The Grand Jury investigated
the need for Automated External Defibrillators (AEDs) in Santa Cruz
County, how they are currently being
deployed, and what policies are in place for their use in saving the lives of
sudden cardiac arrest (SCA) victims.
An estimated 325,000 lives are lost each year in the United States due to sudden cardiac arrest.[1] From October 2004 through September 2006, 484 people were victims of sudden cardiac arrest in Santa Cruz County alone.[2] With the recent advances in technology, the modern AED units are simple and relatively low cost. Many lives could be saved if they were made available and used within the first few minutes after the onset of sudden cardiac arrest. Although fire and ambulance services in the county are well equipped and have an excellent reputation for effective medical response, their ability to reach a patient who is suffering from sudden cardiac arrest in time is highly problematic. The solution lies with AEDs being more widely distributed at key sites throughout the county.
In providing what is fast
becoming a “standard of care,” the
county
must keep up to date with
technology, national trends and the legal liability associated with failure to
be proactive. The county should re-examine
its policy and its requirements for the placement of AEDs as recommended in this
report.
AED
Automated External Defibrillator — a computerized
medical device that automates
the process of administering an electrical shock to the
heart to restore its natural rhythm.
Advanced Life Support (ALS)
Medical care provided by emergency
medical technicians trained to assess a patient's condition,
administer drugs, defibrillate and provide advanced airway management prior to
transportation to the hospital.
AMR
American Medical
Response — a private ambulance
service that coordinates with emergency services agencies
in the county for first responder Advanced
Life Support service.
AMR is the sole provider of medical transport in the county.
Basic Life Support (BLS)
Basic
Life Support consists of a number of life-saving techniques focused on the ‘ABCs’ of pre-hospital
emergency care: Airway, Breathing and Circulation. BLS
generally does not include the use of drugs or invasive skills, but
with advances in AEDs may now include
defibrillation.
CPR
Cardio-Pulmonary Resuscitation.
EMSIA
Emergency Medical Services Integration Authority — a
combination of county fire districts and departments that work
together with American Medical Response to
provide Advanced Life Support medical services in Santa Cruz County.
Net Com
Santa Cruz Consolidated Emergency Communications Center — the
county’s primary response and dispatch center for 911
calls.
PAD
Public Access Defibrillator — an AED that is available
in public and/or private places where large numbers of people gather or people
who are at high risk for heart attacks live.
Standard of Care
The level of service that
the average, prudent provider in a given community would practice.
VF/VT
Ventricular Fibrillation/Ventricular Tachycardia — chaotic heart rhythms
that can be restored to a natural spontaneous rhythm through
defibrillation.
Heart disease is a serious
public health issue. In the United States, at least 61 million
people have cardiovascular disease, resulting in an estimated 1 million
deaths per year. About one-third of these deaths, 300,000 to 400,000, are due
to sudden cardiac arrest, the sudden and unexpected loss of heart function.[3]
Most often,
sudden cardiac
arrest is due to chaotic beating of the large chambers of the heart, called
ventricular fibrillation. Typically, its victims
have no warning and quickly collapse and lose consciousness.
The only treatment that can save their lives is the quick use of a
defibrillator, a medical device that administers an electrical shock to the
heart to restore its synchronous pumping rhythm. Defibrillators work by giving
the heart a controlled electric shock that has the chance to resynchronize the
contraction of the heart muscle and restore its normal rhythm.
The overall survival rate for out-of-hospital cardiac arrest is 6.4 percent nationally and 6 percent in Santa Cruz County.[4] Immediate treatment with defibrillation can improve the odds of survival significantly — resulting in greater than 90 percent survival. Every minute of delay decreases the survival rates by 10 percent; after 10 minutes without defibrillation, it is highly unlikely that a sudden cardiac arrest victim will survive.
Defibrillators are available in two forms, manual and automated. Only trained medical professionals are qualified to use manual defibrillators. Manual defibrillators require interpretation of the patient’s condition and an understanding of the capabilities of the defibrillator to deliver an effective and safe shock.
