A couple of comments here show confusion about who can use defibrillators and in particular whether a doctor is required. I thought I'd add my personal experience.
Specifically, I was defibrillated by bystanders when I had an out-of-hospital Ventricular Fibrillation episode. The staff at the UK building I was visiting had a defibrillator in their office and one of them had been on a training course.
When I collapsed with no warning, there was (according to my wife) about a minute of confusion and then one of the staff grabbed the defibrillator and used it. The device itself plays recorded instructions and itself conducts diagnostic tests to determine whether or not it should be used. If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it. If it can treat you, then it gives clear instructions to the users and delivers shocks as required.
In my case, the visitor centre staff had saved my life before the air ambulance arrived with trained medics. I was then flown to hospital where the critical cardiac care team confirmed that the bystanders had done exactly the right thing. They had also administered manual CPR which had kept my brain supplied with oxygen at the cost of two broken ribs. So here I am today writing this comment, thanks to the immediate availability of a defibrillator to bystanders.
I was lucky. My VF episode happened just as I had entered the lobby of the building that coincidentally contained the defibrillator. If I had been a 20 minute walk away, I would be dead (or brain damaged). Would a drone-based defibrillator have saved my life? Don't know, but it would certainly improve my chances.
> If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it
I was taught how to use one on a course where the instructor said he used to enjoy teaching students this fact by allowing them to take turns attempting to use a live defibrillator on him.
He got away with it for many years until his boss found out and put a stop to it because the company insurance wouldn't cover the company (despite clear witnessed consent being given by the instructor).
On the plus side, the company didn't ban his teaching method of NPA (Nasopharyngeal Airway) insertion. ;-)
> manual CPR which had kept my brain supplied with oxygen
Manual CPR done correctly is critical, and yes if done correctly you WILL end up with broken ribs. Mouth-to-mouth is not deemed particularly necessary these days (since the act of correct CPR will draw oxygen in anyway), better to focus on proper CPR and wait for the ambulance to turn up with high-flow oxygen from a tank.
> If I had been a 20 minute walk away, I would be dead (or brain damaged)
Yes. The most effective time for defib use is in the first 5 minutes. That's not to say you should not have a go after that time, but its effectiveness does drop away quite quickly.
> The device itself plays recorded instructions and itself conducts diagnostic tests to determine whether or not it should be used. If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it
To expand on this a bit, defibs will only deliver a shock if they detect VF (ventricular fibrillation) or VT (ventricular tachycardia). These are considered shockable rhythms. Both involve malfunction of the electrical conduction system usually due to lacking oxygenated blood supply to the heart muscle itself.
A shock seeks (usually up to 300 joules depending on patient size) to reset the hearts' rhythm so the body's natural pacemaker (called the SA node, positioned in the top-right of the heart) can kick back in. If there's no shockable rhythm, the defib machines will usually instruct you to continue CPR (chest compressions) and then will ask you to stop after a cycle of 30 so it can re-analyze the rhythm. Otherwise CPR must continue until medics arrive. If the defib detect a normal rhythm (sinus rhythm) then that's good news and means the defib has been effective.
Pad placement is very important if you're administering defib. The pads are positioned so that the depolarization travels approximately down the septum of the heart, to emulate the normal electrical cascade.
Note: there are many types of heart malfunctions that can't be remedied by a defib but that doesn't mean you should do nothing. Always do CPR. Always call the emergency services.
Possibly of interest to HNers: It is a common misconception that a defib can bring a heart back from 'flat-lining' (asystole). Hollywood movies don't help. If there is asystole, medics will usually continue CPR until the rhythm changes whild trying to reverse any underlying causes of the heart failure (e.g. massive hemorrhaging or hypothermia).
They had also administered manual CPR which had kept my brain supplied with oxygen at the cost of two broken ribs
I did CPR on an elderly man I found having a heart attack in an alley in London. He was conscious when I found him. I called 999 and stayed with him. He "died" in front of me (no pulse, breathing, motion, loss of urine control). I did CPR until the ambulance arrived; I remember the sound of breaking ribs very clearly. They used a defib on him and he survived and until I moved away from the area I'd see him walking around from time to time.
Was a slightly odd feeling seeing him because I literally saw him "stop".
