Drone carrying a defibrillator saves its first heart attack patient in Sweden
theverge.com
theverge.com
Specifically, I was defibrillated by bystanders when I had an out-of-hospital Ventricular Fibrillation episode. The staff at the UK building I was visiting had a defibrillator in their office and one of them had been on a training course.
When I collapsed with no warning, there was (according to my wife) about a minute of confusion and then one of the staff grabbed the defibrillator and used it. The device itself plays recorded instructions and itself conducts diagnostic tests to determine whether or not it should be used. If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it. If it can treat you, then it gives clear instructions to the users and delivers shocks as required.
In my case, the visitor centre staff had saved my life before the air ambulance arrived with trained medics. I was then flown to hospital where the critical cardiac care team confirmed that the bystanders had done exactly the right thing. They had also administered manual CPR which had kept my brain supplied with oxygen at the cost of two broken ribs. So here I am today writing this comment, thanks to the immediate availability of a defibrillator to bystanders.
I was lucky. My VF episode happened just as I had entered the lobby of the building that coincidentally contained the defibrillator. If I had been a 20 minute walk away, I would be dead (or brain damaged). Would a drone-based defibrillator have saved my life? Don't know, but it would certainly improve my chances.
I was taught how to use one on a course where the instructor said he used to enjoy teaching students this fact by allowing them to take turns attempting to use a live defibrillator on him.
He got away with it for many years until his boss found out and put a stop to it because the company insurance wouldn't cover the company (despite clear witnessed consent being given by the instructor).
On the plus side, the company didn't ban his teaching method of NPA (Nasopharyngeal Airway) insertion. ;-)
> manual CPR which had kept my brain supplied with oxygen
Manual CPR done correctly is critical, and yes if done correctly you WILL end up with broken ribs. Mouth-to-mouth is not deemed particularly necessary these days (since the act of correct CPR will draw oxygen in anyway), better to focus on proper CPR and wait for the ambulance to turn up with high-flow oxygen from a tank.
> If I had been a 20 minute walk away, I would be dead (or brain damaged)
Yes. The most effective time for defib use is in the first 5 minutes. That's not to say you should not have a go after that time, but its effectiveness does drop away quite quickly.
Totally! After my experience I booked myself on a defibrillator training course, and looking back now, the main thing I remember from the course was the instructor's key learning point that you should get the defib out as soon as you can and let it take over. It pretty much can't make things worse than doing nothing.
[Edit - that and CPR, it goes without saying]
For a non-beating heart the only treatment is CPR until the docs can deal with whatever caused it not to beat in the first place.
Mouth-to-mouth isn't critical, but clearing the airway is. I remember one story from a first-aid refresher a few year, the guy doing it said he arrived at a car crash (doing a stint on an ambulance). A girl had been hit and was lying on the floor. Nobody had touched her in case they broke her neck or something.
She wasn't breathing. The ambulance had arrived within about 5 minutes, which was too late. Tilting her head back would likely have saved her life.
Sure, but that goes without saying. Anybody who's been taught DRSABCD should know that.
Its also the reason why the FIRST thing you do when someone is choking is call for an ambulance (ideally on loudspeaker so you can get on with it at the same time, or, preferably get someone else to, if available). Even if you are successful in dislodging the item, they will still need a once-over by a trained medic because if you did it by the book it comes with side-risks.... so whichever way you won't be wasting the ambulance's time.
If you start trying things on choking and find you're not getting very far and then call an ambulance .... it'll probably be too late.
(Goes without saying that for heart issues, ambulance is also a high priority, but choking is far more time critical in the grand scheme of things).
Clearly not for the average person at that accident scene where the girl died, and indeed I believe that for most people - especially in a crowd - the first and last action is "shock". Maybe someone will phone for help.
My first aid training comes from hostile environments, where catastrophic bleeding fits in before airway. Unlikely to find someone with a missing limb down the high street, but there's not much point in CPR if the blood you pump is gushing out of the femoral artery.
