Defibrillator failures: causes of problems and recommendations for improvement

Article Abstract:

The use of defibrillators to deliver an electrical shock during a resuscitation attempt is often essential to restart a failed heart or to restore a normal pattern of heart contraction. When a defibrillator fails, there are only two possible reasons: device failure and operator error. A recent working group of the United States Food and Drug Administration has reviewed data from both Medical Device Reporting System (MDR) and from a five-state survey. Federal law established in 1984 set up the MDR reporting system which mandates manufacturers and importers of medical devices to report any equipment failure leading to either a serious injury or death within 15 days of the incident. From these data, the working group concluded that the level of defibrillator failure is too high. In many cases, the source of the failure was not traced to the instrument, but to human error concerning care and maintenance of the device. All to often inadequate user training and the failure of personnel to understand the need for daily equipment check led to failure during a cardiac emergency. The group also found that defibrillators and specific replaceable components (e.g., batteries) were kept in service beyond their useful life expectancy. In smaller hospitals and clinics, appropriate service engineers were either in short supply or totally absence, leading to equipment deterioration. This paper presents the reasons for excessive defibrillator failure and suggestions for correcting this dangerous deficiency. (Consumer Summary produced by Reliance Medical Information, Inc.)

Safety and security measures, Product defects and recalls, Medical equipment, Maintenance and repair, Defibrillators

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Frequency and types of medical emergencies among commercial air travelers

Article Abstract:

To assess the types of medical emergencies that happen to air travelers and to examine whether trained medical staff will be available to assist them, a review of the emergency medical services at an international airport was undertaken. During the course of one year, 1,207 people were seen by the emergency clinic, of which 754 were travelers. Of these, only 25 percent of the complaints occurred during flight; for seven of these travelers the flight was diverted so that emergency service could be rendered. The staff of the emergency center was composed of certified emergency medical technicians. The most frequent complaints were gastrointestinal (nausea, vomiting, diarrhea and abdominal pain), respiratory (asthma and chronic obstructive lung diseases), cardiac, and fainting and seizures. Trauma was responsible for 25 percent of all emergency calls, but for only 14 percent of in-aircraft emergencies. Eight in-flight burns were all related to meal service and involved four flight attendants and four passengers. During the survey period, there were five heart attacks among travelers, but only one of these occurred aboard an airplane. From the perspective of a single traveler, the likelihood of a medical emergency in-flight is exceedingly small. The majority of complaints were successfully handled by the emergency medical technicians, and in only 16 percent of cases was a paramedic requested.

Physiological aspects, Statistics, Surveys, Civil aviation, Air travel, Flight, Medical emergencies, Aviation medicine

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Infection control guidelines for CPR providers

Article Abstract:

In the November 17, 1989 issue of The Journal of the American Medical Association, the Emergency Cardiac Care Committee of the American Heart Association (AHA) issued a position statement regarding infection control for those who administer cardiopulmonary resuscitation (CPR). One of the major concerns of people who administer CPR is the exchange of saliva that takes place during mouth-to-mouth resuscitation. There is no documented evidence that it is possible to transmit hepatitis B virus (HBV) or human immunodeficiency virus (HIV) by means of saliva. More than 70 percent of cardiac arrests occur at home, and most CPR performed by a lay person is administered to a friend or relative. CPR training will most likely equip a rescuer to perform CPR on someone he or she knows, not a stranger. Exposure to blood is the only means of transmitting these diseases during in CPR, and the risk is low. HBV, not HIV, poses the greatest threat of infection to those giving CPR. The AHA position statement should eliminate the fear of infection surrounding CPR use and training. Medical journal advertisements for protective gadgets have raised unnecessary fears of disease transmission during CPR. The AHA position statement reminds emergency personnel that they have 'a moral and ethical and, in certain situations, a legal obligation to provide CPR.'

Standards, Prevention, HIV (Viruses), HIV, Hepatitis B, CPR (First aid), Cardiopulmonary resuscitation, American Heart Association, editorial

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