To Save Lives, Let's Listen to Damar Hamlin

Ah, America: "The land of opportunity," except when it comes to rescuing our fellow humans from sudden cardiac death.

Despite having just celebrated our 60th February as Heart Month, we still largely squander that opportunity. Every year, more than 350,000 individuals in the United States experience a heart rhythm that is fatal without immediate treatment. A recent US-based study found that 50% of adults who had a cardiac arrest at a recreational facility have a shockable and potentially treatable rhythm but that less than 20% received a shock. In this study, using an automated external defibrillator (AED) conferred a 30% chance of survival to discharge from hospital.

Physician Oversight: A Costly Barrier

According to data from AEDLeader, nine states still require a physician to oversee AED training, education, and maintenance at a cost of up to $3000 annually. In my home state of Kentucky, House Bill 22 aims to remove the physician oversight requirement for the state. It leaves intact the protections covered by the Good Samaritan law that limits liability for those who voluntarily perform cardiopulmonary resuscitation (CPR) or use an AED in an emergency. The price tag for physician oversight caused at least one Kentucky business to closet their AED despite being 13 miles from the nearest hospital.

House Bill 22 passed the Kentucky House vote unopposed and is awaiting assignment to a Senate Committee; the Senate will surely agree that having an AED onsite with step-by-step instructions is better than having no device at all.

Even if these constraints are removed, will more people use AEDs on their dying fellow humans? In the recreational facility study above, there was no difference in AED use between states with or without mandates for AED availability. Removing barriers to AED access is a start, but we need more to ensure higher rates of AED use and CPR delivery.

Just over 40% of the US population who experience out-of-hospital cardiac arrest (OHCA) are fortunate enough to get CPR. In a 2019 survey of more than 600 adults about to take CPR training in Florida, less than 65% of respondents were extremely likely or moderately likely to initiate CPR; fear of "causing injury to patient" was their greatest concern.

Contrast these findings with Sweden, where up to 82% of people who suffered OHCA received CPR in 2020, an increase from 31% in 1990. Swedish efforts to improve access to resuscitation included the introduction of the SMS Lifesavers app in Stockholm County. In this program, a text is sent to CPR-trained volunteers when a sudden cardiac arrest (SCA) occurs in their vicinity and directs them to the nearest defibrillator.

Perhaps the most effective intervention is the development of a detailed curriculum for first aid and CPR education in Swedish schools. Children receive first aid training from elementary school to high school. In middle school, students aged 13-15 years are taught CPR and how to use AEDs. In the United States, almost all states have enacted CPR training as a requirement for high school graduation. What if middle school aged children were included, and we also opened training to parents and other family members?

Damar Hamlin and the AHA

The American Heart Association (AHA) rolled up its sleeves to improve SCA survival rates. Last year, they launched the Nation of Lifesavers campaign with Damar Hamlin, the Buffalo Bills safety and an SCA survivor. Hamlin is urging people to learn CPR with a goal to double SCA survival rates by 2030. The campaign includes advocating for federal policy change to increase access to AEDs. The AHA are "currently working in more than 40 states to pass policies to ensure school facilities have cardiac emergency response plans in place," a spokesperson shared with me by email. They recommend that businesses purchase only US Food and Drug Administration–approved devices "as one prerequisite, instead of medical supervision."

One important piece of AED legislation in the works is Senate Bill 1024, called the Access to AEDs Act, introduced by Senator Corey Booker (D-NJ) and others. It would award grants to local K-12 schools to provide CPR and AED training, purchase AEDs, and create cardiac emergency response plans. Two years have passed since the bill was referred to the subcommittee on health; that legislative complacency will continue to cost lives.

"For schools that have AEDs, the survival rate for the children from sudden cardiac arrest is seven times higher," Damar Hamlin told Capitol Hill at an event to publicize the Access to AEDs Act.

How a Soap Opera Saved a Life

My brother suffered a different medical emergency but is living proof that education works. When we were teens, his airway was suddenly and completed occluded by a piece of sausage. With literally minutes to make a difference, I did what I had seen Tom Cudahy do to his love interest, Brooke English, on an episode of the soap opera All My Children. After three attempts at the Heimlich maneuver, the sausage popped out of Shane's trachea and flew across the room. We were miles away from a hospital; my brother would likely be dead were it not for that television learning opportunity. None of my family has ever forgotten.

We need more screen-based education, like the videos Hamlin has done with the AHA. We also need Dunkin'–Ben Affleck moments for CPR and AED use. If one celebrity can drive donut and track suit sales through the roof within 24 hours of a Super Bowl commercial, we can do the same with hard driving TikTok, Facebook, and Instagram campaigns. We need to get the attention of those who don't follow sports. I found a snappy video on YouTube; a rap like this performed by Megan Thee Stallion may appeal to some or a version with a country twang may work for others. We must alleviate concerns about injuring someone during CPR by educating bystanders that the absence of a pulse is uniformly fatal if not addressed. And finally, we need philanthropists to sponsor television and radio ads. These are still powerful advocacy forums for those who are not on social media.

Ah, America! Let us make it the land of opportunity for all who succumb to SCA. Let's aim for a nationwide CPR rate similar to Sweden's. Unfortunately, we're more likely to pull out a smart phone and record the circumstances surrounding a sudden death than to call 911 or render aid. But we have the power to change that. Legislating and talking about CPR and AEDs is important, but we also need to be sure that people are listening.

Melissa Walton-Shirley, MD, is a native Kentuckian who retired from full-time invasive cardiology. She enjoys locums work in Montana and is a champion of physician rights and patient safety. In addition to opinion writing, she enjoys spending time with her husband and daughters, and sidelines as a backing vocalist for local rock bands. Her Heartfelt column was the 2022 northeast regional gold and national silver Azbee award winner.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.