In April 1998, the Chanhassen (Minn.) Fire Department was running routine fire training drills when a 38-year-old department member collapsed. The training instructor immediately assessed his abcs and was unable to find a pulse. Yelling to a nearby firefighter to call 911, the instructor administered cpr while surrounded by the other members.

The ambulance arrived at the scene more than six minutes after the firefighter collapsed. Beginning treatment immediately, the paramedics delivered the first defibrillation shock to the firefighter, but were unable to restore a normal heart rhythm. Subsequent defibrillation shocks also were unsuccessful, and the firefighter died at the scene.

Each year in the United States, sudden cardiac arrest wipes out a population equal to that of Minneapolis. sca can strike anywhere at any time. Most people are unfamiliar with sca or what they can do to help victims.

In fact, early access to defibrillation could save at least one-third of the more than 350,000 people who die annually in the United States from sca. Published studies show that defibrillation performed within the first few minutes of cardiac arrest can save up to 30% of victims.

sca is one of the leading causes of death in the United States - more prevalent than stroke, lung cancer or automobile accidents. The only definitive treatment for sca is a defibrillation shock that delivers an electric pulse to the heart, restoring a normal heart rhythm. When a person is in cardiac arrest, his or her chance of survival decreases by 10% with each minute that passes. Equipping all fire vehicles with automated external defibrillators is a cost-effective way to help save sca victims who may not have time to wait for an ambulance.

Firefighters and AEDS Firefighters are inevitably in harm's way as they battle fires. With the intense heat, harmful smoke and fumes, heavy safety equipment, and highly physical nature of the job, every firefighter is under tremendous stress, increasing the risk of sca.

According to the nfpa, more than 50% of firefighter deaths over the last 15 years have been from cardiac arrest. In 1997 alone, 38 firefighters died of cardiac arrest, and 35 of those deaths were directly attributable to stress or overexertion.

cpr is an essential component of firefighter training but, according to the American Heart Association, the only definitive treatment for sca is a defibrillation shock. cpr works to pump oxygenated blood through the body and hold off brain damage for a time, but it doesn't reverse sca. When cpr is performed without defibrillation, it has minimal impact on sca survival rates.

When sca occurs, time is of the essence. Although all ems units respond as quickly as they can, response times may be as much as 10 minutes and possibly longer in rural and urban downtown settings. The bottom line is that sca victims must have early access to aeds to increase their chances of survival.

aeds are designed to be easy to use and take the decision to defibrillate out of the hands of the responder. Clear, concise voice prompts guide the responder through the rescue, automatically analyzing the patient's heart activity and determining if a shock is required. If defibrillation is needed, the device instructs the responder to push a button on the device to deliver a life-saving electrical pulse to the victim's heart.

Whether firefighters have minimal medical training or are fully trained paramedics, aeds can provide life-saving defibrillation treatment immediately. aeds are also affordable enough to be placed on every pumper truck and engine. Fire departments in Portland, Maine and St. Louis have found success with their aed programs.

An early adopter The Portland (Maine) Fire Department serves a medium-sized urban area, about 30 square miles, with a daytime population of 150,000. Included in its coverage area are five small islands inhabited by full-time summer residents and some year-round dwellers. The department has 230 fire personnel, including fire and ems professionals, spread over 12 engine companies. In addition, several trained volunteers on each island can provide sca victims with prompt defibrillation.

Striving to maintain the highest quality of patient care and improve the cardiac survival rate, Portland Fire was the first in its area to implement an aed program and place the devices on all fire apparatus.

"We are concerned with protecting our residents and ourselves," says Chip Boehm, rn, emt-p, ems education/quality improvement officer, Portland Fire Department. "Eighty-five percent of our personnel are emts, but it was important to find equipment that was reliable, easy to use and durable for use by any of our personnel. We decided to purchase aeds because we could train all our personnel easily, enabling everyone in our department to save lives quickly and effectively."

Portland Fire used an informal selection process, analyzing all aed models for specific features and finally choosing an aed on the basis of features rather than cost. "We selected an aed that provides the best defibrillation treatment for the money, without all of the bells and whistles of the ems defibrillators," Boehm says. "Our goal was to provide aeds to department personnel with all levels of medical training. We needed aeds that could walk responders through each step of the rescue process with voice prompts and easy-to-use features, such as one-button operation and preconnected electrodes."