> The staff at the UK building I was visiting had a defibrillator in their office and one of them had been on a training course.
I have a Philips HeartStart at home. None of us are high risk (we're not obese, fit), or had family history of heart disease. We just like gadgets, and why take a chance?
The last company I worked as an employee at had defibrillators on every floor. While I had to take diversity training, and sensitivity training, I was never required to take -- or offered -- a class in defibrillator training.
At $work we all (or nearly all) get trained in CPR and the use of a defibrillator, and re-trained (and tested and certificated) every second year. We have a defibrillator (and scissors etc) on site where we can easily find it if it's ever needed.
It's kind of crazy how much we rely on ambulances that most often than not feel like they're too slow.Now i know the feeling of time slowing down due to emotional involvement in the heat of the moment, but that doesn't mean there are not a lot of variables from the person needing help to the nearest 'trained medical expert'.The solution imo can be improved by having both more people know basic medical procedures and also more useful devices around.
They're also looking at using them for transporting blood and organs between hospitals. Primarily being tested in western Sweden where it's mountainous enough that the straight line path the drone takes is considerably faster than the roads. Saw it on SVT Rapport a bit over a month ago.
I have a funny defibrillator story that seems tangentially relevant so I thought I'd share it.
I work for a company providing tools for safety-critical software, and so we were in discussions with a defibrillator company. They tried to argue that the defibrillator was not critical to the patient's life, and thus not subject to the relevant regulation, because the patient was already dead. No one bought this argument.
> we were in discussions with a defibrillator company. They tried to argue that the defibrillator was not critical to the patient's life, and thus not subject to the relevant regulation, because the patient was already dead
I'm amazed that they would take this line. In many cases, a person's heart is still very active when it is shocked by the external defibrillator, and the person is still breathing. In some types of VF (see my comment elsewhere [0]), the problem is that the normal synchronised contraction of the cardiac muscle fibres has broken down, and the heart is thus quivering spasmodically, not cleanly pumping. To break this cycle, the defibrillator emits a massive shock that causes the muscle fibres to simultaneously go into their 'reset' phase, and the hope is that the heart's natural pace maker (the sino-atrial node) can then take back control. It's like the defibrillator is shouting "will you all shut the fuck up!" into a crowded auditorium full of people talking over each other rather than listening to a presenter. The defibrillator can't magically restart an insert dead body.
If you're going to post a YouTube video, IMHO the ONLY one to post is the famous BBC one with Chris Solomon.[1]
TL;DR the BBC were in the right place at the right time. They were filming a documentary at a UK Air Ambulance office when the call taker had a cardiac arrest right there infront of them. They filmed the whole thing from start to finish and the guy gave his consent for them to release the video to the public.
> In a four-month pilot study testing the EMADE program, the service got 14 heart attack alerts that would be eligible for drones. Drones took off in 12 of those cases, and 11 successfully delivered the defibrillators. Seven of those defibrillators were delivered before the ambulance arrived.
So if this is the first patient saved does that mean all 11 people that were delivered defibrillators in the pilot study died?
Maybe, as it says, "The survival rate is about 10%" even though large numbers of people experience cardiac arrest in a clinical setting where they had defibrillators for years. Lots of Cardiac Arrest incidents aren't survivable, if your heart actually stopped they can't do anything about that. But without measuring (the first step the AED takes) you can't tell whether the heart is stopped or merely stuck twitching and not pumping blood, in the latter case the defibrillator may fix that, hence the name.
Anyone can do CPR and used an AED. If there's a doctor around let him do it, but if not, it's up to you. Make sure you are ready for it. Take a course if you get the chance, but if not, just read up on the basics of doing CPR and be aware that the AED will talk you through it and you are allowed an encouraged to use it.
Yep, my BS meter went flying. Mostly b/c key information about how the drone got there so quickly seems convenienly left out. Who called the emergency services (it wasn't the doctor)? Who contacted the service to send the drone? How did the drone get the exact location? Did the man just happen to live very close the where it was dispatched? And the fact that this is a press release should preclude it from being posted until an independent source verifies these details.
You say that, but the batteries have an expiration date and cost a significant portion of that $2000 which adds up. My very rural hometown (midwest US) is ending it's volunteer ambulance/first responder service in no small part due to these costs. I would argue having an ambulance without a defib is better than no ambulance, but laws don't care.
