Adam E. Klein, MD - West Virginia State Medical Association

Scientific Article |Figure 1.AED electrocardiogram of ventricular fibrillation successfully converted to normalsinus rhythm.The concept of early defibrillationis based on several principles. 3First, ventricular fibrillation is themost frequent initial rhythm inwitnessed SCA. Second, the mosteffective treatment of ventricularfibrillation is electrical defibrillation.Lastly, the probability of successfuldefibrillation diminishes rapidlyover time. Survival from cardiacarrest is strongly dependent on earlydefibrillation, and the likelihood ofsurviving a sudden cardiac arrestevent decreases by 7-10% for everyminute of delay in defibrillationfrom the onset of cardiac arrest. 3,12Studies have shown the use ofpublic access defibrillation programsin such places as casinos and airportshas greatly improved survival of outof hospital SCA. 13-15 More recently, alarge cross-sectional national surveyof over 1700 high schools across thecountry showed improved survivalin high school student athletes andnonstudents who suffer SCA. Theseschools had Emergency ResponsePlanning and AED access and 23 of36 SCA victims survived to hospitaldischarge. Survival was equal forboth student athletes and oldernon-students. The annual incidenceof SCA in high school athletes wasfound to be 4.4/100,000 in this study. 1The American Heart Association,the American Academy of Pediatricsand other national organizationsendorse the recommendations of thepublic health initiative: The MedicalEmergency Response Plan forSchools. 3,16 These guidelines supportand encourage the implementationof lay rescuer AED programsin schools with a documentedneed. Need is defined by one ofthe following characteristics:The frequency of cardiac arrestevents is such that there is areasonable probability of AED usewithin 5 years of rescuer training andAED placement. This probability iscalculated on the basis of 1 cardiacarrest known to have occurred atthe site within the last 5 years, or theprobability can be estimated on thebasis of population demographics; orThere are children attendingschool or adults working at the schoolwho are thought to be at high riskfor SCA (eg, children with conditionssuch as congenital heart disease anda history of abnormal heart rhythms,children with long-QT syndrome,children with cardiomyopathy,adults or children who have hadheart transplants, adults with ahistory of heart disease, etc); orAn EMS call–to-shock intervalof < 5 minutes cannot be reliablyachieved with conventional EMSservices and a collapse-to-shockinterval of < 5 minutes can be reliablyachieved (in > 90% of cases) bytraining and equipping lay personsto function as first responders byrecognizing cardiac arrest, phoning9-1-1 (or other appropriate emergencyresponse number), starting CPR,and attaching/operating an AED.Based on these recommendations,it is reasonable to assume thatmany schools in West Virginiameet at least one of these criteria,especially given the rural natureof the state. In our state, manyschools are in mountainous areasthat may be difficult to access byemergency medical services in therecommended time. 17 Even in urbansettings, such as New York City, acall-to-shock interval of less than 5minutes is difficult to achieve. 18With the recent push for AEDprograms in schools, we report arise in the number of school basedAED programs in West Virginia. Theincidence of schools with AEDs inthe United States was 32% in 2004. 19Prior studies have shown that theprevalence of AEDs in Iowa andCalifornia high schools in 2001 was25%, 20 54% in Washington statehigh schools in 2007, 5 and 72.5% in22 West Virginia Medical Journal