Recently, as a result of technological advances and the development of special computer applications, a new kind of defibrillator has become available. Today’s AED uses embedded computer chips and sophisticated programming to analyze heart rhythms quickly and accurately and determine if a shock should be given. It will only deliver a shock if the readings indicate that one is necessary. This automation makes it possible for non-medically trained individuals to deliver the same life-saving treatment as medical professionals without risking an accidental or inappropriate shock. Most modern AEDs are equipped with synthesized voice instructions telling the user how to proceed in the case of a cardiac emergency. This new equipment is very easy to use. In fact, in one study, untrained sixth graders took only 30 seconds longer than trained emergency service technicians to prepare a patient for a shock.[5]
Another advantage of modern automated defibrillators is the fact that, like most electronic equipment, they have become more affordable and available to the general public. In the past, their cost put them out of the reach of most people, but today they can be purchased through retail and online outlets for prices ranging from about $1,000 to $2,000.
The American Heart Association has recognized four critical factors associated with improved survival rates from sudden cardiac arrest in communities. More people survive when this sequence of events, called the Chain of Survival, happens as quickly as possible. These four steps are:
Establishing a viable chain of survival in a community requires an integrated plan that relies on the cooperation of local government agencies and ordinary citizens to know what to do and be prepared to take action when an emergency occurs.
Status
of Emergency Services in Santa Cruz County
1. The 911 system for most of Santa Cruz County is administered through the Santa Cruz Consolidated Emergency Communications Center, commonly called Net Com. Additional public safety answering points for the 911 system are in Scotts Valley and at the University of California’s Santa Cruz campus.
Response: The
Santa Cruz Consolidated Emergency Communications Center (NetCom) PARTIALLY
AGREES.
In addition to the primary public
safety answering points (PSAP) mentioned within the Finding, it should be noted
that Cal Fire maintains a secondary PSAP
located in Felton which receives transferred 9-1-1 calls relating to fire
incidents occurring within the unincorporated areas of the County not serviced
by a Fire District.
Response: The
Santa Cruz County Emergency Medical Services Integration Authority (EMSIA)
AGREES.
It is important to note that many 911
calls are made by cell phones. When 911 calls are made by cell phones on or
close to major roadways, the California Highway Patrol acts as the public
safety answering point. Calls are then routed to the appropriate jurisdictional
dispatch center.
2. Net
Com is an up-to-date, modern
facility. Dispatchers have access to computer-aided
dispatch systems that allow them to rapidly send
police, fire, and medical assistance when needed. For medical
calls involving a person not breathing, such as sudden cardiac arrest,
Net Com was able to dispatch Emergency Medical
Service units within 60 seconds 92 percent of the time in 2006.
Response:
NetCom AGREES.
Response: The EMSIA AGREES.
3. The Emergency Medical Services Integration Authority (EMSIA) — consisting of the Aptos/La Selva Fire District, Central Fire District, Scotts Valley Fire District, City of Watsonville Fire Department, and City of Santa Cruz Fire Department — provides first responder Advanced Life Support (ALS) medical services to the urban areas of the county.
Response:
The EMSIA PARTIALLY AGREES.
The EMSIA consists of 12 Fire
agencies in Santa Cruz County; Aptos/La Selva Fire District, Ben Lomond Fire
District, Boulder Creek Fire District, Branciforte Fire District, Central Fire
District, Felton Fire District, Pajaro Valley Fire District, City of Santa Cruz
Fire Department, Scotts Valley Fire District, UCSC Fire Department, City of
Watsonville Fire Department, and Zayante Fire District and acts as a liaison
between the fire service, the County, AMR, and other EMS related entities. It
is the five agencies listed in the finding , not the EMSIA, that actually
provide advanced life support services. The remaining agencies provide basic
life support (BLS) medical services within their jurisdictions.
4. The remainder of the county receives first responder Basic Life Support medical services from a variety of smaller fire departments and the California Department of Forestry.
Response:
The EMSIA MOSTLY AGREES.
As described in #3, the EMSIA BLS
agencies provide BLS Services to much of the county. The California Department
of Forestry and Fire Protection (CALFIRE) provides BLS through its contract as
the Santa Cruz County Fire Department. CALFIRE and Santa Cruz County Fire
Department are not member agencies of the EMSIA.
5. American Medical Response (AMR), a private ambulance service, coordinates with the EMSIA agencies for first responder ALS service and through its contract with the County of Santa Cruz is the sole provider of medical transport in the county.
Response: The EMSIA AGREES.
6. EMSIA fire agencies are able to provide a paramedic to a medical emergency within eight minutes of dispatch 90 percent of the time in urban areas.
Response:
The EMSIA AGREES.
