As Health Care in the US and around the world has improved, the average age of people has increased dramatically. According to the EPA, globally the proportion of persons aged 60 and older is expected to double by 2050, from 10 to 21 percent. By 2030, the number of persons aged 65 and older in the US is expected to double to 70 million, one out of every five Americans. This means that dental practices, as well as other businesses and institutions, will have to adapt to clients with more demanding health needs.
One thankfully rare but increasingly likely possibility is the risk of Sudden Cardiac Arrest (SCA) during a patient visit. CPR has traditionally been the first response to cardiac arrest, but often defibrillation is required. Full function defibrillators require training and certification, but recent innovations in Automatic External Defibrillators (AEDs) have made this life saving technology much more accessible. In 2004, the FDA even approved the first AED (Phillips’ HeartStart Home Defibrillator) for use without a prescription. The question is, does your practice need an AED?
According to the Mayo Clinic, cardiac arrest most commonly occurs when the heart's electrical activity becomes disrupted and the heartbeat becomes overly rapid or chaotic. Because of this irregular heart rhythm (arrhythmia), the heart stops beating and can't pump blood. Although CPR can keep blood moving through the body and extend life, often an electrical shock is needed to return the heart to its normal rhythm. An AED is a portable device that senses the heart's rhythm during cardiac arrest and, in some cases, delivers an electric shock to get the heart beating again.
SCA affects 340,000 people each year in the US alone, and fewer than 5% survive, largely because defibrillators do not get to them in time. For each minute that passes before delivering defibrillation therapy, the chance of survival decreases about 7-10%. The American Heart Association estimates that 40,000 more lives could be saved annually in the U.S. alone if AEDs were more widely available and could reach victims more quickly.
“When the shock is delivered within five minutes of the sudden cardiac arrest, 50 percent of individuals survive,” said Deborah DiSanzo, vice president and general manager of cardiac resuscitation at Philips Medical Systems, manufacturer of several AEDs. “Ambulances typically arrive within nine minutes of a 911 call. Ten minutes after the sudden cardiac arrest, the patient has a 1 percent chance of survival,” she said.
Most states require defibrillators for dental practices that use general anesthesia or deep (unconscious) sedation, and many require them even if the practice uses conscious sedation. A few states, including Florida, require AEDs or full function defibrillators for all dental practices. The ADA Council on Scientific Affairs, in March 2002, recommended that dentists consider purchasing an AED for dental offices in which emergency medical services personnel with defibrillation skills and equipment are not available within a reasonable time frame. Thus the question seems to be, why wouldn’t your practice purchase an AED?
Most debate seems to be centered around the false sense of security an AED might generate. Although easy for a lay person to use, AEDs are much more effective in the hands of trained personnel. Some critics fear that untrained individuals will waste time improperly employing an AED instead of calling 911. If AEDs are not placed where they can be easily accessed, more time might be wasted searching for the device before calling for help. If the AED is not properly maintained and will not function, again it may distract personnel from getting help expeditiously. Although these are serious concerns, AEDs have been designed to address just these issues.
Most AEDs come with simple graphical representations showing placement of the unit’s electrodes. Once activated, many have voice prompts that explain operation and guide the user through the steps required. Once attached to the patient, the device monitors heart rhythm and either automatically shocks the patient if necessary, or instructs the user (graphically and/or vocally) to push a button to administer the shock. Many also instruct the user to call 911 before beginning treatment. Some also indicate if CPR is necessary instead of or before shock administration, and will vocally coach the user on CPR techniques.
If you do decide to purchase an AED for your practice, a wide selection is available. Six AEDs participate in the Seal of Acceptance Program, based on the ADA Council on Scientific Affairs' finding that the devices are effective in dental offices for treating patients in ventricular fibrillation:
- Philips Medical Systems' HeartStart FR2+ AED with ECG Display, HeartStart FR2+ AED with Text Display and HeartStart OnSite AED
- Welch Allyn's Automated External Defibrillator AED 20 and Automated External Defibrillator AED 10
- Zoll Medical Corporation's AED Plus External Defibrillator with CPR Aid
- The Mayo Clinic has also published tips on using AEDs in the home, which would be just as useful in a dental practice:
- Don't rely only on instructional material provided with the AED. Enroll yourself and your personnel in a course to learn how to use your automated external defibrillator properly. This will also allow you to come to the rescue if someone experiences cardiac arrest in a public place and there's an AED nearby.
- Take the automated external defibrillator to a doctor's office and demonstrate how you and your personnel would use it, to make sure you're using it correctly.
- Have a practice run in your office using the automated external defibrillator as you would in an actual emergency. Remember, the AED works only on certain types of cardiac arrest. Know what steps to take if the AED indicates a shock isn't needed but the person remains unresponsive.
- Review your automated external defibrillator instructional material every three to six months to make sure you remember how to use the AED.
- Store your automated external defibrillator in an easily accessible place and make sure all personnel know where it is.
- Keep the automated external defibrillator maintained properly, including installation of new batteries as needed.