Hello community,
I am preparing a newsletter that I will be sending to nursing homes and retirement communities. One of the stories is based upon the following article that appeared in the Toledo Blade just over a year ago. I would be interested in any comments this group may have on the subject and please indicate if I have your permission to publish them in the newsletter.
Article: Many nursing homes lack device to restart heart: Portable defibrillators not found at most Lucas County care centers
(Blade, The (Toledo, OH) (KRT) Via Thomson Dialog News Edge) Jan. 15--Automatic external defibrillators, portable devices used to jump-start a heart beating erratically, can be found in a lot of places. Fifth Third Field has one; so does Toledo Express Airport.
But if you suffer a heart attack in most nursing homes in Lucas County, or other areas of the country, you won't find one.
Dr. David Lindstrom, medical director for Lucas County Emergency Medical Services, was stunned to discover that -- especially when he looked at where all the cardiac arrests in Lucas County were occurring.
Nearly 1 in 4 cardiac arrests last year and in 2004 happened in nursing homes.
"I was shocked," Dr. Lindstrom said. "I thought big doctors' offices would show up the most and they didn't. I mean, good grief!"
And don't assume that most people in nursing homes have "do not resuscitate," or DNR, orders, Dr. Lindstrom said. No, the 1-in-4 number is for those who don't have such orders, meaning they expect everything to be done to revive them, he said. Automatic external defibrillators, also known as AEDs, are small devices that are hooked up to an individual who has had a heart attack. The machines automatically detect whether the person's heartbeat is erratic -- in medical terms, suffering from "arrhythmia" -- which is quite common.
Cardiopulmonary resuscitation (CPR) alone will not save these patients. If the heartbeat is irregular, the device instructs the user to press a button and an electric current is discharged.
Because many nursing homes lack defibrillators -- which cost $1,500 to $3,000 and are becoming the standard of care for treating many heart-attack patients -- Dr. Lindstrom argues that too many nursing home patients could be dying who otherwise might be saved.
"Essentially, all that's happening is there's a delay built in right now if they don't have a device," he said. "Their expectation is that the fire department or county life squad will bring the device they need. But that's an unnecessary delay in care. For every minute we lose, you lose a 10 percent chance of survival.
"Most nursing home officials interviewed, as well as elderly advocates, told The Blade that no one has ever raised the issue before. "This is really the first time in my 25 years I've ever really heard it brought up," said Stephen Mould, spokesman for the Ohio Health Care Association, a trade group representing about 750 long-term care facilities in the state.
After doing some research on the issue, Mr. Mould said that while some facilities have defibrillators, many others choose not to for a variety of reasons. Because many nursing home patients have do-not-resuscitate orders, he said some nursing home administrators feel such a device is likely unnecessary.
"Some facilities have told us, 'We've got them and they're sitting on the wall and we've never used them because of the DNR request,'" Mr. Mould said. Dr. Lindstrom's response is simple: What about those who don't have such orders in place?
Rey Nevarez, administrator of the Orchard Villa nursing home in Oregon, said his organization is "definitely discussing" placing a defibrillator in the building, where Dr. Lindstrom's statistics indicate there were five reported cardiac arrests last year.
Mr. Nevarez said many issues have to considered. "It's not as simple as just putting one up. There's training involved," he said.
Dr. Lindstrom counters that portable defibrillators have become very easy to use. That's why they stick them in airports, casinos, and other public locations, he said."The standard of care in America is moving toward public access to defibrillation. It's like having a fire extinguisher. You pull it off the wall and push one button," he said.
"This is a simple device and it should be used. "The issue is having one available to be used. Dr. Lindstrom said he's speaking out now because his earlier efforts to convince nursing homes to get defibrillators have mostly failed. In 2003, he and Kris Pupos, regional director of community initiatives of the northwest Ohio division of the American Heart Association, quietly approached nursing homes in Lucas County. They chose Lucas County because it's the only county Dr. Lindstrom said he is aware of in Ohio that has analyzed where cardiac arrests are occurring -- though Ms. Pupos said it's likely many other counties have about 25 percent of cardiac arrests happening in nursing homes.