Urban areas, as defined for the
purposes of this finding, are the jurisdictional service areas of the EMSIA ALS
agencies (Aptos/La Selva Fire District, Central Fire District, Scotts Valley
Fire District, City of Watsonville Fire Department and City of Santa Cruz Fire
Department). The actual performance level hovers around 94% of all emergency
calls within eight minutes.
7. AMR
is able to provide an ambulance to a medical emergency within 12 minutes of
dispatch 90 percent of the time.
Response: The EMSIA AGREES.
Response: The EMSIA AGREES.
Response: The EMSIA AGREES.
AED Distribution and Training
10. Manual defibrillators, such as those carried by fire department and AMR paramedics, are expensive and complex and require significant training and experience to be effective. Conversely, automated external defibrillators (AEDs) are reasonably priced and simple to operate by anyone with a minimum of training.
11. Santa Cruz County does not have a comprehensive policy regarding the distribution and installation of AEDs in public locations.
Response: The
County AGREES.
The
County is not required by State law to adopt a policy regarding distribution
and installation of Automatic External Defibrillators (AEDs) in public
locations.
12. AEDs are carried in police patrol cars in Scotts Valley. No other law enforcement agencies in the county require AEDs in their vehicles.
Response: The Santa Cruz County Sheriff's Office
PARTIALLY AGREES.
It is not known which law enforcement
agencies in the county require AEDs in their vehicles.
Response:
The Santa Cruz Police Department PARTIALLY AGREES.
Our agency does not require AEDs in all
of our patrol vehicles but provides an AED in our supervisor’s vehicle and
outside of the main lobby of our police department.
Response:
The Scotts Valley Police Department AGREES:
Scotts Valley Police carries AEDs in our
cars. We do not know what the requirements are in other county law enforcement
agencies.
Response: The
Capitola Police Department DISAGREES.
Currently, the Capitola Police Department
has five AEDs at its disposal. One AED is deployed at the Police Department for
use by staff either in the field or at headquarters. An additional AED is
located in City Hall for use by City Hall staff serving the public. Three
additional AEDs are available and routinely assigned to the Lifeguard Unit
located at the Capitola Main Beach, one AED in the Supervisors patrol vehicle
and one unit deployed in a primary police cruiser. Additional AEDs are scheduled for acquisition
in late 2007 or early 2008. Several of
these AEDs have been in service for approximately two years. Eventually, the Police Department intends to
equip each primary patrol unit with an AED, requiring acquisition of three to
four more devices. It is important to note that an AED also are available at
the Capitola Mall and readily available to department staff working at the
Capitola Police Department’s Community Outreach Center.
Response: The
Watsonville Police Department PARTIALLY DISAGREES.
Capitola Police Department has many
of them. Whether any other police department has them in the car, we don’t
know. We accept the jury’s statement that Scotts Valley Police Department does.
13. The locations of AEDs in the county are not available to Net Com dispatchers.
Response:
NetCom AGREES.
14. When
AEDs are deployed in public buildings, they are often not visible and therefore
not accessible when needed.
15. CPR
classes, including training in the use of AEDs, are available through a variety
of sources in the county.
Need
for AEDs
16. While immediate CPR can buy valuable time for a sudden cardiac arrest victim, defibrillation is the only treatment that can save the victim’s life by restoring the heart’s spontaneous rhythm.
Response: The EMSIA AGREES.
Defibrillation is the most definitive
intervention shown to restore spontaneous circulation in cardiac arrest patients.
However, studies also show that effective
CPR significantly enhances the success of all defibrillation attempts. Proper
compression and ventilation (especially with 100% oxygen) is therefore a
critical component of this “chain of survival.”
To this end, early 911 access is also crucial; the study here in Santa
Cruz County showed higher survival rates with witnessed arrests vs. unwitnessed
arrests.
17. People of any age may suffer sudden cardiac arrest and die suddenly.
Response: The EMSIA AGREES.
While the predominance of sudden
cardiac arrests occur among elderly patients, it is true that no age group is
immune from sudden cardiac arrest.
18. Sudden cardiac arrest is different from a heart attack although coronary artery disease may reduce heart circulation and eventually result in SCA.
Response:
The EMSIA AGREES.
19. Often the
first sign that a person is vulnerable to ventricular fibrillation is an attack
that results in sudden cardiac arrest and
death.
Response:
The EMSIA AGREES.
