The AED is a Life-Point bPLUS fully automatic defibrillator, which defines the rhythm and automatically delivers the shock independently from the operator when defibrillation is required. There is no SHOCK button on Life-Point bPLUS fully automated defibrillator, as the defibrillation procedure is applied by the device. There is no SHOCK button on Life-Point bPLUS fully automatic defibrillator but they are present on Life-Point semi-automated defibrillator. In functional terms, Life-Point bPLUS’ are no different from Life-Point Pro AED or mPLUS semi-automated defibrillators.
Fully Automatic Defibrillator or Semi-Automated Defibrillator: Which to Choose?
In terms of diagnosis and treatment, there are no differences between Life-Point bPLUS fully automatic defibrillator and Life-Point mPLUS semi-automated defibrillators. Unlike semi-automated defibrillators, fully automatic defibrillators do not have a SHOCK / Defibrillation button; after performing ECG analysis if the device detects that delivering electroshock to the patient is necessary, it charges the required energy and automatically delivers the defibrillation procedure. However, if the defibrillator is semi-automated, after performing the ECG analysis and detecting that defibrillation is required, the devices charges the necessary energy and instructs the operator to press the SHOCK / Defibrillation button in order to deliver the procedure. In short, semi-automated external defibrillators perform the defibrillation procedure when the operator presses the SHOCK button.
Even though they could not obtain conclusive results, several research studies have shown that fully automatic defibrillator users managed to perform defibrillation earlier than semi-automated defibrillator users. Moreover, compared with semi-automatic defibrillator users, fully automatic defibrillator users are less likely to make a significant error during use. Apart from that, according to the inconclusive research, when users who do not have medical training operate semi-automated defibrillators, they feel anxious about harming the patient by pressing the SHOCK / Defibrillation button, which in turn causes delays defibrillation or not performing it at all. Therefore, even though there is no difference between these two types of defibrillators in terms of diagnosis and treatment, it may be concluded that fully automatic defibrillators are more effective than semi-automated defibrillators.
In the Simplest Terms, What is a Defibrillator?
A medical device that stops abnormal rapid beating of the heart, and returns it to its normal rhythm is called a defibrillator. It is also called an electroshock device. If the cardiac rhythm called fibrillation affects the atrium, the working order of the heart is disrupted.
What Are the Differences between Life-Point bPLUS Fully Automatic Defibrillators and Life-Point PLUS Manual Defibrillators?
Manual defibrillators are medical devices designed to save the lives patients who are diagnosed with arrhythmia, ventricular tachycardia (without pulse) and ventricular fibrillation, and can be operated only by professional medical specialists in hospitals, ambulances etc. Medical training is required to use this kind of defibrillator, as a specialist physician examines the patient’s ECG rhythm and decides whether or not to deliver an electroshock. These defibrillators, which you usually see on television, have been developed with the rapid advance of technology, and have evolved into automated defibrillators that can be used without the assistance of a physician.
Fully automatic external defibrillators, or AEDs, are only one type of defibrillator being used today.
Fully automated external defibrillators are electronic devices that can be used without medical training and are designed to diagnose even fatal diseases such as cardiac arrhythmia. Besides analysing cardiac rhythm, AEDs can also perform defibrillation, as with conventional defibrillators.
As it is easy to use, the fully automated defibrillator has gained popularity throughout the world. Even an ordinary person without any medical training can use this device and save lives, after taking a short and simple training course. As the name implies, the use of automated defibrillators is very simple. They guide the operator through audible and visual instructions, and help to save the patient by guiding the operator until the very last moment.
What Does Cardiac Arrest Mean?
Cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, can be defined as a suddenly and unexpectedly developing clinical situation in which the heart cannot fulfills its function to circulate blood (systole and diastole), which is characterised by a loss of pulse in the main arteries, and results in respiratory standstill and loss of consciousness. As circulation stops, tissues cannot be oxygenated. Since the organ that is most adversely affected by the lack of oxygen is the brain, during such an incident, loss of consciousness and subsequently hypoxic brain damage may develop, which in turn leads to neurological deficit, memory disorders and cognitive dysfunction. According to the principles of basic life support, the first thing to do is to help to restart circulation, i.e. to perform cardiopulmonary resuscitation (CPR). According to advanced life support principles, in turn, the first thing to do is to monitor the patient and apply defibrillation.
What is the most common treatment for sudden cardiac arrest?
The only proven treatment for victims of the ventricular fibrillation and ventricular tachycardia that occurs during sudden cardiac arrest is, in a word, “defibrillation”. Defibrillation, however, requires a defibrillator.
