immediately.
To place an AED in a public area effectively, here are a few tips:
• Choose the right location. It should be well-lit, publicly accessible 24/7, and in heavily traveled areas.
• Schedule regular checks. There’s nothing worse than needing an AED but finding it won’t work. Regular maintenance is the key. Check the batteries, pads, and any other equipment stored with it.
• Provide accurate information. Make sure 911 dispatchers, first responders, and the community know where the device is located.
• Train the community. The more people who know CPR and how to use the AED, the better. AEDs are simple enough that they can be used without training, but they’re far more effective in the hands of someone who knows even basic CPR.
• There are never too many. People may say one AED is enough for a park, but is it really if that park covers a large area? Easy and early access are key to saving lives, so place AEDs near as many facilities as possible. If it takes someone five minutes to reach an AED, that’s another five minutes to get back to the victim.
Paul Duffy recently retired from the town of Westerly, R.I., serving as Recreation Director for the past 19 years. Prior to 2001, Duffy served as Assistant Recreation Director for the town of North Kingstown, R.I., and Special Projects Coordinator for the city of Warwick, R.I. He holds a Master’s Degree from the University of RI and is a Certified Parks and Recreation Professional. Reach him at pduffy1@cox.net.