20. In Santa Cruz County, approximately 250 people per year are victims of out-of-hospital sudden cardiac arrest. From October 2004 through September 2006, more than half of these victims (51 percent) were not candidates for resuscitation, mostly because too much time had elapsed before emergency medical services could be activated.[6]
Response: The EMSIA AGREES.
The patients in this study who were
not candidates for resuscitation fell into one of three groups:
1. Patients
who had been in cardiac arrest for too long before EMS was activated (the
majority of patients were in this category);
2. Patients
who had signed paperwork indicating that they did not wish to be resuscitated,
usually due to the presence of a terminal illness;
3. Patients
who had suffered traumatic injuries (58 cases) and were deemed unviable prior
to a resuscitation attempt.
21. Some common causes for sudden cardiac arrest include asphyxia due to drowning or other oxygen deprivation, congenital heart conditions, sudden blows to the chest, electrocution, and coronary artery disease.
Response: The
EMSIA AGREES.
The vast majority of cases of sudden
cardiac arrest in adult patients across all age groups can be attributed to the
presence of coronary artery disease and/or cardiomyopathy, and the subsequent
fatal arrythmias which can occur in these patients. The most common cause of
cardiac arrest in children is respiratory arrest secondary to a host of causes
including drowning, foreign body airway obstruction, and respiratory disease.
Sudden blows to the chest, electrocution, and congenital heart conditions are
very rare causes of sudden cardiac arrest in any community. “Asphyxia” refers to fatal anoxia from
respiratory failure (from drowning, foreign body airway obstruction, severe
asthma attacks, etc.) and is a more common cause of SCA in any community, but
certainly far less common than cardiac etiologies.
22. The worst combination for cardiac arrest survival is if patients collapse without witnesses, and when discovered, receive no bystander CPR while emergency services personnel are en route. In a two-year period in Santa Cruz County, only two of 215 patients in this situation had their hearts begin to beat again, and neither survived. When sudden cardiac arrest was witnessed and immediate CPR was administered, nearly a quarter of the victims regained pulses and 10 percent survived. The survival rate jumped to 19 percent when EMS professionals witnessed cardiac arrest and could begin treatment immediately. There were 16 EMS-witnessed cases in the two-year period, and three of those were found to be in ventricular fibrillation (as opposed to those with no electrical activity or pulse). All three were successfully resuscitated with defibrillation only.[7]
Response:
The EMSIA AGREES.
23. Some experts believe that a connection may exist between the use of ‘Tasers’ by law enforcement and sudden cardiac arrest in some individuals.
Response from the EMSIA:
This concept is very hotly debated
among legal, medical and law enforcement experts. Much of the medical data at
this time suggests that sudden, in-custody deaths may in fact be attributable
to a medical phenomenon known as “excited delirium.”
Excited delirium is thought to occur when individuals — often, but not always,
drug or alcohol intoxicated — develop central nervous system dysfunction which
leads to bizarre, violent behavior. When
force of any kind is subsequently used —
wrestling with the patient, batons, Tasers, pepper spray — the patient may
experience respiratory and cardiac arrest. There is no indication that Tasers
particularly are implicated in in-custody deaths any more than any other use of
force to try to control and contain a violent or non-compliant subject who
suffers from this phenomenon.
24. To improve the survival rate of victims of out-of-hospital cardiac arrest in Santa Cruz County, the Emergency Medical Services Integration Authority recommends “promulgating citizen CPR programs, Public Access Defibrillator (PAD) programs, and continued rapid EMS response using all the latest AHA (American Heart Association) recommendations for CPR, defibrillation, and advanced life support care.”[8]
Response:
The EMSIA AGREES.
Laws
related to AEDs
25. Effective July 1, 2007, the State of California will require all health clubs to be equipped with AEDs on site and establish a program of training, maintenance, and record keeping.
Response: The EMSIA AGREES.
26. Good
Samaritan laws protect most citizens from liability if they take action in a
medical emergency, which includes using an AED. Conversely, lawsuits have been
filed against organizations such as amusement parks and airline companies for
not having AEDs readily available.
27. AEDs are now required at FAA governed airports and on all commercial airliners.
28. The
Federal Cardiac Survival Act of 2000 (Public Law 106-505) directed the Health
and Human Services Department to establish guidelines for evaluating and
installing AEDs in federal buildings.
1. In
Santa Cruz County, the American Heart Association’s recommended
‘Chain of Survival’ for victims of sudden cardiac arrest is incomplete.