Not exactly. More precisely, for the “average” out of hospital cardiac arrest in an adult, chest compressions are more important than expired air resuscitation (mouth to mouth). The guidance to the public was watered down because there was recognition that members of the public were not enthusiastic about starting mouth to mouth resuscitation with a stranger. Mouth to mouth definitely helps.
You need a patent airway for any type of CPR to have any chance of working. Chin lift and jaw thrust are important for both compressions only and compression with breaths.
Source: I’m an attending anaesthesiologist and have resuscitated more people than I would like to count.
Yes. Tomorrow.
To expand on this a bit, defibs will only deliver a shock if they detect VF (ventricular fibrillation) or VT (ventricular tachycardia). These are considered shockable rhythms. Both involve malfunction of the electrical conduction system usually due to lacking oxygenated blood supply to the heart muscle itself.
A shock seeks (usually up to 300 joules depending on patient size) to reset the hearts' rhythm so the body's natural pacemaker (called the SA node, positioned in the top-right of the heart) can kick back in. If there's no shockable rhythm, the defib machines will usually instruct you to continue CPR (chest compressions) and then will ask you to stop after a cycle of 30 so it can re-analyze the rhythm. Otherwise CPR must continue until medics arrive. If the defib detect a normal rhythm (sinus rhythm) then that's good news and means the defib has been effective.
Pad placement is very important if you're administering defib. The pads are positioned so that the depolarization travels approximately down the septum of the heart, to emulate the normal electrical cascade.
Note: there are many types of heart malfunctions that can't be remedied by a defib but that doesn't mean you should do nothing. Always do CPR. Always call the emergency services.
Possibly of interest to HNers: It is a common misconception that a defib can bring a heart back from 'flat-lining' (asystole). Hollywood movies don't help. If there is asystole, medics will usually continue CPR until the rhythm changes whild trying to reverse any underlying causes of the heart failure (e.g. massive hemorrhaging or hypothermia).
I'm skeptical of this.
for the Americans out here: 30 Kg is ~66lbs 1 meter is about 3 feet
If an adult male (about 150 lbs) jumps off of a kitchen counter (about 3 feet) - each leg will absorb 75 lbs from 3 feet. I have done this many times and even my thin feet bones held the force. I'm pretty sure my thighs (our strongest bones) would be just fine.
I keep two in my house: one on each floor. (One stays under the kitchen sink.)
I have a Philips HeartStart at home. None of us are high risk (we're not obese, fit), or had family history of heart disease. We just like gadgets, and why take a chance?
The last company I worked as an employee at had defibrillators on every floor. While I had to take diversity training, and sensitivity training, I was never required to take -- or offered -- a class in defibrillator training.
Sounds ripe for disruption by a Startup doing either:
- Defibrillators on Lease or
- Crowdfunding prototype ;-)
I did CPR on an elderly man I found having a heart attack in an alley in London. He was conscious when I found him. I called 999 and stayed with him. He "died" in front of me (no pulse, breathing, motion, loss of urine control). I did CPR until the ambulance arrived; I remember the sound of breaking ribs very clearly. They used a defib on him and he survived and until I moved away from the area I'd see him walking around from time to time.
Was a slightly odd feeling seeing him because I literally saw him "stop".
Sorry about the ribs, but I'm glad they were trained well. Proper CPR breaks ribs.
I helped rescue a drowning man once. I pulled him from the water (he had been under a few minutes), and long story short, other folks did the CPR, and later a defib. The man died, but I had the impression his ribs survived.
Very glad to hear your outcome was different.
I did CPR on an elderly man for almost 10 minutes when I was 22; I was completely exhausted afterward.
It was like doing weird cardio, to a rhythm, while panicking that if your form is bad you will kill someone. Oh, and I stopped every couple of seconds to expell my entire breath into his mouth
Turns out it's vastly more important to circulate blood than to give breaths, and additionally many people fail to deliver any breath, as it's trickier.
