July 14th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
Tags: AARP, Caregiving, Hospitals, News, Podcast, Technology, Weight Loss
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I had the chance to speak with John Rother, Executive Vice President of Policy and Strategy for the AARP about the intersection of online health, information technology (IT), and the baby boomer generation. Find out what America’s most powerful boomer organization thinks about the future of healthcare in this country.
*Listen to the podcast*
Dr. Val: Recent studies suggest that Americans age 50 and older are more Internet savvy than ever before. How are AARP members using the Internet to manage their health?
Rother: People over the age of 50 are the fastest growing set of online users, and healthcare is the major reason why they’re going online. They’re looking for health related news, help with diagnosis, and finding appropriate healthcare providers.
Dr. Val: What role can online community play in encouraging people to engage in healthy lifestyles that may prevent chronic disease?
Rother: Our experience is that online communities can be extremely helpful in several ways. First, it provides emotional support for people who have a shared experience, whether it’s as a caregiver, or being recently diagnosed with a disease or condition. Second, people seem to feel more comfortable asking questions of others with their condition than they do their own physicians. And third, online communities can reinforce needed behavior change. Whether it’s weight loss, exercise, or quitting smoking – online communities can be just as effective in encouraging behavior change as a face-to-face community.
Dr. Val: Tell me a little bit about the communities on the AARP website.
Rother: Currently our communities are organized around medical topics, but in the future I think the communities will become more geographical. An online community designed to serve the needs of people in a given location can facilitate information sharing about how to navigate a particular hospital system, for example, instead of just general information about coping with a disease or condition.
Dr. Val: Intel just announced that it has FDA approval for its “Intel Health Guide.” The unit enables caregivers to provide their patients with more-personalized care at home, while also empowering patients to take a more-active role in their own care. What do you think of this technology?
Rother: I think information technology is going to have all kinds of beneficial applications for people with health challenges. Personal health records and this Intel Health Guide are very well suited to the needs of individuals with chronic health conditions, and I expect to see more Internet based tools developed to help people to make appropriate decisions and change their behavior.
General information is helpful, but personalized information is the key. The more these technologies allow you to have your own individual information at your fingertips and allow that to be the basis for recommendations and decision support, the more powerful it’s going to be. This is all very promising technology – the next question is, can people afford it and will the people who need it be able to use it?
Dr. Val: In your opinion, what role does health IT have in reducing healthcare costs and improving access to care?
Rother: Health IT can support almost every aspect of healthcare. It can decrease costs by reducing duplication. Many people with chronic conditions see different doctors – and if you have to go through the same set of X-rays or CT scans every time you see a different doctor, that can get very expensive. A good, common medical record system is critical in reducing costs and improving care.
IT can also reduce the cost of health insurance, in the way that online car insurance has reduced car insurance premiums. If we reform our health insurance market, this could offer substantial savings to individuals.
People often use the Emergency Department inappropriately – for minor issues instead of true emergencies. A good decision support system that helps people to figure out when they need to go the ER could be helpful in reducing costs.
Dr. Val: What are the AARP’s major health-oriented initiatives?
Rother: The AARP is very focused on healthcare because our members tell us that it’s their top priority. The cost, quality, safety and accessibility of healthcare are important to us, so we are involved in a broad spectrum of initiatives.
First of all, extending coverage to all Americans, regardless of their age or health condition, is a top priority for the AARP. Second, In terms of health quality, it varies quite broadly among hospitals in the US. If we could get everyone to copy the best hospital practices, we’d have a much more manageable problem.
Dr. Val: What needs to happen to America’s healthcare system in order for it to serve the needs of baby boomers on its limited budget?
Rother: We spend almost 2.5 trillion dollars for healthcare in the United States, so I don’t think of it as a limited budget, but quite an expansive budget. There is enough money in the system to fully respond to the needs of the population. It’s just that we’re not organized very well and the system has become fragmented.
The healthcare system needs to be organized in a more person-centered way, and we need it to shift from a focus on acute care to a chronic care model. We need a different system of health delivery – one that relies more on nurses and other physician extenders. People need to join support groups to modify their behaviors and risk factors and rely on IT to help them make appropriate decisions.
