5.0 out of 5 stars
Continuing the legacy of Dr. Eisenberg, May 15, 2011
This review is from: Resuscitate!: How Your Community Can Improve Survival from Sudden Cardiac Arrest (A Samuel and Althea Stroum Book) (Paperback)
Inspiration
This book made me want to be a cardiologist, like Dr. Eisenberg - he brings so much excitement and reason to an otherwise priestly subject. After all, an AED is a magic lamp that can give you back your life if you rub it within four minutes, so he does have something truly cool to work with. Listening to his incantations - he delineates every aspect so clearly, that you come away mumbling about PEAs and those asystoles in government who neglect EMS... ;-)
But seriously, this is the man who wrote "Resuscitate!", the absolute Bible on the subject, one 9-1-1 call at a time, forty years on, and this volume is every municipality's working manual for SCA rescue implementation. Dr. Eisenberg blends heart physiology, pathology and its treatment as if it were a pugilistic endeavor, and he wins on all cards. And he does it with one simple strategy - send in the Hurry Kings.
Your remember the HK, don't you? - of course you do. These are the guys who can get to first base in time, which is what this website celebrates - any other result, and y'er out! We are a certain fraternity that have an interest in this, and like baseball, the dragons that lurk for tardy paramedics are as sinister as those awaiting a tired old DH trying to beat out a ground ball. Time plays no favorites.
The good doctor recounts the problem - here is the major killer of adults in the western world, running around like a serial killer with a weekend pass, unmentioned in the press and studiously ignored by Congress. Emergency services (EMS) are a subdirectory somewhere under the DOT, underfunded and organized on the whims of whatever city committee got in this year. But his is not to complain.
Dr. Eisenberg examines both the ethics and rationale for resuscitation. Sudden cardiac arrest (SCA) is a great way to die, he points out, just five or ten seconds and you're unconscious. No runs to the hospital, no hits by the surgeons, no errors or partial rescues that leave you a vegetable or in pain. Sometimes it's much better to be dead.
OTOH, if you are 16 years old and get spiked in the chest by a football helmet, it is a monster tragedy when that young heart loses its cadence under the impact. There really has to be an AED somewhere, and right now. The best AEDs made cost just $800 in bulk, so like hallway fire extinguishers - just mandate them.
The Doctor on High Rises
Of interest to us (elevaed.com) is his assessment of the risk in high rise buildings. His showcase city - Seattle - is largely made up of houses he explains, so access is not as problematic, say, as New York would be. While acknowledging that AEDs in public places are warranted and efficient, he laments that most SCAs occur in the home, however, with only 15% elsewhere.
He glosses over the fact that high rises are sometimes home, too, and seems not to worry too much about another big demographic - those office towers do have real people in them at times, privately owned or not. While not 'public places' per the federal legislation, they do cry out for at least one AED to bridge the ten minute access time Dr. Eisenberg estimates EMS is honestly capable of, for that class of building.
Everybody stays dead after ten minutes, no matter where they live or work, so he adopts a twofold strategy beyond his many incremental time savers, for all rescue attempts:
a) Dispatchers aggressively talk assisting callers through the delivery of CPR until EMS gets there, to extend the time interval for useful defibrillation.
b) The nearest EMS vehicle, whether fire, ambulance, and sometimes police try to get to the patient within something like seven minutes (more for high rises).
We do it all for you dept:
Left to itself, this approach would expose the characteristic limitation most rescue professionals tend to have, as a culture - they try to do it all themselves. AEDs and bystanders, the power of cell phones, etc. are given little account. When Dr. Eisenberg says some rescue 'services' are little more than 'lip service' by municipalities, in terms of the actual number of SCA victims they save, he is somewhat guilty himself of writing off the role and promise of volunteers, communications and AEDs working in concert, as growing pieces that may complete the solution.
Clearly Tandem AED/EMS should have a pronounced role in high rise heart safety, as the time bridge until EMS can get there. Otherwise - why do we have AEDs??
And the promise of dial-out AED cabinets, with their ability to rouse five or more CPR-trained neighbors or co-workers in your building with an SMS text message - these 'resuscitation networks' will hopefully get some ink in the book's next edition. Granted, some home SCA's are not witnessed in high rises, but there are wearable vital signs monitors coming to address that, and surely workers in towers do notice when someone is unconscious on the job. (Public employees have already taken care of themselves via legislation...;-)
Our takeaway:
The lasting contribution that Dr. Eisenberg's long and triumphant advocacy in Seattle is likely to leave us, is how he architected it. He established a tiered chain of command from the Medical Director, personally, over his elite corps of Seattle paramedics (255) and on down to firefighter EMTs (3500). But all personnel are fully accountable to the Medical Director, who preferably is affiliated with a university medical faculty.
Dr. Eisenberg places a strong emphasis on metrics - how to push quality through documentation. IMHO, if he did a little less paperwork and built out resuscitation networks everywhere by any means, the gains would be more than incremental. Wonderful things happen inside four minutes fiscally as well, with regard to the cost of dealing with brain-damaged individuals who were treated a few minutes late. Those figures need to appear in our ledgers.
This is the blueprint that is now widely recommended for any jurisdiction looking to make an impact on their deplorable SCA rescue success rates - they're almost always under 10%. "Resuscitate!" establishes that firefighters anywhere can and should be medically directed to do something they do best - get there on time. If there is a dispatcher/SCA coach at the beginning, and a few trained volunteers in the middle, the chain of survival is restored. It now hangs open.
As for ourselves, we need to get organized inside our aforementioned high rises and get with our own mini-infrastructure of lobby-based AEDs, dial-out cabinets, and CPR trained volunteers, all in-house, working away independently. This not hard to do, nor expensive - it just needs coordinating.
When Dr. Eisenberg's gang shows up, we need to have a pulse to show them, five minutes in, and leave them to begin transport and aftercare.
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