Response time makes a life-and-death difference for cardiac arrest victims. Now a portable automated defibrillator puts the power to save lives in the hands of those….

First on the Scene

Delaware County Police Officer Daniel Hahn was a vocal skeptic of the PARADE program until it helped him save the life of a friend.

PARADE, an acronym for Police As Responders - Automated Defibrillation Evaluation, is a randomized study being conducted by IUSM faculty in the Krannert Institute of Cardiology to evaluate the use of portable automated external defibrillators (AEDs) by police officers. Since police officers are frequently the first on the scene, they have a unique opportunity to act within the first crucial minutes following cardiac arrest. Hahn proved that point late last January.

On his way to work, he responded to a 911 emergency call reporting a straying car. At the scene, he found two young boys and their unconscious father. The boys, ages nine and six, had bravely managed to steer the car onto a church lawn and stop it.

Fortunately, Officer Hahn was driving a patrol car equipped with an AED. He immediately pulled the AED from his car, attached the electrodes to the man's chest, and waited for the device to offer instructions. The AED prompted him to deliver a shock. Only three minutes had passed since the man's collapse. Prompted by the device, Hahn delivered two additional shocks before being relieved by EMS personnel, who completed the resuscitation. (Fourteen shocks were administered in all.)

Once out of the thick of the action, Hahn was surprised to realize that the victim he had helped resuscitate was friend and colleague Mark Vollmar, 41, a City of Muncie police officer. Vollmar, who was off duty at the time and driving with his two young sons, had experienced cardiac arrest. He was taken to Ball Memorial Hospital, where he was treated and had surgery. The following week, he returned home, the first recorded "save" for the PARADE study.

His Testimony Speaks Success
Hahn, who is now a devoted advocate of AED training among police officers, admits his initial skepticism. "When I first heard about this AED stuff, I thought it was a bad rumor. Now I back the program one hundred percent. I will do anything I can to help promote it and save another life." True to his word, Hahn gives his testimony at the beginning of each AED training session at the Indiana Law Enforcement Academy.

The training teaches the officers how to use the device, which automatically analyzes the heart rhythm and sets the amount of electricity to be delivered. (It will not deliver a shock to a person who does not need one.) It coaches the operator with audio and visual prompts.

William Groh, MD, principal investigator for PARADE and assistant professor of medicine, is leading the research effort by the Krannert Institute of Cardiology. According to Dr. Groh, the rationale for PARADE is that police may help improve the rate of survival from cardiac arrest in Indiana, which is close to the national average of less than five percent. Sudden cardiac arrest strikes approximately 1,000 people each day and is the most common cause of death in the United States.

Preliminary data from the PARADE study suggests that police arrive at the scene of an emergency four minutes sooner than EMS personnel. In rural counties where emergency response time is often eight to 15 minutes, police officers trained to use the AED can act as a complement to traditional EMS responders. Early response and defibrillation is imperative for the survival of cardiac arrest victims.

"We know that the patient's chance of survival is directly tied to the amount of time that lapses from collapse to defibrillation," says Dr. Groh. "If defibrillation is delayed for more than ten minutes, survival rates drop to virtually zero." Since its inception in 1997, the PARADE study has trained about 175 police officers to use the AED and has placed 80 portable AEDs in police vehicles in Howard, Hamilton, Shelby, Delaware and Marshall counties.

Many more counties are eager to enroll in the study, says Mary Newman, study coordinator. To participate, counties must have 911 service and have an EMS response time between eight and 15 minutes, a fairly long time compared to some urban EMS response times. Police officers must be trained in CPR before taking the four-hour AED training course.

Making A Difference
When a county is enrolled in the study, AED devices are placed in half of the patrol fleet with the other half acting as the control group. Devices are rotated among the cars periodically, and officers who do not have AEDs are expected to provide CPR until help arrives.

To date, AEDs have been used by police officers in at least 13 instances, in which 10 people were found to have treatable arrhythmia. The study has recorded two "saves." A save is defined as a patient who is discharged from the hospital. These two saves put the survival rate for victims with treatable arrhythmia at 20 percent.

"The use of AEDs can definitely make a difference in improving cardiac arrest survival," says Ms. Newman. "The survival rate in Rochester, Minnesota, where a similar program exists, has increased to 45 percent."

The use of AEDs by police officers originated at the Mayo Clinic under the direction of Roger White, MD, medical director for Rochester's police department. Other sites involved in police-based AED trials include Lancaster and Pittsburgh, Pennsylvania, and Cincinnati, Ohio.

In Indiana, revised AED legislation was signed into law this spring allowing more widespread use of AEDs by medically certified individuals. The law now requires completion of a CPR and AED course for operators and requires that licensed physicians authorize and oversee defibrillator use. The legislation also grants immunity from civil liability for anyone trained in the use of the device.

To help promote AED programs, a book titled Challenging Sudden Death: A Community Guide to Help Save Lives, co-authored by Study Coordinator Mary Newman, and Jim Christenson, MD, was introduced at the Emergency Cardiac Care Update conference in Orlando last May. The book was peer-reviewed by a panel that included Dr. Groh and Douglas Zipes, MD, director of Krannert Institute of Cardiology and distinguished professor of medicine and of pharmacology and toxicology. The American Health Association and similar organizations will distribute the book to encourage other cities to implement AED programs.

(The A.S. Laerdal Foundation for Acute Medicine, the Medtronic Foundation Heart/Rescue Program and Guidant Corp. provide grants that fund PARADE. Laerdal Medical Corporation, Heartstream, Physio-Control Corp. and SurvivaLink Corporation loan the AED devices to communities that participate in the PARADE study. The IUSM study began after Dr. Groh learned of the Hamilton County, Indiana, program and contacted the organizer with a proposal to make the project a scientific study that would expand to include other countries.)