So you put that all together and you have a pretty big agenda for change. I don’t know if we can achieve this all at once, or if it will occupy us for several years. The upcoming election gives us the opportunity to do this at the Federal level, though there are many private sector initiatives that are currently making important contributions.
Dr. Val: Can you give me an example of someone in the private sector who’s making an important contribution to improving healthcare?
Rother: The AARP just met with the leadership of the Mayo Clinic, one of the most outstanding medical institutions in the country. They provide excellent care at a cost that is less than most other parts of the healthcare system – and with improved outcomes. We asked them about their secret to success.
Mayo has an electronic medical record and all their patients have their information online. The physicians are on salary, so there’s no incentive to order unnecessary tests or procedures, and Mayo has an ethic of patient-centered care, with a long history of attracting the best people and rewarding them.
If Mayo can do it, why can’t everyone else? The AARP believes that the potential is there for most communities to have excellent care – we must emulate the care delivery of institutions like the Mayo Clinic, and put in place payment and information systems that will coordinate care management better. It’s a big job and will take some investment, but we have many opportunities to do a better job than we’re doing today.
*Listen to the podcast*
*Learn more about preventing chronic disease*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 9th, 2008 by Dr. Val Jones in Celebrity Interviews, Expert Interviews
Tags: Allergy And Immunology, Asthma, News, Olympics, Pediatrics, Podcast, Research
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I had the pleasure of interviewing Jeanette Bolden, US women’s track and field coach for the Beijing Olympics, about her life-long struggle with asthma and her thoughts on the upcoming Olympics. We were joined by her physician, Dr. Bobby Lanier, on a fascinating call about how the environment in Beijing might affect Olympic athletes and visitors to China.
*Listen to the podcast*
Dr. Val: What was it like growing up with severe asthma? How did you cope?
Bolden: I’ve had asthma all my life, and unfortunately, when I was young my mom used the Emergency Department as the primary source of treatment for my asthma. So I was in and out of the emergency room all the time and my asthma was really out of control. Things got so bad that I was actually sent to a home for asthmatic children, where I had to live for 9 months – away from my family. I did learn how to manage my asthma with the help of the people at the home, and learned to be much less afraid of it.
However, I had problems with other kids picking on me because of my illness. I used to carry my inhaler in my sock and one time it fell out and a boy picked it up and started spraying it all over the place and shouting “asthma face” and “spasma girl” and he would tell others not to play with “asthma girl.”
Dr. Val: What got you interested in track and field? Did anyone discourage you from athletics because of your asthma?
Bolden: When I returned from the home for asthmatic children, I was a pretty normal kid – and I liked to run and play outdoors. One day I was with my younger sister at a park and we met a local track and field coach – so I asked if I could join his team. I told him that I had asthma and was worried that he wouldn’t want me on the team. However, he really surprised me and simply said, “If it doesn’t bother you, it doesn’t bother me.”
Although my dad was worried about me running and having a potential asthma attack, my mom always encouraged me to do my best and not let it hinder me.
Once I started winning races, my asthma became more acceptable. I don’t think I would have accomplished as much in my career if I didn’t have asthma – because it drove me to strive harder to prove myself to others and to show those kids who picked on me that nothing would stop me from excelling.
Dr. Val: How did you manage your asthma when you were at the 1984 Olympics?
Bolden: I had to submit a letter to the United States Olympic committee about my asthma, along with a note from my doctor about the medications I was taking. I always kept my inhaler nearby (though not necessarily in my sock) and tried to stay away from things that I was allergic to.
Dr. Val: What was the turning point for you – to get your asthma under control?
Bolden: My doctors always told me that I’d outgrow my asthma. I’m now 48 years old and still have it. And it wasn’t until lately that I understood that I have a specific type of asthma, called allergic asthma, which responds really well to a new medicine called Xolair (omalizumab). That medicine has made a real difference for me.
Dr. Val: Dr. Lanier, can you explain a little bit about monoclonal antibodies and how they’re now being used to reduce asthma symptoms?
