Photo A.J. Heightman

“Is there a doctor in the house?” This popular phrase has been tossed around since at least the 1930s. We all know what it means: Someone nearby is having a medical emergency, and they may not have time to wait for paramedics to arrive. What does the 21st Century version of this call for help sound like? Perhaps, “Is there an AED in the house?”

In 1998, Collier County, Fla., paramedics started keeping a list of registered AEDs around the county—where they were located, a person responsible for them and a phone number where they could be reached. Addresses associated with a registered AED were then flagged in the CAD system, identifying the location of the AED and contact information for a possible responder. Most of the time, the responsible party was a security guard assigned to patrol a particular community or office building. When telecommunicators received a call to that location, they called the number on file and asked for someone to take the AED to the scene.

According to a study accepted by the American Heart Association last September, AEDs available on scene at a cardiac emergency or dispatched ahead of paramedics can increase the viable survivability of patients in distress.(1) Without an AED, cardiac patients wait an average of 11 minutes from the time the call is placed to their first shock. The study found that 14.3% of patients suffering cardiac arrest ultimately achieved “neurologically intact survival” without the use of an AED. However, when AEDs are dispatched to the scene ahead of paramedics, the time to first shock drops to just 8 ½ minutes and the viable survival rate goes up by 3.3%. When AEDs were available on scene with the patient, the time until first shock plummeted to little more than four minutes, with nearly half those patients achieving “neurologically intact survival.”

Facing these irrefutable facts, first responders around the nation continue to change their procedures to better serve the public, but some are bumping into some roadblocks along the way.

Privacy Laws
A change in state law last summer may affect how things are done in Collier County and across the Sunshine State. According to Florida State Statute 365.171(12), names, addresses, telephone numbers or personal information that may identify the reporter or person requesting assistance should remain confidential and exempt from public record.
“Unfortunately, we had to halt our program until we could get some clarification on this statute,” says Justin Koval, a communications supervisor at Collier County Sheriff’s Office. “We’re trying to reach out to other agencies in Florida, as well as nationwide, to see if anyone has found a way to achieve this, yet remain in compliance with the law.”

Specifically, the statute restricts any information being disclosed to persons other than public safety agency employees. The exemption applies to the caller’s name, address, telephone number or personal information about them, or information that may identify any person requesting emergency services or reporting an emergency.

One interpretation of this statute could mean dispatchers can’t call individuals near a scene to assist with an AED. And no more yelling, “Is there a doctor in the house?” because it might violate the caller’s right to remain anonymous.

Florida legislators are considering House Bill 739 for approval in July, which would amend state law to authorize public safety telecommunicators to contact owners of registered AEDs in the event of coronary emergency calls.2 The bill would also require local EMS medical directors to maintain registries of certain AED locations and owners of AEDs to register with local medical directors. It would also place an AED in each public school.

Until the change comes, Collier County dispatchers are looking for alternatives, such as one enacted near Syracuse, N.Y., in 2005.

Options
In Onondaga County, volunteer firefighters adopted a program coordinating the community for volunteer AED response.
Interested volunteers received a pager or cell phones through which they were notified to respond with an AED, based on specific CAD types.

“Many times, they could beat responders to the scene,” says Kathy McMahon, who now serves as APCO International’s technical services manager and also worked as a shift supervisor at Onondaga County Department of Emergency Communications in 2005. “Nothing was done directly with the citizens. Community volunteers were considered auxiliary members of the Volunteer Fire Department.”

As auxiliary members, volunteers were considered part of the public safety response system, circumventing the potential violation encountered by Florida law. Members also received additional safety training, such as not walking into a dangerous or unsecured incident.

In Kankakee County, Ill., KanComm 9-1-1 dispatchers operate a different program, also relying on a partnership with local firefighters.

The firefighters advise the location of AEDs when they conduct inspections, which are then relayed to the 9-1-1 center and entered into CAD. Certain EMD call types, such as cardiac arrest, then trigger an alert icon notifying the dispatcher an AED is available on scene.

“If it’s an EMD call, clicking on the alert will give the location(s) of AEDs at the property,” says KanComm Director Kevin McGovern.

KanComm relies on firefighters to keep the list up to date—adding, deleting or noting specific instructions regarding how to find the AED.

In this situation, third parties aren’t sent to the scene with the AED. Instead, callers are directed to the location of the nearest AED, not disclosing information to third parties, while still speeding the process of getting vital help to the patient.
Vendors specializing in emergency communications technology are also eager to offer solutions.

Atrus, a company specializing in AED location software, announced yet another alternative to alerting citizens to the locations of AEDs in Orange County, Fla. The AED Registry allows AED operators to register their devices online and generates regular e-mail reminders to periodically check the device to ensure it’s in working order.

The service, offered free to users, is intended to “provide a system to assure that AEDs in the community are well maintained,” Atrus President Elliot Fisch said, in a statement.

The company’s mantra is simple: “An AED doesn’t do anyone any good if no one knows where it is in the time of need.”
Orange County Medical Director George Ralls, MD, underlines the importance of quick AED use, in support of the Registry. “The availability and proper use of AEDs in workplaces, homes, schools, places of worship and business establishments will help improve survival from sudden cardiac arrest in our community.”

Conclusion
AEDs save lives, and 9-1-1 comm centers need to know where they are in their communities. They need to have a plan, process and procedure in place to ensure they can legally be accessed for patients in need. Work with your medical director to get a registry started in your area.

About the Author
Stephen Martini oversees training and quality assurance at the Hamilton County 9-1-1 District, where he’s worked since 2004. Before joining public safety, Martini was a newspaper journalist in North Carolina and Tennessee. He also operates a business creating custom, response-based dispatch simulators for 9-1-1 agencies around the U.S. Contact him via e-mail.

Footnotes
1.    Accepted by the AHA September 2011. This study was conducted from 2006–2009 by the Department of Cardiology and Heart Failure Research Center and the Department of Cardiology Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands. The study focused on 2,833 consecutive out-of-hospital cardiac arrest patients treated prior to EMS arrival.
2.    See the current status of FL HB 739 anytime at www.myfloridahouse.gov.

Originally published in February 2012 Public Safety Communications