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161 Automated External Defibrillator Awareness and Distribution

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					                                                                                **161** page 1




    Automated External Defibrillator Awareness and
                     Distribution
             in the Rochester Community
                                          **161**
                                        Block 4, 2006


ABSTRACT

       Sudden cardiac death is a leading cause of death in New York State. Intervention with

Automated External Defibrillators (AED) decrease mortality associated with this condition. The

target community of this project is a local business. The key partners are the American Heart

Association, Shock for Life, Eldre Corporation and myself. Shock for Life currently has the

AEDs and plans to implement them with the class on December 14th. Once successfully

implemented, this project is easily sustainable and could serve as a blueprint for future projects,

resulting in a potentially large impact on the community. This is actually a continuation of a

project where students last block attempted to implement an AED in a local church.




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                               **161** page 2


BACKGROUND OF PROBLEM

       Acute coronary syndrome (ACS), is an umbrella term encompassing the following

cardiac events: new onset unstable angina, non-ST segment elevation myocardial infarction

(NSTEMI), or a ST-segment myocardial infarction (STEMI). Briefly, ACS is currently thought

to arise from a common event, that event being arterial atherosclerotic plaque rupture, with

subsequent platelet thrombus formation within the arterial lumen, narrowing and potentially

occluding the artery of interest (1). However, which of the three aforementioned subtypes of

ACS manifests depends on the degree and duration of arterial occlusion observed. Unstable

angina will result from an incomplete or complete arterial occlusion; however, this is a transient

occurrence, often just a few minutes in duration, in nature and does not cause permanent

myocardial tissue damage. NSTEMI results from a longer complete arterial occlusion causing

subendocardial tissue necrosis; however, this arterial blockage does not last long enough to cause

the more severe myocardial tissue necrosis observed in STEMIs. Unstable angina and NSTEMIs

are, logically, one of the strongest predictors of future STEMI and, potentially, sudden cardiac

death (SCD) (1). Sudden cardiac death is generally defined as unexpected death as the result of

cardiovascular causes in a person with or without preexisting heart disease, within 1 hour of

onset of change in clinical status. Most instances of SCD are thought to involve ventricular

tachycardia degenerating to ventricular fibrillation and subsequent asystole (2). STEMIs are the

most serious of the three ACSs and cause the most tissue damage as the completely occluded

vessel is not relieved until transmural myocardial tissue damage has taken place; the logical and

frequent progression of STEMIs, without immediate intervention such as defibrillation, is to that

of SCD.




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                                  **161** page 3


        Strong, proven, common risk factors for atherosclerosis and, thus, ACS and SCD include

the following: hypercholesterolemia, hypertension, smoking, diabetes mellitus, age greater than

65, and male sex; “softer” risk factors also include obesity, frequent alcohol use, lack of routine

exercise, hyperhomocysteinemia, and poor health care access (3,4). Many of these risk factors

are treatable, and thus preventable, with the obvious exclusion of gender and age, making SCD

the most preventable prevalent cause of mortality in the United States. Brain death starts to

occur in four to six minutes after cardiac arrest and a victim's chances of survival are reduced by

seven to ten percent with every minute that passes without defibrillation (5). Few attempts at

resuscitation succeed after ten minutes. Cardiac arrest is reversible in most victims if it is treated

within a few minutes with an electric shock to the heart to restore a normal heartbeat (5). Access

to defibrillation in those critical minutes can save numerous lives. The goal of this project was to

prevent the progression of cardiac arrest to sudden cardiac death with the use of an Automated

External Defibrillator (AED) via the distribution and education of an AED to a local business

within the Rochester community.

       The incidence of community sudden cardiac arrest in the United States is 1 in 2000

people (5). Age-adjusted coronary heart disease mortality in New York State for individuals

older than 35 years of age is the highest in the United States with an incidence of 367 per

100,000 individuals; this risk is doubled in individuals older than 65 years of age. Further,

coronary heart disease is the number one killer of New York State residents (6). However,

despite increased rates of mortality due to ACS/SCD in New York State over the national

average, Monroe County is actually slightly below average for New York with an incidence of

coronary heart disease of 340 per 100,000 individuals, a reduction of eight percent over the New

York State average. However, Monroe County is still above the national average.



Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                               **161** page 4


       The Healthy People 2010 Outcomes targeted by this project include increasing access to

healthcare by the promotion of preventive health services. This will be accomplished by

providing an AED to a local business populated by many people at risk for coronary heart

disease and, thus, at risk for sudden cardiac death (7,8). As describe above, without immediate

access to an AED of the cardiac event, the chances of survival and recovery of cardiac function

decreases rapidly within minutes. The best way to rectify this glaring problem is to provide an

AED in areas with a high-volume of people with the aforementioned risk factors or established

coronary artery disease, such as Eldre Corporation, so that should an event occur near or in this

venue immediate intervention can be started without waiting for the ambulance to arrive losing

precious life-saving opportunity minutes in the process.

BACKGROUND OF COMMUNITY

       As stated previously, the Rochester community at large is at increased risk for the

development of coronary heart disease and, thus, the development of ACS and SCD. Eldre

Corporation well represents the Rochester community as it draws employees from several areas

around and within the city. As observed during my time as an employee there, many employees

harbor many of the previously mentioned risk factors for SCD including male sex, obesity, and

older age. In New York state as of 1999, the prevalence of smoking is approximately eighteen

percent, the prevalence of hypercholesterolemia is twenty-nine percent, and the prevalence of

hypertension is twenty-three percent (6). Undoubtedly, given the prevalence of these cardiac

risk factors and the above average risk for coronary heart disease within New York state and

Monroe county compared with national averages, a substantial portion of employees within this

local community are at above average risk for SCD and could potentially benefit by having an

AED of close proximity within a venue frequently visited.



Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                                  **161** page 5


       Aggressive screening efforts nationwide have been targeted these major cardiac risk

factors, specifically against smoking, hypertension, and hypercholesterolemia, especially in the

older population. In Monroe County, ninety-five percent and seventy-two percent of adults over

fifty-five have been screened for hypertension and hypercholesterolemia, respectively (8). These

screening rates are parallel, if not slightly higher, than national averages and indicate that the

older population of Monroe County is rather healthcare-savvy and would likely be comforted by

knowing an AED is within the close vicinity and most likely would support AED

implementation in such a setting.

       Considering what has been done about this issue in the past, the placement of AEDs in

public settings is anything but an old issue. The installation and education of AEDs in venues

such as schools and airports in an effort to decrease the significant rates of sudden cardiac death

due to intervention delay is another example of a major preventive health issue sweeping over

America the last few years. In fact, legislation exists regulating placement and education of

AEDs in all public schools in the United States (5). The logical next step would be to include

other venues garnering high traffic of individuals at risk for coronary artery disease such as

public pools, churches, train stations, local businesses etc. Eldre Corporation of Rochester, NY

in Henrietta, does not have an AED at their disposal; further, no prior efforts or plans have ever

been made to initiate the implementation and subsequent education of an AED in this setting.

PROJECT DESCRIPTION AND METHODS

       The goal of this project was to continue the previous students’ efforts to help prevent the

progression of cardiac arrest to sudden cardiac death with the use of an AED and thus diminish

the potential for interventional delay, via the distribution and education of an AED to a local

business in Henrietta, New York, a community within greater Rochester area.



Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                              **161** page 6


       This business was chosen by myself as I used to be employed here and my father, uncle,

and sister currently work there. Also this business is in the Rochester community, and has over

200 employees many of which are likely at high-risk for experiencing a sudden cardiac death.

This business has never had, and currently is still without an AED. Again, I got the orginal idea

came from **162**’s and **162.5**’s project when they attempted to implement this in a local

church. I originally was planning on attempting to place AEDs throughout the community in

Temples as this would have had the same type of populations as the church and myself and

family are all members of Temple Beth El. I went to Temple Beth El and found that they already

had 2 AED’s. I then called temple Brith Kodesh to find out that they also had one. I then

contacted Duncan Ververs of the American Heart Association who was my gym teacher when I

was younger and a friend of the family. I met him again in one of the lectures in CHIC where I

received his card. He advised me that all the temples already had AED’s. I then brainstormed

for a while and then arranged a meeting with Lee Moss Vise President of Eldre Corporation who

thought this would be an excellent idea. I called Duncan Ververs back and he also thought this

would be a wonderful idea to put AED’s in local businesses. We had a telephone meeting where

he told me the steps that would need to be taken and the barriers that we might run into. He also

gave me a sample protocol for the AED use. Duncan Ververs then gave me a contact, MaryBeth