Specifically, the availability of early CPR and early defibrillation is
lacking.
Response from the County:
The recommendation is being implemented in conjunction with the
Emergency Medical Care Commission’s Public Information and Education
Subcommittee. The Subcommittee will continue to monitor local out-of-hospital
cardiac arrest data and is working closely with Dominican Hospital to improve
the survival rate.
Response
from NetCom:
Requires further analysis and may not
be implemented because it is beyond this agency’s scope of service. Netcom
computer systems possess the ability to be programmed with AED location data
tied to fixed telephone locations which would become available to call-takers upon
call answering. While the technical capability and capacity exists, there is
currently no program or system available to collect and update this location
data, nor is there a requirement for businesses and individuals to “register”
their AEDs by location. Furthermore, it is beyond the scope of our agency to
mandate a registration and to be responsible for the collection of such data. In
the event that a responsible agency should someday register, collect, and
update AED location data and make it available to our Agency in an electronic
format, we in turn could enter it into our computer systems and make it
available to call-takers handling 9-1-1 emergency calls. In the meantime, it is important to note that
our computerized Emergency Medical Dispatch (EMD ProQA) software is configured
to prompt call-takers to question callers who report “cardiac” incidents as to
the availability and accessibility of an AED. In the event that a caller
answers “Yes” to this prompt, EMD ProQA provides medically approved, step-by-step
instructions which allows NetCom call-takers to “walk the caller through” the
operation of an AED.
Response from the County:
This recommendation will not be implemented at this time. While the
County strongly supports the idea, funds are not available to purchase and
install AEDs in all county buildings with more than 100 employees. The County will look for funding
opportunities and will consider a phased in approach as part of County budget
considerations.
§·
Public schools
§·
Public swimming pools
§·
Public libraries
§·
Large concerts and other public
events
§·
Public golf courses
§·
Churches with a capacity of 100 or
more
§·
Private schools
§·
Private recreation clubs
§·
Medium to large hotels and motels
§·
Shopping centers
§·
Medical and dental offices
§·
Private golf courses
· Senior citizen centers and care facilities
Response from the County:
The recommendation is in the process of
being implemented by the Emergency Medical Care Commission’s Public Information
and Education Subcommittee that is focusing on cardiac care and stroke
prevention. The Emergency Medical Services Program will also be adding
information about AEDs to the program’s webpage.
Response: The Santa Cruz County Sheriff's Office
AGREES.
This recommendation has not yet been implemented
but will be implemented in the future. The Sheriff's Office has just purchased
a few AEDs for deployment. However, due
to the large number of Sheriff's vehicles, full deployment will have to occur
in planned stages, along with the training of staff.
Response from the Santa Cruz Police Department:
The recommendation will not be
implemented. Our agency is not a primary responder for medical calls and the
Santa Cruz Fire Department staffs paramedics [are] primary responders for such
emergencies. In order to outfit our patrol vehicles the department would have
to outlay over $50,000 in equipment and training costs.
Response: The Scotts Valley Police Department AGREES:
The Scotts Valley Police Department has
carried AEDs in our patrol vehicles for several years now.
Response from the Capitola Police Department:
The Capitola Police Department agrees and
is the process of acquiring additional AEDs and the requisite training and
certification required to effectively deploy the devices in each primary patrol
vehicle, office site and the Capitola Lifeguard Unit.
Response: The Watsonville Police Department AGREES.
Watsonville Police Department will
put them in the next two-year budget cycle; FY2009/11 for consideration by the
City Council.
Response from the County:
State law is clear that individuals and agencies that purchase and place
AEDs are shielded from liability if they follow the requirements to maintain
them and conduct training as required by the State.
Response from the County:
Emergency medical dispatchers at NetCom routinely ask callers reporting
suspected cardiac arrests to quickly look around for an AED. It would not be feasible to conduct
inspections to ascertain where AEDs are located and to establish and correct a
database with any regularity. It is anticipated that in the near future AEDs
will be as prolific as fire extinguishers.
Response from the County:
The recommendation is in the process of being implemented by the
Emergency Medical Care Commission’s Public Information and Education
Subcommittee that is focusing on cardiac care and stroke prevention. The
Emergency Medical Services Program will also be adding information about AEDs
to the program’s webpage.