Interview with Assoc. Prof. Dr. Mutlu Vural published in Akşam daily on July 13, 2014
Unless a person suffering sudden cardiac arrest is treated, cerebral death starts after 3 minutes, a period that we call the “golden minutes”. Around 10 minutes later, the victim’s brain is completely dead. In other words, a person who suffers sudden cardiac arrest is already dead when the ambulance arrives. Even so, Turkish society still does not have the skill to perform cardiopulmonary resuscitation or to apply electroshock. Nevertheless, in the last 10 to 15 years, many societies have achieved the skill to perform both cardiopulmonary resuscitation and electroshock. Our main target is to strengthen the basic rescue chain in our society for emergency situations that occur outside hospital, particularly in relation to sudden cardiac arrest.
THE BASIC RESCUE CHAIN
The basic rescue chain consists of 5 links. The first one is to call 112. A healthcare professional must come to the scene. This is the first thing we should do. If there is someone with us, we get him or her make the call in order to save time. If we are alone, we should make the call. After that, we perform basic life support. If the victim is in cardiac arrest, we perform CPR. If we know how to give artificial respiration, we give it, if not, we continue only with CPR. The third link is to use the AED or intervention with an electroshock device in ordinary language. These three links must become public knowledge. The fourth link is the ambulance, and the fifth is the place where the ambulance goes, the hospital. In Turkey, the rescue chain comprises 4 instead of 5 links. The first link is to call 112, something with which we also have problems. The second link is basic life support, where we have only a few first responders. Intervention before the arrival of the ambulance is almost nil. The third link is the ambulance and the fourth is the hospital. Why do foreign countries have a higher level of first aid? Because it is mandatory. Let’s say you had a heart attack at a shopping mall abroad and died. If there is no electroshock device in that shopping mall, this is perceived directly as involuntary manslaughter, as it is compulsory for malls to have AEDs. This is also true for schools and public transport, the personnel of which must also be trained.
FIRST AID TRAINING
The intervention made by healthcare professionals is called medical intervention. In turn, the intervention of those who are not healthcare professionals is called first aid. In fact, in relation to situations that do not require an emergency response, we resort to the healthcare system. First aid training takes 2 days and 16 hours, and you take an exam once the course is completed. Having all adults receive first aid certificates should be our target, because we do not recommend intervention by people who do not have a first aid certificate. Certified first responders must obey the laws too. When we go out, we may witness someone we do not know or a colleague suffering sudden cardiac arrest, and we may find ourselves in a situation where we must intervene. This is a social responsibility, a duty to the society in which we live; yet, even healthcare professionals hesitate before intervening. In order to intervene, he or she should not have negative thoughts such as, “If I intervene now, I will have to give a statement to the police, then they will summon me to the court; the victim may even sue me for damages and I may be charged.” And this is only possible by granting immunity from prosecution to certified first responders.
WHY DO WE NEED THE PUBLIC?
For instance, with sudden cardiac arrest, cerebral death kicks in starting from the fourth minute. When we look at the average time for an ambulance to arrive, we see that it is 10 minutes in urban areas and 30 minutes in the countryside. So, by the time the ambulance arrives, the damage is already done. If no-one intervenes to help a sudden cardiac arrest victim, the patient is considered dead after 12 minutes. In most cases, the ambulance arrives later than 12 minutes. Therefore, there must be solidarity regarding first aid between society and healthcare professionals.
HOW CAN WE RECOGNIZE CARDIAC ARREST?
A healthy person loses consciousness and collapses immediately after the complaints begin. If the person is breathing as if they are sighing and short of breath, they are experiencing a cardiac arrest. This is how we define sudden cardiac arrest. When the heart stops beating, the brain cannot get oxygen, and you collapse on the spot in only 10 seconds, as if you have been unplugged. Unfortunately, in our country 99 percent of those suffering cardiac arrest die before arriving at the hospital. Our aim should be to reduce these deaths. If we intervene within 2 minutes, and perform electroshock, if a device is available, the victim’s heart will start beating again, they will start breathing and regain consciousness. But, if the process takes longer, the person will start breathing again, but it could take several hours for the brain to regain consciousness. Even worse, brain damage may occur if the intervention is too late.
HOW DO YOU PERFORM CPR?
