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License to Heal: Arming Police with AEDs
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by Douglas Page 2002

Cities that equip police with automated external defibrillators (AEDs) are finding that people who suffer sudden cardiac arrest have a better chance of surviving.

Police in Miami-Dade County, Fla., armed with AEDs, for instance, managed to cut response time to sudden cardiac arrest victims by almost three minutes, according to the results of a study reported in the August 11, 2002, issue of Circulation, a journal of the American Heart Association.

Between 250,000 and 450,000 people die from sudden cardiac arrest each year in the United States, with more than two-thirds of those cases occurring outside the hospital. More than 95 percent of these people die because life-saving defibrillators arrive on the scene too late, if at all. Medical experts say those statistics could be improved if more law enforcement personnel, including sheriff deputies, state troopers, correctional officers, treasury police, and SWAT teams were trained to recognize and respond in a timely manner with cardiopulmonary resuscitation (CPR) and to use AEDs.

During the first 10 minutes after someone has a cardiac arrest, every minute saved means about a 10 percent increase in relative survival, said the paper’s lead author Robert J. Myerburg, MD, director of the cardiovascular division and American Heart Association chair of cardiovascular research at the University of Miami School of Medicine.

Over the last few decades, community cardiac arrest survival efforts have been concentrated on the fire-rescue model, in which firefighter/paramedic teams train in cardiac resuscitation skills that include the use of AEDs.

However, data from rural areas, as well as large metropolitan areas with impossibly heavy traffic congestion, still show dismal overall survival rates, sometimes as low as 1 or 2 percent.

In 2002, the National Center for Early Defibrillation (NCED), a non-profit organization based at the University of Pittsburgh, published a position statement and best-practices recommendations on defibrillation for law enforcement officials in both the July/September issue of Prehospital Emergency Care and the July issue of Resuscitation.

NCED recommended that law enforcement officials should strive to arrive at the scene of a medical emergency within three to five minutes after the call to 9-1-1 is made and be prepared to provide basic life support and defibrillation services until the arrival of EMS services.

The Miami-Dade study was prompted by the fact that it has become apparent over a number of years that the old fire-rescue model of responding to cardiac arrest in the community wasn't

yielding acceptable survival rates.

When fire-rescue began in the early 1970s, survival rates were somewhere between 11 and 24 percent. In cities with major first responder programs, survival rates went as high as 30 percent, a vast improvement over outcomes that were uniformly fatal prior to equipping fire-rescue with AEDs.

However, due to delays in reaching victims caused by growing traffic snarls, it has since been recognized that in most metropolitan and rural areas the best survival rates the fire-rescue model has been able to achieve is 5 percent or less. New York City and Chicago are less than 2 percent each. Miami, which once had a survival rate as high as 24 percent in the early 1980s fell to 9 percent by 1996.

These deteriorating survival rates were the impetus behind the idea to expand the use of AEDs to include police. The theory is that police are already on the road when a call comes in, so there is a potential for faster response.

"Police are often the first available at an emergency, whether criminal or medical, so it makes sense that the first

person at the scene provide defibrillation," said Richard L. Page, MD, chief of the division of cardiology at the University of Washington School of Medicine. "What this improves is the time-to-shock, which is the key to saving the life."

According to Page, your chance of survival is about three out of four if you get shocked within 3 minutes. If you go 10 minutes your chance of survival is close to zero - certainly less

than 5 percent.

First on Scene

The 9-1-1 emergency dispatch system in Miami-Dade was reprogrammed so that both police and fire-rescue were dispatched on certain medical emergency calls. Using this dual-dispatch mode, the time from the call to first responder arrival was 4.88 minutes compared to the historical response time of 7.64 minutes. With the dual-responder system, help arrived on the scene of a cardiac arrest in less than five minutes for 41 percent of calls, compared to 14 percent for the standard fire-rescue calls.

From February 1, 1999 to April 30, 2001, Miami-Dade 9-1-1 dispatchers received almost 2.25 million calls, 56,321 of which were medical emergency calls that triggered the dual deployment system. Cardiac arrest was the reason for 420 of these calls -- with police arriving first 56 percent of the time. Survival was 17.2 percent for 163 victims, compared to the 9 percent during the year and a half prior to establishing the police responder program.

Unfortunately, 61 percent of the victims had non-shockable rhythms, which reduced the absolute survival benefit to 1.6 percent, although Myerburg believes it's likely that the high rate of non-shockable rhythms represents time lost from onset of symptoms to placement of the 9-1-1 calls. With longer time from onset of cardiac arrest to treatment, the likelihood of survival declines.

Initially, 1,900 AEDs were assigned to 1,900 individual Miami-Dade police officers, who were instructed to keep the units with them at all times, even off duty, a policy that enabled further community use of the devices. The AEDs stay with officers even when they are assigned to other duties.

One patrolman, who was transferred to a different position in the police force, kept his AED and was able to use it at a Little League baseball game when one of the coaches had an arrest. The officer was there to provide fast resuscitation.

Most law enforcement agencies embrace the idea of involving police in medical response.

"Our police units almost always arrive at the scene of cardiac incidents prior to the paramedics, partially because we monitor their frequency in our cars - with their encouragement," said Jack McKeever, Chief of Police, Lindenhurst, Ill., Police Department. All of McKeever’s officers are trained to do basic

triage, CPR, and AED.