Response from the County:
The recommendation is being implemented by the Emergency Medical Care
Commission’s Public Information and Education Subcommittee that is focusing on
cardiac care and stroke prevention.
Santa Cruz County’s emergency
services teams and organizations for providing the most efficient and
responsive services possible under current conditions.
Responses
Required
|
|||
Entity
|
Findings
|
Recommendations
|
Respond Within
|
|
Santa Cruz County Consolidated Emergency Communications Center |
1, 2, 13 |
2 |
90 days October
1, 2007 |
|
Santa Cruz County Health Services Agency |
11 |
1, 3, 4, 6-9, |
90 days October
1, 2007 |
|
Santa Cruz County Board of Supervisors |
|
1, 3, 4, 6, 8, 9 |
60 days September 1, 2007 |
|
Santa Cruz County Emergency Medical Services Integration Authority |
1-10, 16-24 |
|
90 days October 1, 2007 |
|
Santa Cruz County Sheriff |
12 |
5 |
60 days September 1, 2007 |
|
City of Santa Cruz Police Department |
12 |
5 |
90 days October 1, 2007 |
|
City of Scotts Valley Police Department |
12 |
5 |
90 days October 1, 2007 |
|
City of Capitola Police Department |
12 |
5 |
90 days October 1, 2007 |
|
City of Watsonville Police Department |
12 |
5 |
90 days October 1, 2007 |
American Heart Association. 2003. Working Against Time.
Santa Cruz Consolidated Emergency Communications Center. Annual Report 2006. 2007.
Medic First Aid International. 2003. Medic First Aid AED Supplement, Student Guide.
American Heart Association. 2004. Automated External Defibrillation, Implementation Guide.
Sudden Cardiac Arrest Association. Information pamphlet.
Emergency Medical Services
Integration Authority, Audit of Out-of-Hospital Cardiac Arrests, Santa
Cruz County, October 1, 2004 –
September 30, 2006, May 2007.
Santa Cruz Sentinel, Classified advertisement for employment. EMSIA Firefighter/Paramedic. 4/1/07, E-13.
Praise for Rescuers at S. J. Airport. San Jose Mercury News. 8/31/06, A-1
Jump-Start a Heart: The Simplified Approach. New York Times. 7/4/06. http://nytimes.com.
Automatic defibrillators spreading across Pickens. The Greenville Times. 4/21/04. http://greenvilleonline.com/news/2004/04/21/2004041229733.htm.
Monterey County, Calif., patrol cars to get heart defibrillators. Monterey County Herald. 5/17/06. http://jems.com/products/aeds/articles/104698.
Paramedic service on the horizon Fire district needs county permission. Santa Cruz Sentinel. 2/10/02.
http://www.santacruzsentinel.com/archive/2002/February/10/local/stories/07local.htm
Graniterock takes no chances when it comes to safety. Santa Cruz Sentinel. 4/7/04. www.santacruzsentinel.com/archive/2004/April/07/biz/stories/01biz.htm
New device helps heart attack victim. Santa Cruz Sentinel. 7/30/06. www.santacruzsentinel.com/archive/2006/July/30/local/stories/08local.htm
Heartless burglar swipes Little League’s defibrillator. Santa Cruz Sentinel. 4/29/05. www.santacruzsentinel.com/archive/2005/April/29/local/stories/06local.htm
First action heroes. Davis Enterprise. 12/8/06. http://www.davisenterprise.com/articles/2006/12/10/news/023new0.prt.
Spread of defibrillators urged: Studies find lives are saved when heart devices are quickly accessible. San Francisco Chronicle. 10/29/00. http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2000/10/26/MN6851.DTL.
Woman turns tragedy into personal mission: Son’s cardiac arrest prompts crusade for portable, public defibrillators. NBC Nightly News. 2/23/07. http://www.msnbc.msn.com/id/17303236/
Blow to chest can be fatal in child athletes, study finds. CNN.Com. 11/13/06. http://www.cnn.com/2006/HEALTH/11/13/heart.sports.reut/index.html?eref=rss_us.
Most clubs lack lifesaving devices: 80 percent of facilities without defibrillators. Spokane Review. 1/1/07. http://spokesmanreview.com/local/story.asp?ID=167016
Doctors blame taser stun gun for fibrillation. New York Times. 11/2/05. http://www.nytimes.com/2005/09/02/business/02taser.html.
Heart expert warns about using
Tasers. San Francisco Chronicle.