Dr. Lanier: We’ve had effective medicines for the treatment of asthma for a long time, but a lot of them rely on inhaled steroids, which are not healthy for people (especially women) to take long term. So research has focused on getting to the root cause of asthma. About 60% of people who have asthma also have allergies – and we refer to this as “allergic asthma.” Allergies are caused primarily by a certain type of antibody in the blood stream known as IgE (immunoglobulin E). The “Holy Grail” of asthma treatment is to find a way to selectively cripple IgE without affecting the rest of the body.
Xolair is a targeted therapy that sticks to IgE and removes it from the body. It’s like taking away the fuel for the allergic process and this dramatically helps some people.
Dr. Val: Are there any risks associated with Xolair?
Dr. Lanier: There have been reports of people having an allergic reaction to Xolair, but I’ve never seen a patient with this problem, and I’ve treated hundreds of people with the medication. However, I’m always careful to watch out for a potential reaction. In my opinion the risks associated with Xolair are lower than those of standard therapy (steroids) – and when you’re removing IgE from the system, you’re really attacking the disease at its root.
Dr. Val: Jeanette, how did you become the coach of the 2008 women’s track and field team?
Bolden: I was voted to be the coach by my peers in track and field. There are criteria that they use for the selection process, and eligible candidates must have 1) been an Olympian 2) been a coach for a number of years 3) coached Olympians. There is an Olympic coach committee that handles the selection process and I’m pleased that they chose me. My commitment lasts three years and is over on the last day of the Olympics, 2008.
Dr. Val: What is the “asthma on track” program?
Bolden: It’s a fantastic online resource for people to learn more about allergic asthma, IgE testing, and how to find a specialist who can help. People can also learn more about my story on the website. I think education is really important because it’s the only way to free yourself from the fear of an asthma attack. My hope is that this website will teach people with allergic asthma that they don’t have to sit on the sidelines and watch life pass them by. The proper treatment program can put people back in control of their lives so they can train to become Olympians if they want to. And for me, the proper therapy has allowed me to enjoy having my dog live in the house with me for the first time. This makes both of us really happy.
Dr. Val: Do any of this year’s US women’s track and field team members have asthma?
Bolden: Asthma is the leading cause of absenteeism among school age kids. I’m sure that there will be individuals who make the team and also have asthma.
Dr. Val: Tell me about the environmental conditions in Beijing – what are you worried about as a coach?
Bolden: We’ve all heard about the pollution problem – though the Chinese government has scheduled factory and industrial shut downs many months prior to the Olympics. I really think that the main issues are the heat and the humidity, though. And since the Olympic trials are being held in Eugene, Oregon – where it’s been really hot and humid – the athletes will be well-prepared for Beijing.
Dr. Val: Dr. Lanier – as a physician, what are your concerns about environmental risks to Olympians in Beijing this summer?
Dr. Lanier: I don’t think the environmental risks are going to be as great as some think. If you look at historical paintings of Beijing dating back hundreds of years, you’ll always see a foggy cloud around it. That’s just the microclimate of that area of the world. However, there has been significant construction in the area recently – half the steel in the world went to China last year and a lot of that went to Beijing.
I’ve been going to Beijing multiple times a year for 10-15 years now, and although the construction effort has been extensive, I think that with the steps that the Chinese government is taking to improve air quality will make a big difference. It’s also interesting that the incidence of asthma in China overall is much lower than it is in the United States.
Dr. Val: Are visitors with allergic asthma at risk of having flare ups in Beijing?
Dr. Lanier: I think they actually have a lower risk than they would inside the United States. Allergic reactions are a defensive response from the body, and ordinarily that requires that you’ve had a prior exposure to the allergen. People going to Beijing for the first time have never been exposed to their native pollens, so I think the allergic asthma issues will be greatly reduced.
However the heat and humidity, exercise-induced asthma, and upper respiratory tract infections (that come from large crowds of people being in close contact) could all be problematic in Beijing.
Dr. Val: What general medical advice do you have for people traveling to Beijing?
