Ordinary citizens can play a life saving role in medical emergencies that occur outside of a medical setting.  The Heimlich maneuver is a prime example.

The Heimlich Maneuver

The occasion for this intervention arises when the airway of an individual becomes blocked from a foreign body such as a poorly chewed piece of meat.  The victim displays extreme distress without being able to speak, as no air can flow through the vocal cords.  The would-be rescuer positions himself or herself behind the afflicted individual, puts one fist in the palm of the other, places the hands in the upper abdomen below the rib cage, and applies upwards abdominal thrusts.  When effective, the action compresses the lungs, producing air pressure that dislodges the offending foreign body.  The breathing is restored instantaneously.

One study showed a 46.6 percent success rate for abdominal thrusts in patients with “foreign body airways obstruction.”  The success group had a lower proportion of impaired consciousness and cardiopulmonary arrest than the failure group.

Bystander Cardiopulmonary Resuscitation (CPR)

About 350,000 people in the US suffer a cardiac arrest outside of a medical care setting per year.  Cardiac arrest means that the heart suddenly stops beating altogether.  According to a study presented at an American Heart Association’s Resuscitation Science Symposium, compared to receiving no bystander CPR, those who got CPR within two minutes of the arrest had an 81% chance of survival.  Even intervention up to 10 minutes can be successful, but every second counts positively for a good outcome.

In-hospital success rates are about 15 percent, as defined by successful discharge of the patient.  I find the difference between the success rates of out-of-hospital and in-hospital resuscitations hard to believe.  I suspect that out-of-hospital “success” rates are inflated by the fact many victims did not truly suffer cardiac arrests–more likely a common faint.

Automatic External Defibrillators

These devices are designed to deliver an electrical shock to the chest of a victim of a cardiac arrest from a malignant heart rhythm (e.g., ventricular fibrillation, which finds the heart beating wildly and ineffectively).  The would-be rescuer activates the AED, which gives clear instructions on its use (detailed information is available at redcross.org).  This does not work in asystole (when the heart stops beating altogether), but, when application of the shock is successful, the heart beat returns to normal.  

One study concluded that public AEDs are a cost-effective public health intervention in the United States, given that the AED strategy yielded one “QALY” (Quality-Adjusted Life Year–a year gained in good health from a specific intervention) for an investment of $53,797.  This paper was thin on details, however–it did not specify the location of the AEDs analyzed.  For instance, placing an AED in a gym on senior day would yield a much different analysis than placing one, say, in a high school class.

Another study looked specifically at the cost-effectiveness of home placement of AEDs.  Surveying 582, 536 patients over the course of seven years, investigators found that survival after an arrest was better with AED application compared with no AED application.  However, the cost to gain one QALY was $4, 481, 659. Researchers concluded that, if the overall expenditure for one QALY was less than $200,000, and if the incidence of cardiac arrest per person is greater than 1.3 percent per year, and the cost for each device is less than $65, placement of AEDs in home would be a reasonable and cost-effective intervention.  Each AED cost between $1,200 and $2,500.  Seems like we are a long way from a policy to place AEDs in every home.

Regardless, If the AED is available in an emergency, you don’t need to trouble yourself about the cost.  Use it!  It won’t hurt the patient and you may save a life.