Lack of training voids benefit of portable defibrillators

ALPHARETTA, Ga. -- When rising prep football star Ryan Boslet suddenly went into cardiac arrest during a workout in his school gym, a portable defibrillator was only the length of a basketball court away in the athletic director's office.

But it was never used.

A school staff member couldn't figure out how to operate it. Coaches called 911, then administered CPR to the 6-foot-4, 270-pound defensive tackle. The 17-year-old teen died later that day.

Boslet's death a year ago points to a larger problem: Ordinary people, even with training, often can't use the increasingly popular defibrillators under the pressure of an emergency.

"It's not the box on the wall that saves a life -- someone has to be trained to know what to do in an emergency and how to use it. That's what saves a life," said Robin McCune of the American Heart Association.

Chattahoochee High School had only recently obtained its defibrillator and the model it got was different from the one on which school officials had trained.

When Boslet's heart attack occurred on Feb. 20, 2003, the trained staffer couldn't find the device's pads, which were tucked under a flap inside the box. The adhesive electrode pads, placed on the chest, are needed to deliver the electrical shock that can restore heart rhythm. School officials thought the device was not operable and no one else tried to get it to work.

Because defibrillators are more affordable than ever, they are quickly becoming commonplace in schools, businesses and other public places such as airports. Health officials estimate 200,000 to 300,000 portable defibrillators exist in the United States, although the exact number is not known.

O'Hare test casesWith the help of visual and verbal instructions, six people unfamiliar with the devices used them to revive heart attack victims at Chicago's airports -- including the busy O'Hare International Airport -- in 2002, according to a New England Journal of Medicine study.

Such success is not always the case. Experts say even trained operators can falter if they don't regularly train on defibrillators. Merely having the $2,000 devices is not enough.

"The device is very simple, but the situation is not very common," said Mary Fran Hazinski of the American Heart Association. "When you find yourself in the midst of an emergency situation, it's easy to get flustered."

Over the past 20 years, defibrillators have evolved to automatically detect the heart's rhythm and decide whether it needs a shock. But people need to be familiar enough with the devices through training -- and retraining -- to use them quickly enough to provide a heart attack victim the best chance of survival, Hazinski said.

In one report in a medical journal, volunteers had trouble opening the device's packaging and failed to properly place the pads that deliver the shock. Better instructions on some models may help more people use them, according to an article in the July issue of the journal Prehospital Emergency Care.

Another study published last year indicated defibrillators were used only slightly more than a third of the time by rescuers in places where the devices were nearby. About four out of five non-health workers couldn't use them properly when training on mannequins, according to the December issue of the Journal of Dental Education.

That's why groups such as the heart association and hospitals like Children's Healthcare of Atlanta are working to train more people about the warning signs of cardiac arrest, how to administer CPR and use the defibrillator.

A defibrillator certification program involves a four-hour course and needs to be renewed every two years. The heart association also recommends refresher training every 60 to 90 days.

In addition, a school or company always should have a plan to handle medical emergencies -- that includes use of the defibrillator -- and all staff, students or employees should be regularly trained, Hazinski said.

"If they practice, everyone is able to respond and that will give the victim the best outcome," she said. "It has to be a coordinated and practiced response plan -- it does nobody any good if someone donates [a defibrillator] to a school and it's locked in a cabinet."

Patients who receive CPR and a defibrillator shock within three minutes of going into cardiac arrest survive 74 percent of the time. Just two minutes longer and the survival odds drop to 40 percent, previous studies have shown. Nationally, those who go into sudden cardiac arrest only have a 5 percent survival rate.

Students dying of cardiac arrest is rare -- about 12 to 15 of the nation's 5 million high school athletes, according to the National Center for Catastrophic Sport Injury Research.

Since Ryan's death, his high school has bought three more defibrillators and trained more than a third of the school's 140 staff members.

"Are we more prepared probably than any school in the country? We probably are," said principal Tim Duncan.

Although Chris Boslet, Ryan's father, harbors no ill feelings toward the school, he still wonders if Ryan could have been saved with the device.

"In my opinion, it would have removed that one element of doubt we still live with," he said. "We just don't know if a defibrillator used in the right amount of time would have saved him, and I guess we'll never know that."

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On The Net:

American Heart Association: http://www.americanheart.org/presenter.jhtml?identifier3011859

Federal defibrillator info: http://www.foh.dhhs.gov/Public/WhatWeDo/AED/FOHFAQ.ASP

American Red Cross info: http://www.redcross.org/services/hss/courses/aed.html