Dr. Lanier: The most important thing for travelers (no matter where they’re flying) is to carry their medications with them in their carry-on luggage. Don’t take your pills out of their original bottles, because you may need the exact prescription labels. That way, even if your luggage is lost, you won’t miss any doses of medicine.
There are some vaccines that are recommended for people traveling to China, so people should check with their doctors before they go.
As far as food is concerned, I think that people will be pleasantly surprised by the variety and quality of food available. Food borne illnesses like salmonella are not common in Beijing, but I can’t speak for the surrounding countryside. Of course, it’s always wise to drink bottled water and not eat unwashed foods that may have been handled by many individuals – like grapes for example.
Dr. Val: Do you have any final thoughts about Beijing?
Bolden: I’m looking forward to a fantastic Olympic games. We have so many wonderful Olympic athletes this year – I just know it’s going to be great.
***
Jeanette Bolden is the head coach of the 2008 U.S. Olympic Women’s Track & Field team and the head coach at UCLA, her alma mater. At the 1984 Los Angeles Olympics, she won gold in the sprint relay despite a life-long struggle with asthma. Jeanette is preparing her team of athletes to compete in Beijing this summer – a city known for its asthma-inducing pollution.
Dr. Bobby Lanier, is a Clinical Professor in the Department of Pediatrics & Immunology at North Texas University Health Science Center and a Clinical Professor of Allergy and Immunology at Peking Union Medical College in Beijing. As a former NBC reporter, Dr. Lanier produced and appeared in over 5000 daily nationally syndicated broadcast radio and television segments. He is currently working on a book entitled The New Epidemic: A Patient Survival Guide to Asthma.
*Listen to the podcast*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 8th, 2008 by Dr. Val Jones in Expert Interviews
Tags: News, Podcast, Psychiatry, PTSD, Relationships
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With the recent news about the high prevalence of Post Traumatic Stress Disorder (PTSD) in military veterans returning from Iraq and Afghanistan, I decided to interview Revolution Health’s expert psychiatrist, Dr. Ned Hallowell, to find out more about PTSD and what to do about it.
*Listen To The Podcast*
Dr. Val: What is post traumatic stress disorder (PTSD)?
Dr. Hallowell: As the name implies, it is the response a person has to any traumatic experience or event. The brain really changes in response to trauma, and people can be quite crippled by it. Some will actively avoid people and situations that remind them of the event, others experience “triggers” that set them off into a panicky or dissociated state. PTSD can cause “flashbacks” where people feel as if they’re right back at the scene of the incident, they may also have nightmares or problems with relationships, job function, substance abuse, major anxiety or depression and even suicide.
PTSD exists on a spectrum. You can get fired from your job and experience mild trauma, but if the firing was really unfair and unexpected it can change you fundamentally for years to come. It isn’t the actual event that determines whether or not a person develops PTSD, it’s how you –given your particular neurochemistry and genetics – are able or not able to assimilate, accommodate, and deal with the traumatic event.
Dr. Val: How does a person know if they have PTSD?
Dr. Hallowell: If something terrible has happened to you and you’re not able to calm down, put things into perspective or get back to your old self – then you may have PTSD. Instead of getting your equilibrium back you’re rattled, anxious, and sleeping poorly. Fear builds on fear and you can even become afraid of life itself and begin withdrawing, avoiding, and shutting down, and self-medicating.
What you want to do is “name it” – in other words allow yourself to consider that you may have PTSD, and then get professional help. A mental health professional who specializes in PTSD is ideal. Dr. Bessel van der Kolk has written several excellent books on the subject.
It’s also worth noting that people can get vicarious PTSD. There have been cases where practitioners have developed PTSD simply by listening to accounts of trauma.
Dr. Val: Is early intervention important?
Dr. Hallowell: This is controversial. Some people believe that it’s important to talk about the event right away, but I’m of the belief that people should remain connected to others but not be required to talk about it until they’re ready. I could see someone after a mugging or car accident and never talk about the event – my role is just to create a “safe place” for them to be. Later on we might talk about it, or we might not. Discussing the details of a traumatic event can retraumatize you – and in a funny way you can develop a habit of reliving the trauma, almost the way that people become addicted to worry. However if the patient wants to talk about the trauma, that suggests to me that they need to – and I let them be the guide.
