Where’s the best place in town to have a cardiac arrest?

Reprinted from the Wilton Bulletin, May 30, 2014
By Jeannette Ross

If a person were to suffer a cardiac arrest, he or she would be better off in a gambling casino or airport than in Wilton Center. That’s because there are far more automatic external defibrillators (AEDs) in those locations than in the center of town. An AED is a portable device that checks the heart rhythms of an unresponsive person and can be used to send an electric shock to the heart to try to restore a normal rhythm. They are used to treat sudden cardiac arrest.

According to a map provided by Nancy Capelle of the Cardiac Companion, the only AEDs in the center of town are at Wilton Library and Village Market.

A recent incident illustrates what can happen when a person suffers a cardiac arrest and there is no AED nearby.

One weekday last month, a 911 call came from Stop & Shop on River Road. A man had collapsed in the store. When firefighters and police arrived, they found none of the store’s employees nor any bystanders had attempted to perform CPR. There was no AED in the store. The first responders began compressions, but by this time several minutes had passed since the man was stricken.

Norwalk EMS was called out as mutual aid, and Wilton and Norwalk EMTs continued CPR en route to the hospital. The patient began breathing and had a pulse, but remained unconscious. Ultimately, he did not survive.

Would an AED have saved his life? It is impossible to know, but what is known is that a survival rate as high as 90% has been reported when defibrillation is achieved within the first minute of collapse. It is still above 50% within the first four minutes, but drops to 30% at seven minutes, approximately 10% at nine to 11 minutes, and approximately 2% to 5% beyond 12 minutes, according to the American Heart Association.

There are approximately 33 AEDs in Wilton in 19 locations — the most are at Rolling Hills Country Club, which has five, followed by Wilton High School with four and The Lake Club and Wilton YMCA, which have three each. All first responders — police, fire and ambulance — carry AEDs in their vehicles.

Locations include:

• Cider Mill School: 1
•  Miller-Driscoll School: 1
• Wilton High School: 4
• Comstock Community Center: 1
• WEPCO: 1
• Four Seasons Racquet Club: 1
• Wilton Congregational Church: 2
• Village Market: 1
• Wilton Library: 1
• Middlebrook School: 1
• Louis Dreyfus Corp.: 1
• Rolling Hills Country Club: 5
• The Lake Club: 3
• Our Lady of Fatima School: 2
• Lourdes Health Care Center: 1
• Sacred Heart Church: 1
• Trackside Teen Center: 1
• Town Hall: 2
• Wilton YMCA: 3

Ms. Capelle compiled the map from data collected in February 2012 as a result of the town’s designation as a HeartSafe Community. She has not received any updates to this information.

An AED sign hangs on the wall in the WEPCO building, informing people that the Automated External Defibrillator is located in the kitchen cabinet.

As an EMT (emergency medical technician) and heart attack survivor, Ms. Capelle would like to see the number of AEDs in Wilton increase significantly.

She emphasized that just about any member of the general public can use one.

“It’s great to be trained because it takes out the anxiety factor, but you do not have to be trained to use one,” she said. “Once you turn it on, it talks to you and gives you step-by-step instructions. It walks you through exactly what to do. There are pictures on the pads that show exactly where the pads go and it tells you if a shock is advised.

“The perception is it’s a big, scary piece of equipment … but it won’t shock a person if they don’t need it,” she said.

There are a few places that are obligated to have AEDs, such as schools and YMCAs, Ms. Capelle said, but as for private property such as a country club, an office building or a store, it is up to the owner or manager.

As far as Ms. Capelle is aware, not a single entity in the entire plaza at 5 River Road has an AED, nor the plaza just south of it. Ms. Capelle spoke to the management at Stop & Shop a year ago about putting in an AED, but it has not done so.

She said large offices and employers in town have been approached about acquiring AEDs, but they have not done so. She did a presentation two years ago at one company where she said the employees were under the impression “they must have one. Then they found out there weren’t any at all … and they still don’t have them.

“I don’t know what the concern is,” she continued. “It can’t be the price.” They range from $1,200 to $3,500.

They don’t require much maintenance. When purchased from a local dealer, the dealer will visit periodically to make sure the battery is charged and the machine is in working order.

Almost as bad as not having one is keeping it locked away to prevent theft.

“You have to have it out in a case in plain sight so anyone can grab it,” Ms. Capelle said. Most AEDs are stored in wall cabinets with a clear glass front and a sign that says “AED” with a red heart and a white lightning bolt.

 There are cases that trigger an alarm when they are opened and automatically call 911. They can also be wired into most security systems.

Cardiac arrest

Cardiac arrest is not the same as a heart attack. A heart attack occurs when an artery in the heart is blocked, causing heart tissue to die. The most common symptom is pain, but someone suffering a heart attack will be conscious and able to communicate.

In cardiac arrest, normal heart contractions suddenly stop due to the failure of the heart’s electrical system, and the most effective treatment is electrical defibrillation. It essentially gives the heart a chance to “reboot” and get back into a normal rhythmic pattern. The window of opportunity is just a few minutes.

How do you tell if someone is suffering a cardiac arrest? “You may see them go down,” Ms. Capelle said, “or you may come upon someone lying on the ground or slumped over.”

The first step is to try to rouse them, tap their shoulder or call out to them. Someone who has simply fainted will still be breathing visibly. A cardiac arrest victim may have blue coloring around the lips and ears, or be ashen-colored or sweaty. Most tellingly, the person will not respond or be breathing. The person may be gasping, but that does not bring oxygen into the body.

“The first thing is to call 911, get the AED and go right into chest compressions,” she said. “The longer the blood sits there, it starts to clot. If things are started too late, you will be circulating blood clots. You’ve got to go [into compressions] right away without any pauses.”

There are still no guarantees, but “you want to give that person every chance they have.”

Lawsuits

As for a business’s choice to not have an AED on-site, there may be some changes on the horizon.

The California Supreme Court is taking up the issue of whether large retailers are required to have defibrillators on hand. The case stems from a wrongful-death lawsuit brought by the family of a 49-year-old woman who collapsed while shopping with her mother in a Target store in Southern California in 2008. The woman died in the store before paramedics arrived.

The family is arguing Target should have had an AED on-site and an employee trained to use it. It bases its claim on a California law that requires stores to render first aid, although it does not specify AEDs.

Target, and others in the business community, including the U.S. Chamber of Commerce, say the store should only have to call 911 in an emergency.