In a Heartbeat
Distributor reps can educate dentists on the value of AEDs.
By Laura Thill
The timing couldn’t be better for a heart-to-heart with your dental customers on the value of AEDs. Today, most dentists probably know what an automated external defibrillator (AED) is. However, many do not comprehend the likelihood that they may one day have to use an AED to shock a patient in sudden cardiac arrest. Nor do they know that the American Heart Association recently changed AED guidelines to incorporate better use of chest compressions. The better educated the distributor rep is about the value of AEDs to his dental customers, the easier it can be to ensure that dentists use AEDs to their fullest potential when attempting to save a patient’s life.
Why AEDs?
Automated external defibrillators play an integral role in rescuing a victim of sudden cardiac arrest, or abnormal heart rhythms. In fact, AED programs have grown at an explosive rate over the last 10 years, according to Hank Constantine, marketing director, Zoll Medical Corp. (Chelmsford, Mass.). "There are about 750,000 public access AEDs out there today," he says. This includes AEDs in doctors’ offices, dental practices, ambulances, schools and other public areas.
Cardiac arrest is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC). Responsible for 465,000 deaths each year, it often occurs without warning. About two-thirds of these deaths occur in non-hospital settings. However, it’s hard to tell when — and whom — sudden cardiac arrest will next strike.
Not all cardiac arrest victims have diagnosed heart disease, although most heart diseases, as well as choking and trauma, can lead to cardiac arrest. Both men and women, heavy and thin, at any age, can succumb to sudden cardiac arrest. When the heart’s electrical impulses go haywire, the heartbeat becomes rapid (ventricular tachycardia) and chaotic (ventricular fibrillation). Ventricular tachycardia (VT) involves a racing heart and interferes with blood flow. Ventricular fibrillation (VF) involves an electrical seizure of the heart, also leading to the cessation of blood flow.
It takes only four to six minutes for cardiac arrest to lead to brain death or permanent death. In fact, a victim’s chance of survival decreases by seven to 10 percent with every passing minute, according to the American Heart Association (AHA). After five minutes, most victims of cardiac arrest have an asystolic heart rate, where the heart no longer attempts to pump blood, according to Constantine. Having an AED on site enables onlookers to quickly and effectively "shock" the
heart, restoring normal rhythm. And, cardiopulmonary resuscitation (CPR), which consists of mouth-to-mouth breathing and chest compressions, helps circulate oxygenated blood throughout the body. Together, the two procedures help ensure a victim’s chances of surviving sudden cardiac arrest.
What is an AED?
An automated external defibrillator is a small, battery-operated, portable device that delivers an electric shock to the heart to restore normal rhythm following a heart attack. Designed for use by lay people, the device detects and analyzes any existing heart rhythm and advises the user whether or not to shock the victim. From the time the operator turns on the AED and attaches electropads to the victim, the device provides step-by-step voice prompts, text instructions and graphics, directing him through the rescue process.
Today, more people than not are familiar with AEDs. "About 90 percent of dentists know what an AED is and that they should have one [at their practice]," says Ed Kennedy, national director, distribution, Cardiac Science Corp. (Bothell, Wa.). Whereas the expense of an AED at one time may have deterred dentists from purchasing one, in recent years, the price has decreased by half, from about $3,000 to $1,500 or $1,600 for a basic unit. More expensive devices, ranging in price from $3,200 to $4,200, are designed for physicians interested in studying waveforms or who prefer an AED that they can control on a manual mode.
The role of CPR
Sales reps should be aware of new developments regarding AEDs and cardiopulmonary resuscitation. Every five years, the American Heart Association, which sets industry standards for treatment and response protocols, revises its guidelines. The group’s most recent guideline update in 2005 set a new trend in motion: Today, there is a much greater emphasis on CPR in the rescue process. "Back in 2000, the guidelines [instructed AED users] not to try and take the victim’s pulse," recalls Constantine. "Lay people could make mistakes here."
But the AHA saw that cardiac arrest survival rates were not keeping pace with the influx of AEDs to the market. "The survival rate was only increasing [minimally] in spite of the push to make more AEDs [available]," he says. "The AHA concluded that CPR was the missing link."