Dr. Val: What happens if PTSD is not treated?
Dr. Hallowell: It can wreak havoc on people. “Avoidance” as a lifestyle is very incapacitating. If you can’t go places and do things, you’re feeling anxious all the time, and having nightmares and flashbacks, you can’t enjoy life.
Dr. Val: Can PTSD be prevented? In the case of soldiers, for example, who are likely to experience horrible things in times of war – can they be mentally prepared for this kind of thing?
Dr. Hallowell: Part of what makes trauma traumatizing is that it’s unexpected. So it makes intuitive sense to me that if you’re prepared for what you’re going to see or experience that you will find it less traumatic when it happens. The surprise and lack of control are what’s overpowering about trauma. Having a plan (knowing what to do in case of a traumatic event) and knowing what to expect afterwards (and how to get help) will go a long way in reducing the damage of trauma. You can still be traumatized, however, even if you’re “ready” for it.
Dr. Val: Tell me a little bit about kids and PTSD. Do they express PTSD differently?
Dr. Hallowell: In children, the dissociative state is pretty common – they become vacant and unreachable. Sometimes the opposite happens and they are inconsolable, experiencing night terrors, crying, and temper tantrums. However, kids are remarkably resilient and I’ve seen play therapy work wonders for them after traumatic events.
For example, four-year-olds might sit on the floor and not talk to me at all about the trauma they’ve been through, and the next thing you know they’re reenacting the scene with their toys and dolls. They have no idea that they’re replaying the event this way (a form of “displacement”) – and may do it over and over again for a period of six weeks… and the next thing you know they’re over it. It’s remarkable. They use their imagination to heal themselves. It’s the greatest therapy in the world. No medication is used, and it’s a permanent fix. It’s almost like doing psychoanalysis at the point of the childhood trauma. When you’re 40 you try to relive these experiences in analysis to resolve the conflict – but as a child you’re actually doing the work near the time of the incident.
Dr. Val: What’s the most important thing for families to do for loved ones who have PTSD?
Dr. Hallowell: Connect with them. Understand them, listen to them, and don’t let them get isolated. Take their concerns seriously, and don’t judge them. Then find out what they need and get them to a mental health professional who understands PTSD.
*Listen To The Full Conversation Here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 3rd, 2008 by Dr. Val Jones in Expert Interviews
Tags: Disabilities, Parenting, Pediatrics, Physical Medicine And Rehabilitation, Technology
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If you or your friends or family have a disability, there’s no reason you can’t enjoy a vacation at Disney World. This post is a continuation of my interview with Bob Minnick, the Technical Director of Global Accessibility and Facility Safety at Walt Disney Parks and Resorts. He explained to me how Disney theme parks are committed to providing access to guests with disabilities. I’ve captured some highlights from our discussion here, and then summarized the services offered to guests with disabilities.
Dr. Val: Why is Disney so committed to universal access?
Minnick: Walt was all about guest service – he wanted the place to work for everybody, even guests who have unique needs. Our mantra is “guest service,” not “compliance.” We do things because it’s the right thing to do. For example, we were building wheelchair-accessible rides long before the ADA (Americans with Disabilities Act) became law. Also, we won’t patent a ride vehicle design because there are only so many ways to make rides accessible. If we invented a great idea and patented it, then nobody else could use it. Since we’re about creating access for everybody, we don’t mind if people use the idea or approach to improve the world we live in for people with disabilities.
Dr. Val: This must cost a lot – what’s the business case for it?
Minnick: I’m truly blessed to work for a company that “gets it.” We want to bring our guest service amenities to everybody. It’s the right thing to do, and it’s the Disney brand. For us, it’s worth the investment to give everyone the opportunity to experience the joy and magic of Disney parks. All the senses are stimulated at Disney – scents, sights, sounds, and touch and we want to enable as much of the sensory experience as we can for all our guests.