If there is no electroshock (fully automatic defibrillator / semi-automated defibrillator) device around, we perform CPR. We call this hands-only CPR. And in this practice, when we apply pressure on the victim’s chest, keeping our elbows straight, the victim’s heart is compressed between the chest and vertebra, and starts to pump blood. When we compress again, the victim exhales, and when we release the pressure, the chest rises on its own. With each compression, the victim exhales, the heart pumps blood, and when released, the heart refills with blood and the lungs refill with air. So, you are maintaining blood circulation, as well as providing respiration and this, to a certain extent, is enough. That is why the importance of respiration has declined, and nowadays CPR has come to the fore. Of course, what I have been talking about so far related to people who are 13 years of age, or older. The situation for children is somewhat different. Respiration is slightly more pronounced in children.
WHAT KIND OF PROBLEMS DO WE HAVE?
For instance, the first link of the rescue chain is to call 112 (or the local emergency line). The number of calls received by 112 is excessive. Yet, regrettably, 90 percent of these calls have nothing to do with medicine. And this may delay the 112 answering service responding to an actual patient by up to one minute. A 112 operations center receives 90,000 calls per day in Istanbul alone, and more than 90 percent of these are not related to medicine. People call emergency (112) for anything other than emergencies. Above all, we need to prevent this from happening.
The number of those who are trained in first aid should be increased, and first responders should be encouraged, as well as legally protected. For instance, there is no obligation to have automated defibrillators available. Consequently, the basic rescue chain in our country has only 4 links.
If automated external defibrillators are included in the chain, it will have 5 links. Operating these devices is so simple that even a 10-year-old child can do it. It guides you with commands in Turkish. Commands already should be in the native language.
We are completely falling behind in this respect. In America, they have one device per 10 people.
WHAT DOES THE ‘STAY ALIVE ASSOCIATION’ DO?
We have initiated events for the 1st Basic Rescue Chain on the Street. We are doing this at 11 busy locations in Istanbul. At each of these locations, 15 people perform various moves to the rhythm of our song, Stay Alive. We teach them the importance of the first inner link of the rescue chain. The fourth link is the ambulance. And the fifth is the last stop of the ambulance, the hospital. At these events, we tell them about the fact that thousands of lives could be saved provided the community makes good use of the golden minutes before the ambulance arrives. Of course, we do all this in cooperation with other institutions, for this is not something that the Stay Alive Association can achieve alone. We work with many other non-governmental organizations including the Emergency Medicine Specialists Association and the Emergency Medicine Technicians Association. We cooperate with governmental institutions as well.
IS IT POSSIBLE TO GET ONLINE TRAINING?
Online training is quite common overseas, because in this way you can reach more people. You can reach people very easily and create awareness in a very short time. In addition to online training, training is also provided using public service advertisements, and certificates are issued after these too. We want to pave the way for this approach to be used in our country. And we are willing to provide such training free of change. Our target is to teach 10 million people CPR in 10 years and 30 million people in 20 years.
AT 103 BEATS PER MINUTE
The Bee Gees’ song, “Stay in’ Alive”, has been used around the world in first aid training since 1972. Our first responders have been using that song as well. So we decided to compose a national song. And we called it “Hayatta Kal” (“Stay Alive”) in Turkish. The song has a beat of 103 bpm. This is because we don’t want to have CPR of less than 100 beats per minute. It should be between 100 and 110 per minute. This beat of 103 bpm is also used globally for training. As a result, we composed a song called “stay alive” with a beat of 103 bpm. Vural Şahin wrote the lyrics of the song. It was composed by Tuncay Yalın, a composer endorsed by the Ministry of Culture. And Ali Avni performed the song. People will be able to learn CPR according to the beat of this song. We will also shoot a video clip for the song. We will also try to reach to more people through television as well. The beat of the awareness song is faster, 120 bpm. We are thinking about filming a video clip for that song also. We applied to “ttmuzik” to get them on air. For training though, the song was composed at 103 bpm.
WHAT IS THE SITUATION ABROAD?
In the US, they have 1 minute videos explaining how to intervene in cases of sudden cardiac arrest. We translated the hands-only CPR video of the American Heart Association into Turkish. It is only 1 minute long but explains the subject very well. Moreover, there is a website called www.cprtoday.com supported by CNN International. They teach CPR on that website as well.
They also suggest that CPR can be learned in 30 minutes to an hour, depending on the trainee’s level. They have reached 500,000 people so far and granted them online certificates. Since the law supporting the society in sudden cardiac arrest intervention was ratified in 2000, the survival rate has increased by 5 percent (15,000 people per year). Moreover, in many European countries, the answering service personnel at emergency health services operation centers encourage intervention over the phone to those around the patient, until the ambulance arrives.