Cardiac Arrest in Peoria in the 90s

When a person suffers a cardiac arrest, the person’s heart is usually not stopped...it is “fibrillating”. In other words, the lower chambers are beating so fast that they are not allowing the heart to fill and very little blood gets pumped to the body. No blood means no oxygen and this causes cellular death. 

The best way to convert this heart back to a normal beat is to shock (defibrillate) the heart as quickly as possible. For each minute that a heart is not shocked in this condition, there is a 10% chance that the patient will not survive. Medical personnel have been shocking people back to life for decades. It is the only single modality that has been too shown to save lives in the prehospital setting.

More than 350,000 adult Americans die each year of sudden cardiac arrest. The event is unpredictable and can occur in patients with no history of cardiac disease or cardiac symptoms. The necessary response is rapid application of electrical shock.

In 1991, the Emergency Cardiac Care Committee of the American Heart Association concluded that…”all emergency personnel should be trained and permitted to operate an appropriately maintained defibrillator if their professional activities require that they respond to persons experiencing cardiac arrest.” AMT was shocking arrest victims in the 1990s; however, the PFD was unable to do this until they purchased their own defibrillators with the Foreign Firefighters Fund in 1996. Thus, they became a Basic-D unit. The Peoria Fire Department should have been permitted to shock victims of cardiac arrest for years and not have to wait for AMT to show up and administer the shock when the PFD was at the scene first.

Did the Project Medical Director, Dr. Hevesy, ask the PFD to acquire these units? Did he talk to the City of Peoria to purchase these units for the PFD? Did he ever say or do anything to obstruct the PFD from becoming a defibrillation unit? Was he trying to protect AMT as being the only pre-hospital service in Peoria that could shock the patient in a full cardiac arrest? Why was AMT shocking patients but the PFD was not? What did Dr. Hevesy think about the AHA’s conclusion established in 1991 derived from research from the previous decade?

I took care of many cardiac arrest victims in the ER at OSF for 13 years. Many were brain dead. Were they shocked soon enough in Peoria?

My comments in 2021--

• When the PFD acquired their defibrillation machines in 1996, in a political deal, they traded their efforts to advance from Basic to Intermediate Life Support for the ability to defibrillate patients. In other words, they stayed at a Basic level in order to be granted the ability to shock patients.

• I cannot make something like this up.

• As the years went by, the PFD advanced from Basic to Advanced Life Support for the people of Peoria. But it was a long and slow journey with many bumps in the road. 

• Prehospital cardiac care was first established in Belfast, Northern Ireland in 1966 and patients were being defibrillated on the streets for the first time. This was revolutionary and a radical break from existing practices. Medical providers were rushing to the patient in their homes to treat them in the early stages of their heart attack rather than the patient rushing to the hospital. (Archives of Internal Medicine--"The Revolution and Evolution of Prehospital Cardiac Care"--August 12/26, 1996)

• One of the most important parts of this "revolution" was shocking the fibrillating heart with the new defibrillators. This saved the lives of patients who had cardiac arrests. Their sudden death was often averted.

• The first prehospital care team started in the United States in 1968 in New York City out of St. Vincent's Hospital in Greenwich Village.

• Community members in Seattle were taught how to do effective CPR and combined with early defibrillation by newly formed paramedic teams, lives were being saved. 

• In 1968 the Seattle program received a 3-year-grant of $450,000 from the Washington/Alaska Regional Medical Program. The funding primarily paid the salaries for 15 firemen to be trained as paramedics. Salaries at that time were about $10,000 a year. With money from the grant, the fire department purchased a mobile unit which was a mobile home, and one of the deputy chiefs drove it from the Midwest back to Seattle. These firemen were taught ECG rhythm interpretation, defibrillation, emergency medication administration, and starting intravenous lines. By 1970, the newly formed firefighter-paramedics were being taught endotracheal intubation to protect the airway during cardiac arrest. Remember, the PFD firefighters in the mid--90s were being told to stay Basic and to "spray the white stuff on the red stuff" by our EMS leaders in Peoria.

• One of the first persons to be resuscitated in the Seattle program was a 17-year-old boy who probably had a form of cardiomyopathy. The boy was visiting his father's downtown office. After he had gone into the bathroom, somebody went in and found the boy unconscious. The newly formed paramedic unit was called and the boy was successfully defibrillated. It took 10 days for the boy to regain consciousness. he went on to make a full recovery and finished high school.

• During the first year of the paramedic program, the Seattle program successfully defibrillated 61 patients who were admitted to coronary care units, and 31 survived to leave the hospital. The Seattle program was the first program in the world to make citizens an active part of the emergency system. It was being realized that after cardiac arrest, the sooner CPR was started, the better the patient did.

• In 1980, EMTs in suburban Seattle were trained in the use of defibrillators and authorized to provide up to 3 shocks for patients in ventricular fibrillation. Survival went from 7% to 26% after the EMT defibrillation program began. Since then, defibrillation by EMTs has become the standard of care for prehospital EMS.

• Standard of care except in Peoria. The PFD finally obtained the ability to defibrillate the patient as noted above in 1996--16 years after this intervention was proven to save lives for the prehospital patient.

John A. Carroll, MD

www.haitianhearts.org