Indeed, an automated external defibrillator, vital as it is to restoring normal heart rhythm following sudden cardiac arrest, cannot replace the need for CPR. "CPR is important because it helps supply (or circulate) oxygenated blood to vital organs in the body, including the heart," Constantine says. "So, the [rescuer] wants to do as much CPR both before and after [shocking the victim].
"Now we know we can’t shock [a victim] with an AED and leave it at that," he continues. "After sudden cardiac arrest, the heart distends, or fills with blood. The chemistry in the heart starts to wear down. After five minutes, the heart is so engorged in blood, even if [the rescuer] tries to shock it with an AED, it won’t help much. The most important thing is to move oxygenated blood throughout the body to the heart [from the start]."
The guidelines for administering CPR also have changed, he says. Previously, a rescuer was supposed to give 15 chest compressions, followed by two breaths, and he would repeat this pattern for one minute. Today, guidelines call for 30 chest compressions and two breaths, and the rescuer repeats this pattern for two minutes.
For distributor reps working with dentists, this means reeducating customers and helping them update their rescue equipment. Adrian Alvarez, marketing director, Welch Allyn Inc. (Skaneateles Falls, N.Y.) has seen a big need for reps to bring their dental customers up-to-speed. "[Dental] customers must be retrained [according to] the new AHA guidelines," he says. "In the past, the [rescue process] involved three shocks with the AED, followed by CPR. Now, after the first shock, the AED automatically moves into a two-minute period, during which CPR [should
be administered]. The idea is that, following chest compressions and breathing, consecutive shocks will be much more effective."
The new emphasis on CPR has impacted AED technology, notes Alvarez. "AEDs incorporate more prompting for CPR." For instance, Welch Allyn has added a CPR-prompting piece to the AED, which ensures that the chest is compressed (pushed down) at the correct rate. And, it instructs the user when to recoil, or pull up, from the victim’s chest. "There is tremendous value in incorporating CPR in [the rescue process]," he notes.
Today, distributor reps must show their dental customers that newer technology is "a much better fit," Alvarez continues. "More dentists now understand that purchasing an AED for their practice is the right thing to do. [In fact], we are seeing a trend where more dentists than doctors are [showing interest] in AEDs." This may be due to changing state legislation, he explains. "The state of Florida now has an AED mandate stating that dentists must have an AED in their office." Other states are expected to take Florida’s lead in the near future.
In addition, dentists are more aware of the risk different sedation drugs may pose to patients who are unaware that they are sensitive to them. "Some drugs — or drug combinations — increase the heart rate among some patients who are sensitive," says Alvarez. "Epinephrine is one example of such a drug. And, sometimes generic forms of drugs have a different mix of ingredients."
Liability
Dentists now tend to be more concerned over their role and liability in owning and using AEDs and knowing their equipment meets the most current AHA guidelines. When distributor reps approach their dental customers, they should begin by emphasizing the value of having a life-saving AED on site.
Given that it typically takes emergency personnel between eight and 10 minutes to respond to an incidence of sudden cardiac arrest, it is difficult to justify not having on AED on site, Kennedy says. In fact, the American Heart Association recommends spacing the devices in an office such that an operator can respond to a victim of cardiac arrest within three minutes. For this reason, it is critical to communicate the location of an AED to everyone who may have to use it.
Good Samaritan laws should reassure dentists that they are not at risk for using an AED on a patient. "There is virtually no liability [issue]," says Kennedy. "[In fact], there is more exposure for a dentist who doesn’t have an AED when one is needed." While liability may vary from one state to the next, it usually is the same as the liability of using other dental equipment, says Alvarez.
Particularly for dental offices, where patients range from young children to the elderly, automated external defibrillators can be one of a dentist’s most important tools. The technology is such that the same device can be used on any patient, from 8 years old and up. Patients under 7 years old require an AED with an energy-reducing solution to decrease the intensity of the shock.
"An AED is the cheapest insurance a dentist will ever buy," says Alvarez. "Distributor reps should ask their customers, ‘What is your cardiac emergency plan?’ They will be surprised at how many dentists don’t have one."
"This should open the door and engage the dentist in a conversation about AEDs," he points out. Dentists must contend with a broad patient population, and they don’t always know their cardiac background or drug sensitivity. These are key points for distributor reps to bring up.
Time is one of the most critical factors where sudden cardiac arrest is concerned. It is essential for dentists to purchase the right automated external defibrillator from a qualified rep they trust. [FI]
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