This is wonderful, and I also wonder how it compares cost-wise to maintaining AEDs in a distributed fashion. I know where my nearest defib is, and I know roughly how much it cost to install (Chf 2000) and maintain (Chf 200 / yr). What I don't know is how many fixed points like that could be replaced by one drone, even if it cost a lot more.
Also, most places in my village, it would be a 5 minute trip from my house to a patient. If I was dispatched towards a patient, would the AED arrive on their driveway before/with me?
Even in a country with a medical payment system as terrible as the US insurance is only a factor after an emergency, not during one. A homeless bum collapsing with a heart attack outside a hospital and they'll treat him just as well as Bill Gates. Now, outside an emergency like with followups after your heart is beating again this is a huge difference and going into collections after you can't pay is Not Fun. But lets not pretend the system is worse than it is.
We regret to inform you that your Trauma Team policy has expired due to lack of
payment. Please remember to activate your card immediately, so we may continue
to keep you healthy and safe in life's most dangerous moments. You can't afford
to hesitate when your livelihood is at stake.
Trauma Team
They are hardwired, to stay on trickle charge. And they need to be serviced once a year (check battery, check that the pads are not expired). So your best bet is to call the phone number on your fire extinguisher, which also needs yearly inspections.
> In a four-month pilot study testing the EMADE program, the service got 14 heart attack alerts that would be eligible for drones. Drones took off in 12 of those cases, and 11 successfully delivered the defibrillators. Seven of those defibrillators were delivered before the ambulance arrived.
It doesn't say how many of the 7 were actually used. I imagine it's less likely if there doesn't happen to be a doctor on scene.
Defibrillators are now fairly fool proof and relatively easy to use, some of them even give you audio instructions on how to use them. I’m sure in most cases someone would be on the phone to an emergency medical expert.
My guess is that they either didn’t save the patient or it wasn’t the right tool needed.
The only difference between a medically trained person and an average bystander is that the medical person will be more used to assessing the situation, taking a decision and then intervening with the patient.
You need no training to safely use an AED, though it will ask you to do chest compressions, and without training, the compressions are likely to be ineffective. Good compressions are surprisingly violent, and you'd never do that to someone unless you'd received training explaining why and how.
Less likely yes, but the publicly accessible defibrillators are pretty easy to use.
They have big prints on them where to place the pads and after pressing the big green "On" button they start talking to you, explaining what to do.
They are also included in the standard CPR first-aid courses nowadays.
Yup. I wish these were required in every business and public space, similar to fire extinguishers. Or even in every car, part of the mandatory first aid kit (I'm talking Europe here).
I think this is a chicken&egg problem: such requirement would be expensive initially but as the production of AED scaled up prices would drop.
Obviously training is required too, I'm not sure how feasible it is to get large fraction of population trained...
They seem to be coming down a lot - I remember looking a year or two ago and they were above $3000 AUD here, but now I can find some for around $1500 - $2000 (around US$1100 or €950). It's getting down to the point where I could basically justify buying my own one to carry with my first aid kit...
[+] [-] KineticLensman|4 years ago|reply
Specifically, I was defibrillated by bystanders when I had an out-of-hospital Ventricular Fibrillation episode. The staff at the UK building I was visiting had a defibrillator in their office and one of them had been on a training course.
When I collapsed with no warning, there was (according to my wife) about a minute of confusion and then one of the staff grabbed the defibrillator and used it. The device itself plays recorded instructions and itself conducts diagnostic tests to determine whether or not it should be used. If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it. If it can treat you, then it gives clear instructions to the users and delivers shocks as required.
In my case, the visitor centre staff had saved my life before the air ambulance arrived with trained medics. I was then flown to hospital where the critical cardiac care team confirmed that the bystanders had done exactly the right thing. They had also administered manual CPR which had kept my brain supplied with oxygen at the cost of two broken ribs. So here I am today writing this comment, thanks to the immediate availability of a defibrillator to bystanders.
I was lucky. My VF episode happened just as I had entered the lobby of the building that coincidentally contained the defibrillator. If I had been a 20 minute walk away, I would be dead (or brain damaged). Would a drone-based defibrillator have saved my life? Don't know, but it would certainly improve my chances.