1/5/05.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/01/05/BAGOGAL4CS17.DTL&hw=defibrillator&sn=023&sc=471
Cardiologists warn of stun gun dangers. foxreno.com. 1/5/05. http://www.foxreno.com/news/4050534/detail.html
From the editor: Don’t be shocked. JEMS Magazine. May 2005. http://www.jems.com/jems/30-5/244715/
Heart expert warns about using Tasers. San Francisco Chronicle. 1/5/05. http://www.sfgate.com/cgi-bin/article.cgi?file=chronicle/archive/2005/01/05/BAGOGAL4CS17.DTL.
Jump starting the guy in 23C. San Francisco Chronicle. 12/22/02. http://www.sfgate.com/cgi-bin/article.cgi?file=chronicle/archive/2002/12/22/TR224209.DTL
OC grand jury blames bad nursing in jail death. San Francisco Chronicle. 5/1/07. http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/05/01/state/n0141603.DTL.
Muni stations to get defibrillators. San Francisco Chronicle. 12/11/04. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//2004/12/11/BAGJOAAEJM1.DTL.
Oakland: 16 new defibrillators on duty at the airport. San Francisco Chronicle. 4/23/05. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//2005/04/23/BAEBDIGEST2.DTL
Defibrillators on hand at Alameda County fair. San Francisco Chronicle. 6/22/01. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//2001/06/22/MNL157010.DTL
Tiburon cops to carry portable defibrillators. San Francisco Chronicle. 4/19/99. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//1999/04/19/MNR1BA3.DTL
Spread of defibrillators urged. San Francisco Chronicle. 10/26/00. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//2000/10/26/MN6851.DTL
Pac Bell Park gets defibrillators. San Francisco Chronicle. 10/5/01. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//2001/10/05/MN120651.DTL
Patrol cars will be getting defibrillators. San Francisco Chronicle. 11/19/98. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//1998/11/19/MNR4C01.DTL
Portable defibrillator is often a lifesaver. San Francisco Chronicle. 11/10/98. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//1998/11/10/MN38198.DTL
Town arms cops with defibrillators. San Francisco Chronicle. 2/7/97. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//1997/02/07/MN56981.DTL
Life-saving devices in Bay Area airports. San Francisco Chronicle. 10/27/99. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//1999/10/27/MN20764.DTL
User-friendly defibrillators
saving lives. San Francisco Chronicle.
7/9/01. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a//2001/07/09/MN176397.DTL
Police Chiefs, Sheriff, Launch Defibrillator Drive, effort underway to equip all patrol cars with life-saving devices. Salinas Valley Memorial Healthcare System. http://www.svmh.com/pressroom/news.asp?itemid=91&type=newsdetail.
A guide to the Seattle-King County Community Responder CPR-AED Program. King County, Washington. Emergency Medical Services. http://www.metrokc.gov/health/ems/aed.htm
Automated External Defibrillators. University Health Service Tang Center. http://www.uhs.berreley.edu/aed.shtml.
EMS-Public Access Defibrillation. San Mateo County Health Department. http://www.co.sanmateo.ca.us/smc/department/printable/0,2151,1954_291885143,00.html.
Automatic external defibrillator system. San Diego State University. http://police.sdsu.edu/aed.htm.
City of Sunnyvale. Council meeting award of bid no. F0505-81 for Automated External Defibrillators and accessories. http://sunnyvale.ca.gov.City+Council+meetings/2006.
Orange County Board of Supervisors receives Lifesaving AED. Orange County Government On-line. http://www.oc.ca.gov/press/2001/2001_Apr05a.asp.
Automatic External
Defibrillators (AEDs). San Francisco Board of Supervisors. http://www.sfgov.org/site/bdsupvrs_page.asp?id=286414.
Schools, children and SCA
Gregory W. Moyer Defibrillator Fund. http://www.GregAED.org.
Parent Heart Watch. http://www.parentheartwatch.org.
Project TJ. http://www.svmh.com/pressroom/lifeline/2005_spring/page2.html.
Response to cardiac arrest and selected life-threatening medical emergencies: The medical emergency response plan for schools. American Heart Association. http://www.onelife.americanheaert.org/presenter.jhtml?identifier=3017969.
Why your child’s school needs and AED. http://www.startaheaert.info/needschool.html.