Dr. Val: Do any of your competitors go out of their way like you do to accommodate guests with disabilities?
Minnick: Many in the industry are doing a great job accommodating their Guests with disabilities. We have some unique services that many of them don’t offer. For example, the reason why we provide hearing and visual aids is that our rides are designed to tell a story. You can build an iron roller coaster to create a “motion” experience of being turned upside down and thrown about. But we tell a story with our rides and we want to bring that story to life for everybody.
Services for Guests with hearing disabilities
Sign language interpretation is provided at many shows, 2 days a week at all of the parks (except Animal Kingdom).
Assistive listening service (ALS): amplified audio and captioning technologies are bundled into a Blackberry-sized device that is free of charge and may be carried throughout the parks.
Services for Guests with visual disabilities
Audio Description: Visually impaired individuals can listen to a description of what’s happening on stage or in the shows in between the audio narrations. It is also equipped with a GPS module so that as the guest walks around the park, it offers a way of finding information and tells you where you are.
Braille is available on most park maps. There are Braille guide books available as well.
Services for the Guests with mobility disabilities
Seated parade viewing – special roadside sections exist for guests in wheelchairs so that they get a clear view of Disney parades without other guests standing in front of them.
Zero grade entrance to pools. Gentle slopes (rather than stairs) lead in to all water attractions. This facilitates wheelchair entry and is safe for young children.
Aquatic wheelchairs are provided as needed.
Accessible golf carts are available. They are designed to allow the seated rider to be raised up to standing level so they can swing a club more easily.
Special design features of rides. Many rides are designed so you can’t tell if a guest is in a wheelchair (this normalizes the experience, especially for kids). A special “spur track” feature takes the coaster car offline so that the guests with disabilities can take as long as they need to get in. Then the car rejoins the next line of coasters and enters the ride stream. Toy Story Mania is an innovative ride that provides an optional, closed-captioning service with a shooting mechanism designed for people who can push a button but can’t pull a trigger.
Practice vehicles are available just outside the entrance to various rides. Guests can practice transfers, and getting in and out of the ride vehicle before getting on the actual ride. They can even have pictures taken in the model vehicle.
General Services
Guest Assistance Cards are available to customize services to the needs of individual guests. Customized cards include requests for shade while waiting to enter a ride, the ability for parents to use strollers in lieu of wheelchairs for young children with disabilities, a front row seat pass, a pass to enter attractions via special entrances, and a green light pass for the Make-A-Wish Foundation participants.
Alternate entrances are available for all attractions so that guests with special needs may be ushered in discretely as needed. This design feature is particularly useful for guests with cognitive disabilities who cannot tolerate waiting in lines.
Dietary accommodations are made by Disney chefs trained to prepare food to accommodate special dietary needs.
Make-A-Wish Foundation is a partner of Disney’s. Children with terminal illnesses whose last wish is to go to Disney World are offered special accommodations and service, free of charge.
Emergency medical services are available at all theme parks in case a guest has an immediate medical need. EMS staff arrive within minutes of any distress call.
Bob Minnick summarizes it this way: “Walt Disney World is a place where everybody gets to be a kid. It levels the playing field for children with disabilities – even 60 year olds wear Goofy hats. Everyone’s having fun and acting funny, so it really normalizes the experience for guests with disabilities – because no one stands out or feels different from others.”
*For more information, visit the Disney guests with disabilities website.*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 2nd, 2008 by Dr. Val Jones in Celebrity Interviews, Expert Interviews
Tags: Cardiology, Health Tips, News, Parenting, Podcast, Research
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Would you know what to do if someone in your office collapsed in front of you and became unresponsive? Having a defibrillator handy could save their life – and it’s important for you to know how to use one. I interviewed Dr. Jon LaPook, Medical Correspondent for CBS Evening News with Katie Couric, to get his take. [Interesting factoid: Jon became passionate about cardiac defibrillators after a friend of his died while exercising at a gym in NYC. The health club did not have a defibrillator on site – which could have saved his friend’s life.]
