Crisis Management: Response in a Heartbeat

Heart attacks are the leading cause of death in the United States. According to the American Heart Association, 1.1 million Americans have heart attacks each year, and about 480,000 people die.

Because schools mirror society, some of those cardiac arrests will take place in schools, and education officials need to know how to deal with this crisis. With proper training and the purchase of equipment, education institutions can be an important link in the chain of survival needed by all cardiac victims.

Most of our students are young and healthy, so at first glance school officials may think that there is little need for advanced life-support training or the purchase of automatic external defibrillators (AEDs). However, when we consider that many students are medically fragile, many school activities have high concentrations of adults on our campuses and several of our own staff members may have cardiac health concerns, training and equipment become a priority.

The response time of our local emergency medical services (EMS) is excellent. They are usually at the scene of medical emergencies within five minutes of receiving an emergency call. However, it is important to know that after the onset of a cardiac arrest, the victim's chance of survival decreases approximately 10 percent for each minute that cardiac care is not given. Thus, when an emergency team arrives on a scene at the five-minute mark, where no care has been given, that person's chance of survival is cut in half.

Data from our local EMS shows that in 1998, about 25 percent of the people in cardiac arrest received no cardiac care until EMS arrived. This is the main reason that our local EMS has enthusiastically assisted us with an initial purchase of five AEDs for locations in our district where we have the highest concentration of adults and students.

TRAINED STAFF With training and commitment, one can provide three of the four early links in the chain of survival for cardiac victims (see sidebar). Our district's staff has embraced this training, and we are pleased to have 500 staff trained in CPR and first aid and 74 trained in the Advanced Heartsaving Course needed to operate the AED.

Our school crisis plan calls for at least three people in each building to be trained in CPR and first aid. We are striving to have all athletic coaches and physical-education instructors certified by either the American Red Cross or the Heart Association in CPR and first aid. The philosophy of our district's crisis team is that we will have the knowledge and training to be the `gap fillers' until the professional response community arrives. We all know how long and traumatic those five minutes are until the professionals arrive!

As one can imagine, the training component to keep 500 people current in CPR, first aid and heartsaving is quite a commitment. Our district's board and superintendent have supported the training of more than 20 certified instructors, and a part-time registered school nurse has been hired just to coordinate the training.

With the guidance of our district health-services coordinator, our physician medical adviser and our local EMS, we have developed treatment protocol for the use of an AED pending the arrival of EMS.

THE RIGHT EQUIPMENT An AED is a device used to deliver an electrical shock to the heart of a person who has experienced a sudden cardiac arrest. Sudden cardiac arrest usually occurs when the heart's electrical impulses suddenly become chaotic, causing the heart to stop effectively pumping blood. As this is happening, the victim becomes unresponsive, stops breathing and the heart stops beating. Often, CPR alone is not enough, and an AED is needed to restore effective heart rhythm.

There are several different brands of AEDs. They come with different shock strengths and phases. Have a thorough discussion with medical personnel before purchasing any AED. The brand we purchased is compatible with the type used by our EMS. Therefore, when they respond at one of our schools where the AED has been used, they have the ability to use the same electrical leads and exchange data from our machine.

In our research before we purchased AED units, we found the cost to be between $3,000 and $5,000 per unit. While the cost is not inexpensive, the trend is for it to become lower. We also found by purchasing more than one unit, the cost decreased. There are some medical, government and private agencies that may have an interest in helping districts purchase the AEDs.

We have found the use of the AEDs to be relatively simple. In Kansas, before using the AED, a person must be current in CPR and pass advanced heartsaving training. The AED unit that we purchased has a voice module that will talk a user through the necessary steps. These units also have the ability to detect if a victim is in cardiac arrest and will not deliver a shock unless needed.

The AEDs have batteries, which usually last a year. Our unit has a self-checking battery feature so we always know the charge status of the battery. In addition, we keep a fully charged backup on-hand.

As we review our district's crisis log over the last 10 years, the majority of crisis events are `people crises,' and the most significant number of those are medical emergencies. Thus we have come to believe that training for crisis situations not only is a responsibility, but also a benefit we offer our students and staff.

We try to provide the safest educational environment for our students and staff. But when the crisis occurs, through planning and response, we increase the chances for a positive outcome.

The American Heart Association instructs about the chain of survival for cardiac victims. The four steps:

- Early access.

- Early CPR.

- Early defibrillation.

- Early advanced care.

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