Barber from Shock for Life. He told me that she would be able to take care of all of this. I then

met with Lee Moss Vice President of Eldre Corporation where we did a walk around the plant

and decided how long it took to get from one side to the other that we would want to purchase 2

AEDs. I also then got key volunteers from each department to become trained in CPR for the

adult and AED use. A meeting was then arranged with MaryBeth Barber and myself at Eldre

Corporation where we discussed different potential units, training classes and number of units



Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                                **161** page 7


and people to be trained. Lee Moss was then contacted again by myself where after my meeting

with MaryBeth Barber we decided on 2 Welch Allyn AEDs with wall units and that she would to

the CPR/AED training from the American Heart association as this was a cheaper and better deal

than training from the Red Cross. Further more this training is good for 2 years and she comes to

our facility to do this. The AED was sold to Eldre Corporation for $1995. MaryBeth Barber will

be creating our protocol, taking care of Dr. Eric Davis getting Eldre Corporation’s NY

certification for the AED and maintaining the machines and maintenance will be handled by

MaryBeth Barber who will send out e-mail reminders of when checks need to be done.

Barriers

     1. It was difficult at first to find a venue to put the AEDs into after I realized the temples

           already had them when I was initially told by people at the temple that they didn’t have

           them.

     2. I had some initial difficulty with who to contact in the company but was able to quickly

           side step this given my families involvement. To help future people doing this there is

           generally a human resources person at companies that deals with environmental safety

           who was also helpful to me as to who to contact.

     3. I had some difficulty initially in convincing the company to spend such a large sum of

           money on a project but after presenting them with the data they were very excited about

           this.

PARTNERSHIPS


1. Duncan Ververs
   Vice President
   Health Outcomes Northeast Affiliate
   American Heart Association
   2113 Chili Avenue

Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                             **161** page 8


   Rochester, NY 14624
   Phone #: (585) 697-6278
   Email Address: duncan.ververs@heart.org

       Duncan Ververs I have known from Brighton High school when he taught my gym class.

   He also gave an introductory talk about the American Heart Association and CHIC

   opportunities at one of the first lectures during CHIC block 4. Dr. Scott McIntosh offered for

   people to meet him afterward and I took this opportunity. Mr. Ververs was happy to help

   and provided several contacts to me as well as protocol mentioned above. He also gave me

   helpful information about the temples already having AEDs.

2. Lee Moss
   Eldre Corporation
   1500 Jefferson Road
   Rochester, NY 14623
   Phone #: (585) 427-7280

       My Father, Harvey Erdle, is president and CEO of this company and made it easy for me

   to contact Mr. Lee Moss. Lee Moss was easy to work with, negotiate with and get off to a

   fast start the implementation of the AED in this office.

3. Mary Beth Barber
   Shock for Life
   shockforlife@HOTMAIL.COM
   (w) 924-4235
   Cell: 924-8360

       Mr. Ververs provided contact with Mrs. Barber of Shock for Life. She is an AED

   distributor and trains people in its use. Mrs. Barber was contacted to help Eldre Corporation

   and myself implement this AED. She was eager to help, offered many options for AED’s

   training and available dates.

RSRB approval




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                               **161** page 9


       RSRB approval was not sought as no human subjects were going to be individually

questioned or researched in any way as part of this project. Also as this was the beginning stage

of this project no evaluation aspect was going to be done for this project.

IMPLEMENTATION

       There is not much of a difference in what I planned and what I did if you refer to the

“Project Description and Methods” section for how this plan was completed The discrepancy

between what was planned what was accomplished is really only delays. As I spent my first

week trying to figure out how to get these AED’s in the temples, and once I found out they

already had them I had to change my plan. I then decided to implement the AEDs in the local

business as discussed above. I would have liked to have them in-house earlier but the earliest

date I could get them was in December and the earliest training class I could get that Eldre and

Marybeth Could do was December 14th which is now the date the machines are coming in house

and the training class will be conducted.

SUSTAINABILITY

       The finances for the project have been paid. Marybeth Barber will be sustaining all

aspects of the project including contact and paperwork to be done with Dr. Eric Davis of the

Emergency Department at URMC. He will be the overseeing physician. Marybeth Barber will

also be sending out reminders for maintenance checks and recertification of CPR and AED

training for at least 6 employees there. Eldre Corporation actually has well over 10 that will be

trained. Hopefully this project can be evaluated in a couple years as mentioned in **162**’s

paper as well.