For context, this was before the standards changed. I'm glad the standards reduced the amount of breathing (to make room for more heart pumping). Either way, it wouldn't have made a difference in my situation: the patient had a brain aneurysm with a "<1% chance of survival even it it happened in the ER"
----------------
Also, for future readers:
The probability that an amateur using CPR saves someone's life is 1:10,000
For paramedics, it is 1:1,000
So if your person dies, go easy on yourself and get some therapy
I work for a company providing tools for safety-critical software, and so we were in discussions with a defibrillator company. They tried to argue that the defibrillator was not critical to the patient's life, and thus not subject to the relevant regulation, because the patient was already dead. No one bought this argument.
I'm amazed that they would take this line. In many cases, a person's heart is still very active when it is shocked by the external defibrillator, and the person is still breathing. In some types of VF (see my comment elsewhere [0]), the problem is that the normal synchronised contraction of the cardiac muscle fibres has broken down, and the heart is thus quivering spasmodically, not cleanly pumping. To break this cycle, the defibrillator emits a massive shock that causes the muscle fibres to simultaneously go into their 'reset' phase, and the hope is that the heart's natural pace maker (the sino-atrial node) can then take back control. It's like the defibrillator is shouting "will you all shut the fuck up!" into a crowded auditorium full of people talking over each other rather than listening to a presenter. The defibrillator can't magically restart an insert dead body.
https://www.youtube.com/watch?v=ecVHYg4_vZw (skip to min 3 for the action)
TL;DR the BBC were in the right place at the right time. They were filming a documentary at a UK Air Ambulance office when the call taker had a cardiac arrest right there infront of them. They filmed the whole thing from start to finish and the guy gave his consent for them to release the video to the public.
[1] https://www.youtube.com/watch?v=h0xWZ0aBGiI
(The above video does say "edited" I don't know what they've edited out, so you might need to searching the web for the full version).
So if this is the first patient saved does that mean all 11 people that were delivered defibrillators in the pilot study died?
My bs meter is swinging wildly for some reason, this sounds like something that should have been widely reported...
https://lakartidningen.se/aktuellt/nyheter/2021/12/akutlakar...
Strangely the article in Läkartidningen doesn't say when this incident occurred (just the middle of December).
I'm not saying it didn't happen, just that everything written about it reads like promotional material rather than journalism.
https://www.aftonbladet.se/nyheter/a/qW7oRO/dronare-leverera...
But I'm a bit surprised that this is not considered bigger news.
I'd take expired batteries and pads over no AED.
Also, most places in my village, it would be a 5 minute trip from my house to a patient. If I was dispatched towards a patient, would the AED arrive on their driveway before/with me?
So many questions.
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Dental is even worse. its cheaper for me to fly to latin america, get some dental work done and enjoy a month long vacation than to get the same procedures done in the united states.
Since Emergency Medical Treatment & Labor Act (EMTALA) in 1986, hospitals in the US MUST provide emergency treatment regardless of ability to pay.
If you go into labor, US hospitals will help you deliver. Even if you can't pay.
There are real downsides to the US medical system but this isn't one of them.
Furthermore, proactive visits to the doctor aren't "emergencies." Prenatal checkups aren't either. Mom going into labor is not a good time for the doctors to find out the baby is coming in the wrong way or its head is stuck in her pelvis.
I'm tired of people making excuses for the shit-show that is healthcare in the US. It only looks good if you're coming from the third world.
There is some homestead exemption act that prevents lawsuits from making you sell your only house... another one protects your retirement money
I'm tired of people exaggerating the financial impact of lawsuits in Maerica
It would be the number 1 thing I would invent drones for....helping people in numerous ways. Package delivery is another.
I think there's a bit of a nuanced difference in how we use the word "clever" as well. Where you would call someone clever, we would usually say he is smart (or maybe brilliant, if smart enough). "Clever" in the US often has a slightly derogatory sense to it. Someone who is good at solving a Rubik's cube is clever. Yes, it takes a certain intelligence but of a gimmicky sort.