[+] [-] traceroute66|4 years ago|reply
I was taught how to use one on a course where the instructor said he used to enjoy teaching students this fact by allowing them to take turns attempting to use a live defibrillator on him.
He got away with it for many years until his boss found out and put a stop to it because the company insurance wouldn't cover the company (despite clear witnessed consent being given by the instructor).
On the plus side, the company didn't ban his teaching method of NPA (Nasopharyngeal Airway) insertion. ;-)
> manual CPR which had kept my brain supplied with oxygen
Manual CPR done correctly is critical, and yes if done correctly you WILL end up with broken ribs. Mouth-to-mouth is not deemed particularly necessary these days (since the act of correct CPR will draw oxygen in anyway), better to focus on proper CPR and wait for the ambulance to turn up with high-flow oxygen from a tank.
> If I had been a 20 minute walk away, I would be dead (or brain damaged)
Yes. The most effective time for defib use is in the first 5 minutes. That's not to say you should not have a go after that time, but its effectiveness does drop away quite quickly.
[+] [-] padolsey|4 years ago|reply
To expand on this a bit, defibs will only deliver a shock if they detect VF (ventricular fibrillation) or VT (ventricular tachycardia). These are considered shockable rhythms. Both involve malfunction of the electrical conduction system usually due to lacking oxygenated blood supply to the heart muscle itself.
A shock seeks (usually up to 300 joules depending on patient size) to reset the hearts' rhythm so the body's natural pacemaker (called the SA node, positioned in the top-right of the heart) can kick back in. If there's no shockable rhythm, the defib machines will usually instruct you to continue CPR (chest compressions) and then will ask you to stop after a cycle of 30 so it can re-analyze the rhythm. Otherwise CPR must continue until medics arrive. If the defib detect a normal rhythm (sinus rhythm) then that's good news and means the defib has been effective.
Pad placement is very important if you're administering defib. The pads are positioned so that the depolarization travels approximately down the septum of the heart, to emulate the normal electrical cascade.
Note: there are many types of heart malfunctions that can't be remedied by a defib but that doesn't mean you should do nothing. Always do CPR. Always call the emergency services.
Possibly of interest to HNers: It is a common misconception that a defib can bring a heart back from 'flat-lining' (asystole). Hollywood movies don't help. If there is asystole, medics will usually continue CPR until the rhythm changes whild trying to reverse any underlying causes of the heart failure (e.g. massive hemorrhaging or hypothermia).
[+] [-] jgrahamc|4 years ago|reply
I did CPR on an elderly man I found having a heart attack in an alley in London. He was conscious when I found him. I called 999 and stayed with him. He "died" in front of me (no pulse, breathing, motion, loss of urine control). I did CPR until the ambulance arrived; I remember the sound of breaking ribs very clearly. They used a defib on him and he survived and until I moved away from the area I'd see him walking around from time to time.
Was a slightly odd feeling seeing him because I literally saw him "stop".
[+] [-] fortran77|4 years ago|reply
I have a Philips HeartStart at home. None of us are high risk (we're not obese, fit), or had family history of heart disease. We just like gadgets, and why take a chance?
The last company I worked as an employee at had defibrillators on every floor. While I had to take diversity training, and sensitivity training, I was never required to take -- or offered -- a class in defibrillator training.
[+] [-] Tor3|4 years ago|reply
[+] [-] matheusmoreira|4 years ago|reply
[+] [-] jacquesm|4 years ago|reply
[+] [-] sebow|4 years ago|reply
[+] [-] krn1p4n1c|4 years ago|reply
https://www.svd.se/dronare-transporterar-blodprover
[+] [-] InfiniteRand|4 years ago|reply
I work for a company providing tools for safety-critical software, and so we were in discussions with a defibrillator company. They tried to argue that the defibrillator was not critical to the patient's life, and thus not subject to the relevant regulation, because the patient was already dead. No one bought this argument.
