1. DEFIBRILLATORS 1

2. 2 DEFIBRILLATORS Responding to Sudden Cardiac Arrest

3. DEFIBRILLATORS 3 All Other Cardiovascular Total Deaths: 945,800 Sudden Cardiac Arrest The Odds Annual Deaths from Cardiovascular Disease – U.S. 695,800 250,000 American Heart Association. Heart Disease and Stroke Statistics - 2003 Update. Dallas, TX.:American Heart Association;2002.

4. DEFIBRILLATORS 4 Common Causes of Death in the U.S. 1 http://www.americanheart.org 2 http://www.cancer.org 3 U.S. Statistical Abstract of the United States, 1998, Table 138. House Fires (1998 1 ) Prostate Cancer (2001 2 ) Breast Cancer (2001 2 ) Automobile Accidents (1996 3 ) Total SCA (annual 1 ) 118,495 43,300 40,800 31,500 2,895 250,000

5. DEFIBRILLATORS 5 680 patients per day (one every 2 to 3 minutes) 80% out-of-hospital 50% of men, 63% of women, have no prior symptoms 95% die without very early treatment < 5% survive The Stakes Annual Sudden Cardiac Arrest (SCA) Events – U.S. American Heart Association. Heart Disease and Stroke Statistics - 2003 Update. Dallas, TX.:American Heart Association;2002.

6. DEFIBRILLATORS 6 STEREOTYPE REALITY Male Old Overweight Smoker High cholesterol Chest Pain Dizziness Heart Attack Male and Female Any Age Often No Clear Risk Factors Often No Cardiac History Often No Symptoms Gender Age Risk Factors Medical History Presenting Symptoms SCA Fiction vs. Fact

7. DEFIBRILLATORS 7 Recovery prospects for survivors are high 80% alive at one year 57% alive at five years SCA deaths prevented annually* Total SCA Events: 250,000 The Benefits of Early Treatment of SCA 100,000 *estimated American Heart Association

8. DEFIBRILLATORS 8 The Heart Pump: a series of events... An electrical event … stimulates a mechanical event … which results in a rhythmic and coordinated pumping action of the heart muscle

9. DEFIBRILLATORS 9 Sudden Cardiac Arrest: A Heart in Distress Uncoordinated, very fast heart rhythm –Ventricular fibrillation (VF) –Some ventricular tachycardias (VT) Ineffective heart pump Unconscious, no breathing, no pulse Death certain without defibrillation

10. DEFIBRILLATORS 10 What Is Defibrillation? Electric shock to the heart Stops uncoordinated activity Allows coordinated heart rhythm and pumping action to resume Only effective treatment for ventricular fibrillation

11. DEFIBRILLATORS 11 Adapted from the American Heart Association Chain of Survival Defibrillation an EARLY priority

12. DEFIBRILLATORS 12 0 20 40 60 80 100 13579 10 30 50 70 90 08642 Chances of success are reduced 7% to 10% each minute Why “Early” Treatment? Time (minutes) % Success Cummins RO, et al. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC, Circulation (Suppl) 2001;102:8, August 22

13. DEFIBRILLATORS 13 Early CPR Very Early Defibrillation Early ACLS Early CPR Early Defibrillation No CPR Delayed Defibrillation minutes 246810 ? survive CPRALSDefibrillation 20% survive CPRDefibrillation 0 - 2% survive Defibrillation Early CPR Delayed Defibrillation 2 - 8% survive CPRDefibrillation Survival Rates

14. DEFIBRILLATORS 14 What Happens When You Call 911? *Travel time varies depending on weather, traffic, distance (vertical and horizontal), and ambulance (with defibrillator capability) availability. **Cummins RO, et.al. Automatic external defibrillators used by emergency medical technicians: a controlled clinical trial. JAMA. 1987; 257:1605-10 Identify emergency/ Activate emergency response plan30seconds 1911 callminute Alert ambulance and rescue squads (dispatch)30seconds Responders to their units30seconds 5minutes*Travel time to location Unload equipment/ Distance to patient2minutes Assess patient/ Apply defibrillator/ Deliver shock1.1minutes** TOTAL 10.6minutes Best Case Scenario

15. DEFIBRILLATORS 15 Low-maintenance Uniquely small, lightweight and rugged Safe, effective, and easier than CPR Designed for lay rescuer Expand lifesaving opportunities AEDs to the Rescue

16. DEFIBRILLATORS 16 HeartStart FR2+ Defibrillator OPERATION

17. DEFIBRILLATORS 17 Verify SCA not breathing normallyunresponsive Assess ABCs

18. DEFIBRILLATORS 18 Using the HeartStart FR2+ 1 2 3 Turn on defibrillator. Apply pads to patient and plug in connector. Deliver the shock.

19. DEFIBRILLATORS 19 HeartStart OnSite Defibrillator OPERATION

20. DEFIBRILLATORS 20 Verify SCA not breathing normally unresponsive Assess the victim

21. DEFIBRILLATORS 21 Using the HeartStart OnSite 1 PULL green handle PLACE pads on chest PRESS shock button

22. DEFIBRILLATORS 22 Cannot make things worse HeartStart Defibrillators designed to shock only when needed Product indemnification policy Good Samaritan laws, AHA standard of care –Possible reverse liability What if the victim has a pulse and I can’t feel it? Can I hurt someone using the defibrillator? Is there legal liability?

23. DEFIBRILLATORS 23 What happens if I reverse the pads? Can I defibrillate a child? Can I defibrillate on water, snow, ice or metal? Analysis & therapy not affected by pad reversal OK to defibrillate on water surfaces and metal –Standard safety precautions Using HeartStart FR2 and OnSite Defibrillators is acceptable < 8 years old with Infant/Child pads

24. DEFIBRILLATORS 24 Early defibrillation programs have already demonstrated success by saving lives in a variety of environments Sudden Cardiac Arrest DOES Happen Las Vegas (Clark County), Nevada On-site Early Defibrillation Programs enhance 9-1-1 EMS systems… resulting in more lives saved Rapidly becoming a standard of care

25. DEFIBRILLATORS 25 The Ultimate Reward Jerome Fuentes Bob Adams Bridgette McDonald

26. DEFIBRILLATORS 26 AHA Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Textbook. “Public Access Defibrillation has the potential to be the single greatest advancement in the treatment of prehospital SCA death since the development of CPR.” Something to think about