RESULTS/DISCUSSION/RECOMMENDATIONS




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                             **161** page 10


       Everyone I came in contact with for this project was extremely open to this idea,

enthusiastic and friendly. I think that funding, man hours, and money are the only real issues and

barriers to these projects. Again, everyone was easy to work with and if there were some ways

the community could help to subsidize this project or make this equipment and training less

costly, this would be helpful.

IMPACT SECTIONS

       IMPACT ON MY CAREER:

       I have been helping with community service since I first started at university of

Rochester. My first experience was with One-on-One where we would visit patients in the

hospital with no friends or families. I continued on to work with Operation Smile, the American

Cancer Society as well as teaching grade school children about nutrition in the city with the

AMA. I was also fortunate to be a senior clinician at the UofR Well Outreach clinic This

experience has helped me to see how just myself can impact the communities health in such little

time. This furthers my drive to help the community at large.

       I plan on completing my career as a dermatologist and I can for see myself being able to

do similar types of projects to help my patient population. An example of this is more

community awareness of skin cancer risk and perhaps better access to skin cancer screening for

patients. Perhaps even a free clinic once a week for the un insured might be able to be created as

paralleled with my UoR Well Out reach experience. The opportunities are endless and are

exciting to think about as my career progresses.

       I don’t think that I would be into community service if the UofR did not make it so easy

to get involved with and thus this experience DOES validate the University of Rochester’s




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                               **161** page 11


decision to make Community Health one of its MISSIONS along with education, research, and

clinical care.

        IMPACT ON THE TARGET COMMUNITY:

        No impact will be measurable right away on the community for this project as it has not

been fully set in place yet. I will however, because of my connection to the business, be able to

oversee its use in the future and be able to report back the clerkship director about this. Further

more I have heard of some positive impacts AEDs have had on the community from Marybeth

Barber. I was told of an 18 year girl’s life who was saved at MidTown Tennis and Athletic.

Hopefully this project will decrease the incidence of sudden cardiac death in Monroe County and

the Rochester Community. With continued efforts from people in the community this should

become a reality.

OPTIONAL SECTIONS AS APPROPRIATE

LONGITUDINAL EXPERIENCES

Please see my above section on impacting my career for my previous experience in community
service.




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                           **161** page 12


REFERENCES:

   1. Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald's Heart Disease, 7th Edition -
      A Textbook of Cardiovascular Medicine. Saunders, 2005.

   2. Lopshire JC. Zipes DP. “Sudden cardiac death: better understanding of risks,
      mechanisms, and treatment.” Circulation 2006; 114: 1134-6.

   3. Glasser SP, Selwyn AP, Ganz P. “Atherosclerosis: risk factors and the vascular
      endothelium.” American Heart Journal 1996; 13: 379-84.

   4. Kaikkonen KS. Kortelainen ML. Linna E. Huikuri HV. “Family history and the risk of
      sudden cardiac death as a manifestation of an acute coronary event.” Circulation 2006;
      114: 1462-7.

   5. American Heart Association. http://www.americanheart.org/. Accessed November 20,
      2006.

   6. Burden of Cardiovascular Disease in New York: Mortality, Prevalence, Risk Factors,
      Costs, and Selected Populations. New York Department of Health, Bureau of Chronic
      Disease Epidemiology and Surveillance, Bureau of Health Risk Reduction.
      http://www.health.state.ny.us/. Accessed October 20, 2006.

   7. Healthy People 2010 Goals. US Department of Health and Human Services. November
      2000. http://www.cdc.gov/nchs/about/otheract/hpdata2010/abouthp.htm . Accessed
      November 20, 2006.

   8. Monroe County Adult Health Survey Report 2000. Monroe County Health Department.
      April 2002. http://www.monroecounty.gov/health-index.php. Accessed November 20,
      2006.

   9. **162** “Automated External Defbrillator Awareness and Distribution Throughout the
      Rochester Community” CHIC block 3 2006




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.
                                                                           **161** page 13




Many parts of the abstract and background sections of this paper were taken from the paper
written by **162** with permission from Dr. Scott McIntosh the CHIC clerkship director.