[+] [-] KineticLensman|4 years ago|reply
I'm amazed that they would take this line. In many cases, a person's heart is still very active when it is shocked by the external defibrillator, and the person is still breathing. In some types of VF (see my comment elsewhere [0]), the problem is that the normal synchronised contraction of the cardiac muscle fibres has broken down, and the heart is thus quivering spasmodically, not cleanly pumping. To break this cycle, the defibrillator emits a massive shock that causes the muscle fibres to simultaneously go into their 'reset' phase, and the hope is that the heart's natural pace maker (the sino-atrial node) can then take back control. It's like the defibrillator is shouting "will you all shut the fuck up!" into a crowded auditorium full of people talking over each other rather than listening to a presenter. The defibrillator can't magically restart an insert dead body.
[0] https://news.ycombinator.com/item?id=29821574#29837367
[+] [-] andylynch|4 years ago|reply
[+] [-] MauranKilom|4 years ago|reply
https://www.youtube.com/watch?v=ecVHYg4_vZw (skip to min 3 for the action)
[+] [-] traceroute66|4 years ago|reply
TL;DR the BBC were in the right place at the right time. They were filming a documentary at a UK Air Ambulance office when the call taker had a cardiac arrest right there infront of them. They filmed the whole thing from start to finish and the guy gave his consent for them to release the video to the public.
[1] https://www.youtube.com/watch?v=h0xWZ0aBGiI
(The above video does say "edited" I don't know what they've edited out, so you might need to searching the web for the full version).
[+] [-] stripline|4 years ago|reply
So if this is the first patient saved does that mean all 11 people that were delivered defibrillators in the pilot study died?
[+] [-] tialaramex|4 years ago|reply
[+] [-] LorenPechtel|4 years ago|reply
[+] [-] tmikaeld|4 years ago|reply
[+] [-] user-the-name|4 years ago|reply
[+] [-] sandos|4 years ago|reply
My bs meter is swinging wildly for some reason, this sounds like something that should have been widely reported...
[+] [-] fumeux_fume|4 years ago|reply
[+] [-] sorenjan|4 years ago|reply
https://lakartidningen.se/aktuellt/nyheter/2021/12/akutlakar...
[+] [-] collyw|4 years ago|reply
[+] [-] belter|4 years ago|reply
https://youtu.be/7ukk5hOV8e0
[+] [-] vhplp|4 years ago|reply
[+] [-] Zigurd|4 years ago|reply
[+] [-] 83|4 years ago|reply
[+] [-] jeffrallen|4 years ago|reply
Also, most places in my village, it would be a 5 minute trip from my house to a patient. If I was dispatched towards a patient, would the AED arrive on their driveway before/with me?
So many questions.
[+] [-] jcun4128|4 years ago|reply
[+] [-] Kiro|4 years ago|reply
[+] [-] Symmetry|4 years ago|reply
[+] [-] Dah00n|4 years ago|reply
[+] [-] teruakohatu|4 years ago|reply
[+] [-] lostlogin|4 years ago|reply
Successful CPR would be worth more to advertisers of course, but deaths also require a range of goods and services. Entirely sarcastic, but…
[+] [-] shmerl|4 years ago|reply
[+] [-] d-d|4 years ago|reply
[+] [-] exhilaration|4 years ago|reply
[+] [-] jeffrallen|4 years ago|reply
[+] [-] pmdulaney|4 years ago|reply
[+] [-] tempestn|4 years ago|reply
It doesn't say how many of the 7 were actually used. I imagine it's less likely if there doesn't happen to be a doctor on scene.
[+] [-] uf00lme|4 years ago|reply
[+] [-] jeffrallen|4 years ago|reply
You need no training to safely use an AED, though it will ask you to do chest compressions, and without training, the compressions are likely to be ineffective. Good compressions are surprisingly violent, and you'd never do that to someone unless you'd received training explaining why and how.
[+] [-] dubbel|4 years ago|reply
They are also included in the standard CPR first-aid courses nowadays.
[+] [-] xaduha|4 years ago|reply
[+] [-] progbits|4 years ago|reply
I think this is a chicken&egg problem: such requirement would be expensive initially but as the production of AED scaled up prices would drop.
Obviously training is required too, I'm not sure how feasible it is to get large fraction of population trained...
[+] [-] stephen_g|4 years ago|reply
[+] [-] perilunar|4 years ago|reply
[+] [-] bashwizard|4 years ago|reply
[+] [-] avidphantasm|4 years ago|reply