Some Portland Fire Department personnel resisted the aed program at first. According to Boehm, aed and sca education and demonstrations showing that aeds are easy to use erased skepticism. "Our personnel were initially resistant, quickly moved to ownership and now are very protective of their equipment," he says. "The community also has been supportive of our program, and we continue to receive positive feedback from the residents."

Using the aha guidelines, the Portland Fire Department trained everyone in the department. Initial sessions were two to three hours, and annual re-certification courses are two hours. The ems staff trained department personnel internally to keep costs down, decrease liability and maintain the same high-quality training standards throughout the department.

"We followed the training requirements from the aha and other nationally accepted standards to develop the program and made sure everyone in our department has been certified on the aeds," Boehm says. "By holding everyone in our department to the same aed training requirements, we were able to implement an effective program while empowering our personnel to save lives."

To date, the Portland Fire aed program has worked well. They have saved seven people and are now talking with the Portland Police and Public Works departments about starting their own programs. Portland Fire is also educating residents of the community about the need for early defibrillation and for aeds. By continuing to provide value-added services to the community, such as the aed program, the Portland Fire Department is making early defibrillation top of mind in their area.

"Educating the community about the importance of early defibrillation in sca cases is a department priority," Boehm says. "And one day, I hope aeds will be as common as fire extinguishers. The plain and simple truth is that these devices save lives."

An urban AED program St. Louis Fire is a large urban department, covering 63 square miles, with more than 800 department personnel, including 600 firefighters (first responders) and 175 ems personnel. The service area, bordering the Mississippi River, has a daytime population of more than 1.5 million and includes several interstate highways and Lambert International Airport.

After receiving a grant to seed an aed program, St. Louis Fire studied the effectiveness of aeds and evaluated several models. The department selected an aed with user-friendly features, including self-diagnostic capability, one-button design and comprehensive voice-prompt instructions that take the decision to defibrillate out of the hands of the first responder.

St. Louis Fire implemented its aed program department-wide, placing the devices with all engine companies, to increase survival rates and enable first responders to provide defibrillation to sca victims. The department carefully reviewed the program's guidelines to ensure compliance with the aha's aed protocol and to determine that those guidelines wouldn't interfere with the department's normal course of treatment.

"It was important to implement an aed program to enhance our department's care of patients while maintaining the integrity of the aha's guidelines," says Kim Wood, emt-p, public information officer, St. Louis Fire. "We also wanted our personnel to feel comfortable with administering defibrillator treatment to sca victims while providing timely care."

St. Louis Fire's physician advisor established the training protocol for the program, requiring department first responders to take a four-hour aed/cpr session. Annual continuing education and re-certification courses keep first responders current on changing requirements and technology. The department trains all first responders in house to reduce costs and ensure high-quality training.

"Our training program is very thorough. We want to assist sca victims with quick intervention and improve survivability," Wood says.

St. Louis Fire continues to improve response times and is educating people in the community on the need for early intervention and defibrillation. With six lives saved to date, the department is quickly realizing the benefits of aeds. "To help us save lives, it became obvious that we needed to involve everyone in our community to make the program successful," Wood says. "Ideally, with early intervention and continuing education about sca and defibrillation, everyone can help increase our survival rate. Awareness and education are the keys to a successful aed program."

Components of program success Although manual defibrillators are useful in the hands of trained personnel, they're often too complex for personnel with minimal medical training. Manual defibrillators are also expensive, limiting the number each fire department can purchase.

aeds can be used by people of all levels of medical training and cost significantly less to purchase and operate than manual defibrillators. When evaluating aed features, ease of use should be the most important consideration. Other features to consider include preconnected, non-polarized electrodes; one-button operation; durability; and voice prompts that direct the responder through the rescue.

Rescue situations are stressful, making it essential that training is easy to recall and that the decision to defibrillate is made by the aed.

Life-saving opportunities Firefighters have an important role to serve in saving sca victims with early defibrillation. They are close to their communities through the many life-saving roles they serve, so it's a natural fit for firefighters to have aeds and respond to sca incidents. Access to aeds can also help save the lives of many firefighters.

Saving sca victims requires access to early defibrillation. Everyone needs to play a role in saving many of the 1,000 people who die each day from sca. Through sca awareness and aed deployment and training, the ability and opportunity to save lives is at everyone's fingertips.