Dr. Lindstrom and Ms. Pupos showed Lucas County nursing home officials some of their preliminary data showing that 25 percent of cardiac arrests were occurring in their facilities. Those who suffered cardiac arrests "are people whose loved ones expect everything will be done to keep their loved ones alive," Ms. Pupos said.
"These are often people that still have a lot of living left to do ... and long-term care is not just about going somewhere to die, but rehabilitating them to go home.
"Though some nursing homes were receptive to adding defibrillators,
"We haven't seen much of a response," Dr. Lindstrom said. Lake Park, a large six-story nursing home on the campus of Flower Hospital in Sylvania, placed three defibrillators in its building after its parent company, ProMedica Health System, agreed to buy them. It was an easy call, according to Mark Mullahy, administrator for Lake Park.
"Many of our residents are sicker, but many are younger. We get 50 or 60-year-olds here [recovering] from hip replacement and who need rehab," he said. "It just made a lot of sense. Before, we'd call 911 and it only took two or three minutes [for help to arrive], but Dr. Lindstrom said that two or three minutes makes a difference.
"Robert Boerst, a registered nurse and patient-care supervisorfor Lake Park, said nurses have used the defibrillators seven or eight times since adding them about a year ago, including the three times he's used them. He said the device was simple to use: "It tells you everything you need to do.
"Mr. Boerst said he didn't know the outcomes for all the patients but added that he knows that some of those patients were saved who otherwise could have died had they not been shocked with the defibrillators.
Arbor Health Care at Toledo added a defibrillator about a year ago. Apparently a wise decision if one goes by Dr. Lindstrom's statistics: Arbors of Toledo reported 17 cardiac arrests last year, the most of any long-term care facility in the county.
Shawna Haering, a registered nurse and regional director of operations overseeing the local Arbor facilities, said her company has ordered a defibrillator for its Sylvania facility and eventually wants to add them in Oregon and Waterville too.
Still, Ms. Haering said defibrillators in nursing homes are the exception, not the rule. For example, of the 30 long-term care facilities they own in Ohio, Toledo's Arbor facility is the only one that has a defibrillator. It's acting as a "pilot program" for the entire company, she said.
She said she's glad the trend toward acquiring them appears to be catching on, at least for her organization. "I'm a nurse by trade and it just made sense," she said. "Even though Arbors of Toledo is so close to the hospital, it just made sense to give us a little more time.
"No state or federal rules require defibrillators in nursing homes, according to Mr. Mould. Beverly Laubert, Ohio's long-term care ombudsman, said that's not necessarily a bad thing. As ombudsman, Ms. Laubert acts as an advocate for the state's long-term care residents, fielding concerns and complaints from residents and their families.
Ms. Laubert said it might make sense to add defibrillators in some facilities, but she said it depends on the facility. Some nursing homes have hospice patients; others are facilities geared more toward rehabilitating younger patients. And, like some nursing home officials, she said it wouldn't be wise just to add a device without proper training.
Ms. Pupos, echoing Dr. Lindstrom's complaint about that rationale, disagreed. "Most of these devices are simple to use," she said. "If they are a true AED, they're designed to be used by someone with a third-grade education."
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Comments Requested
- By pdminc
- Posted April 17, 2007 at 8:07 am · 5 replies
- In Promoting CPR and AEDs
- Shared with the public
Explore topics in this discussion:
Suicide Arrhythmia Cancer Anoxic brain injury Sudden cardiac arrest Heart attack Stomach cancer Stroke
5 replies
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- By Butch
- Posted April 17, 2007 at 5:25 pm
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Of course nursing home should have AEDS. In addition to the residents, there are staff members and visitors who might become SCA victims while in the facility. People automatically think of the residents, but others are there, too. Just like schools---everybody thinks of the students, but there are adult staff and visitors in the buildings each day. That AED hanging on the wall just might be used on an employee of the facility.
- By LifeSavers
- Posted April 23, 2007 at 12:27 pm
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The article is very informative and certainly offers better insight as to the benefits of an AED. But, a few things I noticed that was not clear, was that a 'heart attack' is not necessarily treated by an AED, although a heart attack may lead to SCA it is commonly treated without an AED when appropriate medical attention has been acquired.