*Listen to the podcast*
Dr. Val: What is a defibrillator?
Dr. LaPook: It’s a machine that can convert a life threatening heart rhythm (like ventricular tachycardia or ventricular fibrillation) back into a normal beating pattern. It uses a pulse of electricity to do this. These machines are potentially life-saving.
Dr. Val: Why is it important for offices to have them on hand?
Dr. LaPook: About 1.2 million people in the United States have a heart attack every year and 300,000 of those have “sudden death.” The reason why these people die is not because of the heart attack, but because of the irregular heart rhythm that accompanies it. When the heart isn’t beating in a coordinated fashion, it can’t pump blood effectively and people pass out and ultimately die if there’s no intervention.
If a defibrillator is used to administer a shock to the chest during one of these life threatening heart rhythms, there’s a much higer chance that the person’s life will be saved. For every minute of delay (from the time a person collapses) to receiving a shock to the chest, their chance of survival decreases by 7-10%. So it’s very important for people to get defibrillation quickly.
Dr. Val: How do you use a defibrillator?
Dr. LaPook: When you first see someone collapse and become unresponsive, all you have to do is get the defibrillator and press the “on” switch. It will talk you through the next steps. Remember that the first step is always to have someone call 911 so that EMS will be on its way while you continue CPR. Then you expose the victim’s chest so that you can apply two sticky pads, and the defibrillator will tell you where to put the pads. Then it will analyze the victim’s heart rhythm and decide if it requires a shock to get it beating in a coordinated way. If a shock is recommended, the machine will announce that and ask you to step away from the person. Once the shock has been received, it will then give you instructions for CPR (which includes chest compressions and rescue breaths) until EMS arrives or a pulse is able to be felt. If a person doesn’t require a shock, the machine will not give one – so there’s no risk of harm to the victim.
It’s important for people not to be intimidated about defibrillation because it’s really very simple and can save a life.
Dr. Val: What are a person’s chances of surviving a cardiac arrest?
Dr. LaPook: Nationally, your chances of survival (without intervention) are about 4-6%. If you receive CPR, your chances increase to 15% but with a defibrillator – especially if it’s used quickly – the chances are 40% or higher.
Dr. Val: What do you think about the new research suggesting that rescue breaths may not be as important for CPR as initially thought?
Dr. LaPook: I spoke to Dr. Rose Marie Robertson, who is the Chief Science Officer at the American Heart Association, and she said that in a “witnessed arrest” (when you actually see someone collapse) it doesn’t seem to make a {big} difference if you do rescue breathing (i.e. mouth-to-mouth resuscitation) or not. The reason they studied this is because one of the main reasons why people don’t perform CPR is the “ick” factor of mouth-to-mouth resuscitation. As it turns out, chest compressions alone are about as successful at saving lives as traditional CPR. However, if you’ve been trained to do the rescue breathing technique, you should definitely use it. The key to CPR is “hard and fast” chest compressions, about 100 compressions per minute. Whatever form of CPR you use, the key to success is using the defibrillator as soon as possible, ideally within several minutes.
Dr. Val: What should people working in an office environment know about first aid?
Dr. LaPook: The most important thing is for people to be trained in CPR, the Heimlich maneuver, and defibrillator use.
Dr. Val: Are there enough defibrillators out there nowadays?
Dr. LaPook: Not at all. At the very least, defibrillators should be in every single health club in America. I also think they should be installed in every office building and be widely available at schools.
A cardiologist friend of mine told me about some parents who lobbied for their daughter’s school to purchase a defibrillator. (They were in tune to cardiac issues in children because their daughter had an arhythmia called Wolff-Parkinson-White syndrome.) Two years after the school purchased the device, the girl – only 13 years old at the time – collapsed while walking past the nurse’s office at the school. The nurse saved her life with the very defibrillator that her parents fought so hard for. So defibrillators are incredibly important, and although they’re not inexpensive (about $1200), you really can’t put a price on life.
*Listen to the podcast*
*Check out Dr. LaPook’s defibrillator training video with Katie Couric*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