It doesn't say how many of the 7 were actually used. I imagine it's less likely if there doesn't happen to be a doctor on scene.
They are also included in the standard CPR first-aid courses nowadays.
You need no training to safely use an AED, though it will ask you to do chest compressions, and without training, the compressions are likely to be ineffective. Good compressions are surprisingly violent, and you'd never do that to someone unless you'd received training explaining why and how.
I think this is a chicken&egg problem: such requirement would be expensive initially but as the production of AED scaled up prices would drop.
Obviously training is required too, I'm not sure how feasible it is to get large fraction of population trained...
In which country is it mandatory?
> In the following countries it is compulsory to carry a first aid kit in your car:
> Albania, Armenia, Austria, Azerbaijan, Belarus, Belgium (locally registered vehicles only), Bosnia & Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia (company cars only), Georgia, Germany (locally registered vehicles only), Greece, Hungary, Latvia, Lithuania, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Slovakia, Turkey, Ukraine
Check out the link, it also has color coded maps for first aid kit, fire extinguishers and high-vis jacket requirements.
The first aid kit also usually means required first aid training as part of getting a driver's license. However I don't know if any countries require refresh sessions, so most people probably forget all except the basics.
[0]: https://www.safetyfirstaid.co.uk/what-do-i-need-for-driving-...
First aid training and an exam are also mandatory for getting your driver's license in many countries.
[0] https://www.oponeo.co.uk/blog/mandatory-equipment-for-vehicl...
An unused (hopefully) defibrillator needs to be periodically checked for battery levels and (I believe) some sort of diagnostics run to be certain that when/if needed it will be efficient.
Like with fire extinguishers or other periodical checks, most probably this must be done by someone qualified/specialized, which may represent a non trivial cost, I wouldn't be surprised if it was something in the 200-400 Euro/year or something like that, and probably every n (5-8?) years you would need to replace the device with a new one.
Besides, there is an issue (in non-restricted access placements) about theft and vandalism.
Vandalism and theft sure are problems, placing them in locations with either camera surveillance (bank foyers, gas stations) or 24/7 personell available might be solutions to these problems.
It has been introduced by Law only recently here (Italy) in a number of public places, and there are a lot of perplexities about the bureaucracy connected, the reliability of this or that model (or manufacturing firm) availability of spares, legal responsabilities of the provider, etc.
I believe (but I may be wrong as - as said - they are not yet common here) that the trend is towards some forms of "service" or lease/rent for the devices including their maintenance and all the bureaucratic paper and electronic work (by Law the device needs to be "registered" on a "online map").
Costs at the moment for this latter approach (rent + service) start from as low as 20 to something like 60 Euro/month for 48/60 months contracts, AFAIK, and they include an insurance against theft/vandalism, but it has to be seen how it will work out.
Some details of the norms around these are not clear (yet).
Most business have one here in Sweden and almost all public places like train stations, malls, hotels have one. Most taxis carry one to and can be alerted by 112 (the SOS number operators, 911 in the US) if they are close. Rural areas are the unsolved problem that these drones might help with.
How it works here is bigger business and public places have them - the public ones are in little boxes and the 999 operators will tell you where they are plus give you the key codes (I just checked and surprisingly my city has roughly six public ones for every 10,000 people, not even counting the ones routinely in ambulances and DC police cars)
I doubt putting it in every car is cost effective.
defibrillatore automatico esterno → automated external defibrillator
https://en.wikipedia.org/wiki/Automated_external_defibrillat...
Map to find public AEDs in the UK: https://www.heartsafe.org.uk/aed-locations
e.g. in small villages the red phoneboxes that used to have payphones now often contain defibrilators
Due to their medical training, the doctor is likely to have done a better job at providing CPR than a random passing member of the public though.
https://lakartidningen.se/aktuellt/nyheter/2021/12/akutlakar...