Additionally, the staff of a nursing home are most likely trained healthcare providers and should recognize specific conditions such as heart attack and stroke. SCA can happen to anyone, anywhere at anytime...it would stand to reason that visitors and staff would also be protected by the AED device, if implemented as a public access defibrillator.
- By NWWriter
- Posted April 24, 2007 at 2:27 pm
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Dear pdminc,
I'm glad this was posted again because it made me admit how ambiguous I am on this topic.
I'm a survivor of a 1987 Sudden Cardiac Arrest. When I read The Blade article I heard (whether correctly or incorrectly) a voice that was testing the highly emotional waters of
"Who's going to LIVE and who's going to DIE?!?!"
which is a common motivational (and demagogic) tactic on this subject.
I was offended by the reporter's lack of ethics (not unusual with me these days!) at attempting to make the readers upset while simultaneously delivering faulty information on the topic.
A heart attack is NOT a sudden cardiac arrest, and if you're considering speaking on the topic, you should know the difference or hold your tongue.
Simultaneously, on a more personal level, as I read the article I recalled a job I'd had years ago. One of my first volunteer positions after my SCA/ABI (sudden cardiac arrest/anoxic brain injury) was that of a Home Hospice Volunteer. In that role I learned of really awful situations when a dying person was resuscitated against their wishes because the DNR was either ignored or not-known-about by the first responder/staff member/family member who impulsively dialed 911. The Blade article corrected my faulty assumptions as to the frequency of those incidents, though.
Another conflict I realized I had as I read the article was that Retirement Centers and Care Centers are often underfunded and understaffed. My initially-prejudiced reaction was
"It's too risky to trust 'those people" (staffmembers) with the judgment necessary in an SCA situation."
This morning I am apologizing to any and all Care Center employees for my arrogant condescension and prejudice and have altered my opinion accordingly.
In my opinion, automatic external defibrillators are important to have on hand EVERYWHERE.
One thing The Blade article got right was that, according to Dr. Lindstrom, "two or three minutes makes a difference".
In my case, twenty years ago I was 35 years old, a married mother of two young children in apparently good health when I dropped dead during a softball game. By the time Medic One arrived and I was resuscitated, it was estimated that fourteen minutes had passed....
The prognosis was that I was going to be "a vegetable" if I ever regained consciousness...
As you can read, though, I'm NOT a vegetable and have quick CPR and an onsite "car phone" to thank for that.
I do have an anoxic brain injury, though, and although I've been disabled from gainful employment, I've been able to contribute in a wide variety of fields during that twenty year time span, one of which was that Hospice job.
All these years I've known I was "lucky", but didn't realize how differently my situation could have been until a few years ago when a very memorable story changed my perspective about "accessible AEDs".
It was Terri Shiavo. In one description of her case, I read that the length of time of her SCA was twenty minutes.
Hers was twenty minutes and mine was fourteen.
I was shocked at the difference 6 minutes could make in the "end of the story" for a survivor.
I've since met SCA survivors who are more impaired than me but whose anoxia was shorter. Why? I don't know.
But Terri Schiavo made me realize the difference just a few minutes can make in the quality of life after resuscitation.
And as for "AEDs in Care Centers"; I've taken my kids to visit folks in Care Centers. I've visited recovering friends who are in those facilities for brief stays. I've met other friends to go and visit a single person recuperating until they could return home alone. It appalls me to think that any of those groups would die or be permanently impaired were they to suffer a Sudden Cardiac Arrest onsite.
How tragic is that?!
Most Care Center employees are hardworking folks who are doing their best in very challenging and low paying jobs which most of us would avoid taking if given the choice. They are not stupid, though, and can certainly learn the proper situations in which to use an AED.
The variety and volume of people going through those facilities on a daily basis, along with the variety of situations evidenced in the patient population as a whole, are certainly grounds to provide AEDs onsite.
My initial prejudice about "old people and the folks who care for them" caused me to be silent on this topic but I've realized my blindness and now enthusiastically support the installation of AEDs in all Care facilities.
"Six Minutes Difference" is my story and I encourage us all to consider the financial and ethical cost of ignoring the risk that "just" a few minutes can mean in these situations.
