Sue Hostler was running through a parking garage of Philadelphia International Airport in late August, hurrying to catch a flight home to Pittsburgh, when she came upon a young man in even more of a hurry – for someone to save his life.
Robert Hallinan, a 25-year-old limousine driver from Broomall, Pa., was sprawled on the floor of an elevator, unconscious. He was in cardiac arrest. Hostler, a frequent business traveler and private pilot trained in CPR, acted almost instinctively.
She called 911 and quickly started CPR. The operator stayed on the line, but said nothing about the possibility of retrieving an automated defibrillator from the adjacent terminal. Another traveler, Vivian Nolan, a cancer patient, came by and offered help. Together they were able to roll Hallinan on his back as Hostler continued hands-only compressions, hard and fast, 100 times a minute.
More than a dozen other people passed by, but no one else stopped. “We were getting increasingly desperate. I was keeping up the compressions, but he wasn’t responding. I kept calling out to people passing by to find an AED, but all I got were these deer in the headlight looks. I knew there was an AED somewhere across that walkway, but I didn’t want to send Vivian away because I wasn’t sure the EMTs would be able to find us,’’ Hostler said in a recent interview.
Finally, after about 15 minutes, an airport police officer arrived. Then Nolan led emergency medical technicians with an AED to the elevator. Hostler had been doing CPR for 17 minutes when they took over and shocked Hallinan’s heart back to life. Although he was in a medically-induced coma for several days, he is recovering with no neurological damage.
Hallinan is one of about 1,000 Americans who experience sudden cardiac arrest outside of a hospital care every day. Most collapse at home, but hundreds have their hearts stop at work, at school, in a gym or athletic facility where someone like Hostler might help them. Yet less than a third of those victims get CPR from a bystander; only four percent are treated with an AED before medics arrive.
The overall survival rate from sudden cardiac arrest away from medical facilities is less than 10 percent. But if an AED delivers a shock to reset the heart’s rhythm within the first three to five minutes after a person's heart stops, studies show, the odds of survival rise as high as 70 percent.
Philadelphia International, like most major airports, has AEDs throughout its terminals, 122 in all, according to a 2012 assessment done by the city’s fire department. Yet to those units were invisible to Hostler and the dispatcher managing her call that day.
When she got back to her home in suburban Pittsburgh, Hostler downloaded several phone apps designed to let users know where the nearest AED is to their location, and tested them for the parking garage. “None of them showed anything within a three or four minute walk.”
The situation in Philadelphia is not unique. Researchers, doctors and emergency workers around the country say all too often, bystanders trying to help people in cardiac arrest don’t realize an AED is nearby or can’t find the device or access it because it’s locked away.
“There are so many AEDs in public places, but the system didn’t come close to working the way it should that day,’’ Hostler said. “While there was good news this time, there could have been an awful outcome.”
“We know there are many times when a cardiac event occurred at a location where there was an AED very close by, even 50 feet away, and people didn’t know this and it didn’t get used. It happens time and again,’’ said Dr. Bentley Bobrow, an American Heart Association spokesman and emergency physician who oversees Arizona’s AED registry.
There are more than 2 million AEDs nationwide, tens of millions too few even to cover even urban areas, a Scripps News investigation earlier this year found. No one knows where they all are, not the companies that make and sell them, not the Food and Drug Administration that regulates them, nor the state or local health agencies that are supposed to oversee them.
There are several competing national registries and numerous web and mobile programs that track AEDs in the U.S. and overseas, but none capture every device.
Philadelphia officials are looking at ways to remedy AED blind spots there.
Researchers at the University of Pennsylvania ran a community-wide scavenger hunt for AEDs throughout Philadelphia last year, identifying more than 1500, many previously unknown to city officials. “We’re still working to refine the database to give to the city. We wanted to build the most comprehensive map possible,” said Dr. Raina Merchant, one of the organizers.
The Penn researchers are also developing a phone app to use the information they collected. There are already numerous AED mapping tools that can be bought or downloaded for free, including one in Europe that uses street view image to show buildings on a block with an AED. But all are only as good as the information entered behind them.
A growing number of communities are using a system called AED Link that allows emergency dispatch centers to alert 9-1-1 callers to the location of the nearest device within 1200 feet when they report an apparent cardiac arrest, and can also call out alerts to the owners of the devices who might be able to get to to the victim.
For instance in Collier County (Naples), Fla, nearly 1750 AEDs are registered through AED Link, and the system has been used several times in the past year, county officials said.
It uses a national registry of AEDs run by Atrus, Inc., a Boca Raton, Fla. firm. It’s AED Link program covers 26 emergency medical systems serving more than 5 million people in 8 states and Canada.
“How many times does someone go into cardiac arrest in a high rise building and a law office three floors up has an AED, but nobody trying to help the victim about it,’’ said Elliot Fisch, president and CEO of Atrus.
More than 400 communities in 16 states are going a step further with a phone app that alerts people willing to respond to a cardiac emergency that they are close to someone in need, as well as where the nearest AED is located.
Called Pulse Point, the system, first set up in the San Ramon Valley Fire District in California, combines AED Link data with a registry of CPR volunteers who are notified by phone when a suspected cardiac arrest is called in to the local dispatch center.
“This completely redefines the traditional meaning of a witnessed (cardiac) arrest by expanding awareness over a much broader area,’’ said Richard Price, San Ramon fire chief and president of the Pulse Point Foundation set up to share the techno logy.
Pulse Point is being set up in Anderson County, S.C., where officials say they’re trying to get more people trained in CPR so they can register for the service, and working to compile a more complete list of AED locations.
Getting accurate information on AED locations remains elusive for the nation’s nearly 6,000 emergency dispatch agencies. Even where registration to a state or local agency is mandated, devices may be left out or information is not kept up to date.
For instance, one study done by researchers at the University of North Carolina in 2004 found that only 18 percent of supposedly public access AEDs included in a statewide registry.
“I don’t think a focus on registries and mobile apps is a good use of resources now,’’ said Richard Lazar, who helped set up the Atrus registry and now runs his own AED consulting firm, Readisys, Inc. “That may change in the future when the data is more reliable and centralized, but now we need more AEDS and more awareness of their benefits.”
Atrus’ Fisch agrees that much of the information about AEDs remains isolated or incomplete. “There are challenges. We’re not going to get all the devices in the registry, and not everyone will choose to be a responder, but dispatchers knowing where 50 percent of the devices are in a community is better than none.”
(Contact Scripps national correspondent Lee Bowman at BowmanL@shns.com)