The policy of arming police with AEDs is highly beneficial to the general public, said James McMahon, Superintendent of the New York State Police. Not only are police often first on the scene greatly aiding in chain of survival for sudden cardiac arrest patients, one other major benefit of police carrying AEDs is the positive visible role in helping the public.

Many in society see police as a reactive force. With the deployment of AEDs in police vehicles, police can be viewed as a proactive agent, McMahon said.

Other agencies, who may favor police use of AEDs, are throttled by budget constraints.

The Colorado State Patrol supports the police/AED policy because of the life saving capabilities of AEDs, but their research has shown that the costs of equipping hundreds of patrol vehicles with the units, combined with administrative overhead, to be prohibitive when compared with the historical statistics and projected frequency of use of the devices.

When Miami-Dade began its program in 1999, the list price on AED units were about $3,000, although Dade County was able to negotiate a sizable discount from the low bidder. Currently, a number of companies market smaller, dedicated devices that do essentially the same thing without all the bells and whistles and

cost less than $1,000, some as low as $500. From a practical point of view of what a police officer needs, these economy models may be sufficient, Myerburg said.

Frequently, civic groups donate the units to police departments. The Glendora, California, Police Department, which became the first community in Los Angeles County to train and equip its police officers with AEDs, now has nine AED units, all donated by various groups and individuals. The annual cost of $400 in supplies for each unit is also covered by donations.

In the bigger municipal or county budget picture, police-AED programs tend to pay for themselves quickly. One study (Resuscitation 2002 Jan;52(1):23-9) of the cost effectiveness of a 7-year police-AED program in four suburban Michigan communities estimated the cost per life saved with police-AED varied from $23,542 to $70,342, while the cost of the AED program per year ranged from $1,582 to $16,060. The study concluded that police-AED appears to be a cost-effective intervention in suburban communities that have relatively rapid EMS response intervals.

Philosophical Barriers

Aside from financial, there are philosophical barriers. While AEDs may be valuable in the hands of first responders, their use by police begs the question of whether law enforcement's continued expanding role into areas of non-law enforcement or non-peace keeping tasks is appropriate in these days of limited resources and increasing mandates of the profession, said Lt. Col. Mark Trostel, of the Colorado State Patrol.

Be that as it may, police are still part of the public safety continuum, are generally respected by the public, are trained to operate in stressful environments, are able to communicate with other responding emergency services, have a structured process for command and control, and are relied upon by the citizenry to provide assistance.

Nevertheless, AED/police experiments in other communities has often failed to match the success achieved in Miami. In some cities, such as New York or Chicago, police may not be the best AED solution because of crippling metro traffic. In those cases, distributing AED devices throughout office buildings and training security guards or floor wardens to handle them may make more sense.

Traffic is not the only snag. Long travel distances that delay rapid response in rural areas represent insurmountable barriers. Other factors, however, may be more easily addressed, including absence of a police medical response culture, discomfort of police with the role of medical intervention, insecurity among officers with the use of medical devices, a lack of proactive medical direction, infrequent refresher training, and dependence on EMS intervention.

Most experts believe, however, that these problems result primarily from inadequate AED program implementation. Police need to feel comfortable with the AED idea.

"It's clear in some cases police haven't been made to feel comfortable," Myerburg said. "I think that's more a problem of how the plans were put into place than a problem with the police themselves. It’s a different responsibility, but it's also a major advance in healthcare."

It was also a major change in responsibilities when AEDs were placed aboard commercial airplanes, but flight attendants accepted the new duties without revolt because the program was introduced properly, Myerburg said.

The key to police acceptance of the Miami-Dade program is rooted in the training strategy used to encourage police interest. In training the police to perform defibrillations with AEDs, Myerburg first trained a few police officers in device background and use, emphasizing the goals of the AED program. Those officers then went out and taught the other officers.

The plan allowed Miami-Dade to train and deploy AEDs to 1900 police officers, and get the entire county covered in a five month period. Since the study was implemented, Miami-Dade has added 400 more AEDs for its police.

Coordination Caveat

Law enforcement organizations contemplating the addition of AED's to their fleet and associated responsibilities are cautioned to consider the role of their personnel in the EMS response system.

"Efforts to expand service delivery within this area should be coordinated with other emergency service responders including

access to training, medical control (off-line), and quality assurance programs," said Jack Krakeel, chief of the Fayette County, Ga, Department of Fire and Emergency Services. "My only concern would be with agencies undertaking this effort independent of the EMS system."

Miami-Dade avoided most inter-agency political squabbling by instituting regular meetings four times a year with the leadership of fire-rescue, police, and the physicians involved in the study. That kept everyone on board, and kept dialogues going between fire-rescue and police - important because sometimes these departments don't talk to each other, Myerburg said.

Some fire departments see another problem in dispatching without assigning the closest unit. "What we don't want is for all emergency services to be racing each other across town to see who can beat the other to the victim," said Chief Luther Fincher, of the Charlotte, No. Car., Fire Department.

However, if it is implemented properly and does not create problems between the emergency services - if it can be done with true collaboration, cooperation, and coordination - a police-AED policy can be a positive asset to the community and to all those citizens who die every year from heart attacks, Fincher said.

-end-

Comments? Questions? Purchase Orders? douglaspage@earthlink.net
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