Sincerely,
Mary Lyons
Member, Sudden Cardiac Arrest Association
Longview, WA
- By pdminc
- Posted April 24, 2007 at 7:46 pm
- Report post
Mary,
I want to thank you for an excellent and insightful response. I want to give you a little more information on me, and my background to give you a reference point on where I am coming from. I work in the defibrillator industry for a company who services the nursing home industry in addition to other market segments. My primary focus is to saves lives by making defibrillators more available. I spent today soliciting funds from businesses for a GA county school defibrillator program, writing the policy and procedure manual for a chain of retirement homes and negotiating a low cost or donated medical oversight program to cover the defibrillators in a local football stadium. I am very familiar with nursing homes from both a personal and business prospective. My mother spent three years in an Alzheimer’s facility and my mother-in-law has been in a nursing home for two years with Alzheimer’s. I supply the defibrillators to various nursing home corporations (I shipped one last week to Friday Harbor WA) and thus see the industry, both as a customer and a vendor.
Your are truly one in a hundred to survive as you did. Having worked with Hospice you also have an understanding of the value of life and when that balances is tipped. When I talk with people, many think that being revived with an AED and CPR will leave you like Terri Shiavo and It is just not worth it. Others think who would want to live with Alzheimer’s any way so request a DNR. Having spent considerable time with my mother and mother-in-law I have seen life through their eyes. Both have been content and relatively happy. They remind me of my cat. They don’t know what happened 5 minutes ago, they don’t plan ahead or think about what I’ll do this afternoon, they both enjoy a nap and having company to play or interact with. I certainly don’t think my cat would be better off dead, why would I think my mother or mother-in-law would be any different? I just don’t understand people who say if I have a SCA it is just my time to go. Or even worse when people make that decision for others either overtly or through inaction.
Some facilities require a DNR because they do not want the responsibility of providing care while others such as Medicaid do not require AEDs because they don’t want the cost of survivors. From your perspective should CPR/AED application be considered separately from other DNR applications (ie life support or feeding tubes) or are they one in the same?
I think of living without a defibrillator nearby is much like jumping off a ship without a lifejacket. Both will probably result in death without the lifesaving tool. The only difference is who is in charge of starting the event, the person or luck. If you are not ready to jump off the ship now, why would you live without a defibrillator nearby now. At what point do we trust our life to luck? If we do not allow a life saving tool, is it suicide or euthanasia depending upon who made the decision?
My mother-in-law requested a DNR several years ago if she ever entered a nursing home. This was before AED general availability and success was very limited as you understand. We are honoring her request, but you can see I am troubled by her decision that was based upon what is now outdated information.
P.S. My mother died of stomach cancer a few years ago. She never understood she had a problem, and thought her full feeling was because she must have just eaten.
- By NWWriter
- Posted April 25, 2007 at 11:50 am
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Dear Peter,
Your perspective on death is founded in the American man's drive to "overcome". To "win". As if death is an enemy to be fought off and challenged in almost all circumstances.
Your metaphor of the sinking ship and the life jackets is an invalid metaphor for me. We get on a ship to sail, not to drown. And avoiding drowning will almost always be the choice of the passenger (unless you're Kate Winslet and have Leonardo DeCaprio floating on a board next to you).
And before I go any further (while I'm thinking of sailing) I encourage all readers to check out the location of Peter's noted customer, the beautiful community of Friday Harbor, Washington at www.fridayharbor.org Come visit our evergreen state!
Now, getting back to death, Peter, your perspective isn't uncommon in Hospice. We're programmed as Americans to "fight!", to "resist!". But in Hospice we learn first to respect and support the wishes of the client and DNR doesn't apply. Acceptance of death's approach has occurred and the team works to overcome any obstacles (including resistant or ambiguous family members) which might hamper that person's peaceful death.
Save the kids. Save the employees. Save the doctors. Save the short term patients. Save the cheerleader! ;) Those people are invisible in this situation and warrant an advocate. Leave the saving decisions of the patients to the patients and their families. Model full and humble acceptance and support in your thoughts and actions (and heart) and folks won't run the other way when they see you coming.
I'm sorry about your Mother-in-law but hang in there. Her decision was a FINE one and there's no need to second-guess her. She and your wife need your support in making the rest of her life the best it can be, so get on board.
Prayer helps.
Mary
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