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‘If you’re going to have a heart attack, Naperville is a pretty good place to do it’

by Liz Hoffman
Jan 31, 2009


City of Naperville

Naperville is a self-proclaimed heart-healthy community and is backing that claim with a progressive city program to increase the number of AEDs and the number of people trained to use them.

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New state law brings AEDs to more places, but has its roots in seven-year-old tragedy

What can other communities learn?

Rochester and Seattle have been the gold standards of emergency cardiac care for almost two decades, dwarfing national survival rates.

Dr. Roger White, medical director for the Rochester police and head of the city’s AED program, and Dr. Mickey Eisenberg, medical director for King County’s emergency medical services, shared their best strategies.

Stock up: Rochester started with AEDS in every police car and fire truck. Then they went in shopping malls, schools, health clubs – “anywhere a lot of people might be,” White said. Some of that was mandated by Minnesota state law – and the same for Naperville and Seattle – but some of it was community initiative. “We realized we had a chance to be a test tube for all of this,” White said. “If it works here, that could have real ripple effects other places.”

Training is important: Naperville has trained more than 30,000 people in emergency care, said Vincent Bufalino, a cardiologist and head of the city’s heart-healthy initiative. While AEDs have consistently been proven safe for an untrained person to use, just knowing they are trained may make people more willing, and quicker, to act in an emergency situation.

Get everyone on board: Eisenberg said Seattle used a stick-and-carrot approach to encourage businesses and other public places to buy AEDs. “There’s a law you have to adhere to, but then the idea is that you can offer this incredible service, help the public. A little bit of both seems to be the best strategy.”

Keep track of your successes: White and Tom Rey, chief of King County’s public defibrillator program in Washington, have an editorial that was recently accepted by the Annals of Emergency Medicine urging other counties to track and accurately report their statistics on cardiac arrest survival. “These devices can make a real difference, but if we don’t quantify it, no one will know, and then it makes it hard to convince people of their value.” 

Chris Knight was walking back to his Naperville hotel room on a Saturday morning last August when he felt something tighten in his chest.

Knight, a 56-year-old television executive from Amarillo, Texas, had none of the risk factors for cardiac arrest. He was in good shape, had no family history of heart disease and his last cholesterol test was in the low 150s.

But as he left the hotel restaurant to get ready for his nephew’s wedding, a massive blockage in his coronary artery cut off blood flow to his heart, which began to spasm out of control.

“They don’t call it sudden cardiac arrest for nothing,” he said. “I went down like a ton of bricks.”

Knight owes his life to an automated external defibrillator, a computerized device about the size of a desk phone that can deliver an electric shock to a failing heart and get it beating again. The hotel had one, and an off-duty Woodridge police officer trained in AED use was on the scene within minutes.

Knight was lucky. If his nephew had been getting married just about anywhere else in the country, odds are, Knight would be dead.

The national survival rate for sudden cardiac arrest – which occurs when a change in the heart’s rhythm causes it to stop pumping blood – is between 5 and 8 percent.

In Naperville, it is far higher, said Dr. Vincent Bufalino, CEO of the Naperville-based Midwest Heart Specialists and the head of the city’s defibrillation program. Bufalino said he is working with local hospitals and the coroner’s office to better track the data, but the numbers he’s seeing from cardiologists and emergency departments are good.

“If you’re going to have a heart attack, Naperville is a pretty good place to do it,” Bufalino said.

This statement highlights a grim and under-publicized fact of cardiac care: Where you are when your heart stops is often the difference between living and dying.

Disparities in emergency response time, available equipment, quality of local medical facilities – and, yes, how quickly CPR and AED are started – cause cardiac arrest survival rates to vary widely, from as low as 2 percent to more than 40 percent in some places, depending on the type of heart attack.

Ventricular fibrillation, the most common form of cardiac arrest, can be treated with a quick shock, like one from an AED. It has higher survival rates, between 10 and 20 percent, according to several studies. Overall cardiac arrest survival rates generally hover between 5 and 8 percent, experts said.

“Sometimes it’s hard to compare apples to apples, but there is a drastic gap,” said Dr. Roger White, medical director for the police department of Rochester, Minn.

Rochester is one of two gold standards of emergency cardiac care on the top end of that gap.

King County, Wash., which includes Seattle, is the other. Over the past two decades, the two have consistently reported survival rates of 30 to 40 percent for witnessed ventricular fibrillation – about three times the national average.

Why are some cities like Rochester, Seattle and, now, Naperville, able to consistently save patients in cardiac arrest while others are not?

This is “a complex question with a complex answer,” said Dr. Mickey Eisenberg, who heads Seattle’s program, but it starts with leadership.

“There’s no secret to what we do here,” said Eisenberg, medical director of King County’s emergency services. “It takes a kind of a collective will and requires initiative, whether it be from physicians or politicians or emergency medical personnel. Someone has to stand up and say ‘We can do better.’”

In Seattle and Rochester, that impetus came from doctors at the University of Washington and the Mayo Clinic, respectively, who approached receptive public officials. Police and fire departments were early partners and as the program gathered momentum, businesses and other public facilities jumped on board.

There are about 2,200 AEDs in King County and more than 180 in Rochester. More than half the population of King County has been trained in lifesaving skills over the years, Eisenberg said, and the University of Washington maintains two Web sites – one on CPR and one on AED – to give citizens a free refresher.

In Naperville, the spark came from Bufalino’s group about a decade ago.

Midwest Heart Specialists is the largest group of cardiologists in Illinois, and happens to have as a patient Naperville Mayor George Pradell, who signed on immediately, Bufalino said.

“It starts with one conversation,” Bufalino said. “Someone who gets it talking to someone who can do something about it.”

In the mid-1990s, emerging research was showing that rapid defibrillation – within two to three minutes of collapse – could drastically increase survival rates for cardiac arrest. The same technology that had been saving people in emergency rooms for decades was getting smaller, more portable and cheaper.

With the mayor’s support, he approached Edward Hospital with the idea to place AEDs in strategic public locations around Naperville. The hospital signed on and contributed $50,000, which Midwest Heart Specialists matched, and 50 AEDs went in rec centers, health clubs and shopping malls throughout the city.

There are now more than 200 AEDs around Naperville, with more coming over the next few months, officials said. Over the past seven years, more than 30,000 people – about a quarter of the city’s population – have been trained to use them, Bufalino said.

Bufalino said everyone he approached in Naperville was enthusiastic, but getting a city to buy into the idea is not always so easy.

King County has used a stick-and-carrot approach to great success, Eisenberg said. The stick: laws, like the one recently beefed up in Illinois, that require AEDs at certain places. The carrot: simple peer pressure.

“Laws certainly help get awareness out there, but I think there’s a growing sense among businesses that there’s a responsibility to have these devices,” Eisenberg said. “If you don’t have one, you’re really below the community standard. A little bit of both seems to be the best strategy.”

As the public AED model catches on in municipalities nationwide, Naperville’s program may serve as a template, Bufalino said. He is in talks with DuPage County’s health commissioner, Bob Schillerstrom, to take Naperville’s blueprint countywide.

“It used to be that [Rochester and Seattle] could do it and everyone else was kind of scratching their heads trying to figure out how,” Bufalino said. “We’ve shown that it’s not a mystery.”

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