Glen Falls boy saved by defibrillator. Times Union. Albany, NY. http://timesunion.com/aspstories/story.asp?storyID=560749.
Stueben sheriff saves boy. Star-Gazette, Elmira, NY. http://www.stargazettenews.com/apps/pbcs.dll/article?AID=/20070205/update/302050018.
Automated external defibrillator. Wikipedia. http://en.wikipedia.org/wiki/Automated_external_debibrillator.
Cardiopulmonary resuscitation (CPR): First Aid. MayoClinic.com. http://www.mayoclinic.com/health/first-aid-cpr/FA00061.
Sudden Cardiac Death. eMedicine.com. http://www.emedicine.com/med/topic276.htm
Automatic External Defibrillation. eMedicine.com. http://www.emedicine.com/emerg/topic698.htm.
Ventricular fibrillation. eMedicine.com. http://www.emedicine.com/med/topic2363.htm
EMS and Cardiac Arrest. eMedicine.com. http://www.emedicine.com/emerg/topic710.htm
Automatic External
Defibrillation. eMedicine.com. http://www.emedicine.com/emerg/topic698.htm
Cardiac Science, Inc., http://www.powerheart.com
Philips, Inc., http://www.medical.philips.com/main/products/resuscitation/
Medtronic, Inc., http://www.medtronic-ers.com/
ZOLL Medical Corp., http://www.zoll.com/
Organizations with SCA interest
Sudden Cardiac Arrest Association. http://www.suddencardiacarreat.org.
American Red Cross. http://www.redcross.org/services/hss/courses/aed.html#train
American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=1200000 and search for AED.
Local government and EMS
partners
Santa Cruz County Health Services Agency. http://www.santacruzhealth.org/1welcome.htm
Santa Cruz County Emergency Communications Center. http://www.sccec.org.
Santa Cruz County Health Services Agency, Public Health Department, Emergency Medical Services. http://www.santacruzhealth.org/phealth/ems/3ems.htm.
The State of the County’s Health 2005. Santa Cruz County Health Services Agency. http://www.santacruzhealth.org/pdf/2005%20STATEOFTHECOUNTYHEALTH.pdf
The State of the County’s Health 2006. Santa Cruz County Health Services Agency. http://www.santacruzhealth.org/pdf/2006%20STATEOFTHECOUNTYHEALTH.pdf
American Medical Response. http://www.amr.net.
Federal Occupational Health, Public Access Defibrillation Guidelines. http://www.foh.dhhs.gov/public/whatwedo/AED/HHSAED.asp
Occupational Safety and Health Administration. Cardiac Arrest and Automated External Defibrillators (AEDs). U. S. Dept. of Labor. http://www.osha.gov/dts/tib/tib_data/tib20011217.html
Automated External Defibrillator (AED). U. S. Food and Drug Administration. http://www.fda.gov/hearthealth/treatments/medicaldevices/aed.html.
California Codes and Statistics
Defibrillation statistics, 2005.California Emergency Medical Services Authority. http://www.emsa.cahwnet.gov/Data_inf/defib05.asp.
Defibrillation statistics, 2004. California Emergency Medical Services Authority. http://www.emsa.cahwnet.gov/Data_inf/defib04.asp
Cause of Death. California Department of Health Service, Center for Health Statistics. http://www.dhs.ca.gov/CHS/OHIR/tables/death/causes.htm
California Codes, Health and Safety Code, Sec. 104100-104140, Health Studios require AEDs after July 1, 2007.
California Codes, Health and Safety Code, Sec. 1797.190-1797.196, AED installation requirements.
California Codes, Health and
Safety Code, Sec. 1714.2-1714.21, Release of liability for AED use in an
emergency.
Local health, emergency services and medical personnel.
Survivors of sudden cardiac arrest.
This page intentionally left blank.
[2] Santa Cruz County Cardiac Arrest Audit 2004-2006, May 2007, p. 2 (hereafter referred to as “SCA Audit.”).
[3] American
Heart Association, http://www.americanheart.org/presenter.jhtml?identifier=4478
[4] SCA Audit, p. 4.
[5] Gundry,
W., Comess, K., DeRook, F., and Jorgenson, D. AEDs user-friendly — even for
children, October 17, 1999.
http://www.eurekalert.org/pub_releases/1999-10/AHA-Auef-171099.php
[6] SCA Audit, p. 6.
[7] SCA Audit, p. 6.
[8] SCA Audit, p. 9.