 Joining us is Dr. Jeremy Pollock, cardiologist at the University of Maryland, St. Joseph Medical Center. Dr. Pollock, thanks for visiting. Jeff, thanks for having me on. It's good to be back. We thought it was a good opportunity to talk about the importance of automatic external defibrillators in particular, and we have one here that we can demo in a second. But the bottom line is that these things work. They do. Yeah, AEDs, automatic external defibrillators, they save lives. We saw that on a national audience scale two weeks ago, but we see it every day in health care. These are the most important, one of the most important parts of the chain link of survival, to getting a person safely to a hospital alive. You have people in your practice who are walking around today because of one of those? Absolutely. I have more than a few, and fortunately, they were in a place that had an AED. You have to have one on location, which I'm sure you guys do here. Down the hall? We know the airport, for example, has them all over the place. Everywhere. They can be scary, right? You walk by that. It's that big box that says AED on it. You don't think that you're allowed to touch it, but what we all have to recognize, and what I would love the viewers to know, is this is something any of us can use, and it can be life-saving. So getting that to a person that is undergoing cardiac arrest in a timely fashion can be life-saving. Better if you've had the training course, but if you haven't and somebody collapses and there's an AED available, we'll walk you through it. Absolutely, right? So these devices are meant for a fifth grade level of education or greater. So most of us can use it. You do not need to be ACLS or BLS certified. You don't have to be a physician or an EMS provider. All you have to do is have the courage to take it off the wall and open it up. And we'll go through this. It's very simple. It talks you through what to do, and you can be the life-saver in these situations. Let's talk about the difference between a heart attack and cardiac arrest. I think that's a great question, and I think it's a very common misconception, right? What is a cardiac arrest and what is a heart attack? Those two things are related, but they don't typically aren't always caused by each other. So what's that mean? Every cardiac arrest is not caused by a heart attack, and every heart attack does not cause a cardiac arrest. So it's important to go back a step and ask, what is a cardiac arrest? So the heart, very simply, cardiologists like myself were plumbers, right? The heart is a pump. Its job is to pump blood forward. It has an electrical system, literally a wiring, no different than the wiring in this building that connects all the different chambers of the heart and tells it how and when to be. When that electrical system goes haywire, it can cause the heart to go into a lethal heart rhythm, and that simply means the heart is no longer pumping blood effectively to your brain. We think of it, the heart is being stopped cold, not doing anything, but in fact it's spinning its wheels, so to speak. That's exactly right, Jeff. So the technical medical term is ventricular tachycardia or ventricular fibrillation, and break the word down, ventricular, the ventricle, the bottom pumping chambers of the heart, tachycardia or fibrillation, fast. So it is still beating, but it's beating at 300 to 400 times a minute. So it's beating so fast it can no longer move blood forward. And usually within 6, 10, 20 seconds of not getting blood to your brain, that's when you suddenly lose consciousness. And that's what we see if you've ever witnessed this. This is somebody that suddenly drops down to the ground and loses consciousness and you cannot wake them up. That's cardiac arrest, and that's typically due to that electrical rhythm. Now, what's a heart attack, right? So a heart attack can cause cardiac arrest, but not always. A heart attack is the number one reason for cardiac arrest. We talked about the electrical wiring. Heart attacks are due to the plumbing or the piping in the heart. The heart's a muscle, no different than our bicep. It needs oxygen, it needs blood flow. So it provides blood flow to itself via three arteries, and they're no different than water pipes. And unfortunately for you and I, we don't control our age, right? So our pipes are as old as we are, and they look that way when we look inside of them. So we all have a little bit of crud as we get older in our pipes. And if that crud is unstable, it can suddenly explode and block off an artery. And that happens suddenly. And if there's enough muscle that's not getting oxygen, now we go back to the electrical wiring, that wiring stops functioning well. And you go into that ventricular tachycardia fibrillation. Let me remind our viewers if you have a question about CPR and defibrillation and cardiac arrest and heart attacks, give us a call at the number on the screen or send an email to livequestions at mpt.org. I was watching the football game two weeks ago and the thing they had, I mean if you're going to have cardiac arrest, best place would maybe be in your emergency department. But on this football field, there are trainers from both sides, there are MDs on both sides, there are EMS used to be an EMS guy, they had all the right people, all the right equipment. That's not generally how it happens. That's true. But with a lot of public policy and public health, American Heart Association, we have put in AEDs in most public places, your airport, your pool, your gym here in this building. So they are typically around where you are. And if you're in a public place and you can locate that AED, even with all that medical staff, they still recognized that this was a cardiac arrest. They got the AED to him or to whoever had a cardiac arrest and were able to get him out of that life threatening rhythm. So we say heart is time is muscle or time is brain. Once you have a cardiac arrest, your heart starts pumping blood, you have about six minutes. So once you get beyond that six minutes, the chance of having a good outcome walking out of the hospital alive starts to drastically go down. All right, here's the box. Somebody is having an emergency. You're a bystander. What do you do? Well, I mean, I'm going to bring the question back to you. You're trained, right? So we're here. We're here at 7.15 at night. One of your staff isn't feeling well and they go down right in front of us. I may be a good example of this because back in my lifeguarding days, which was many decades ago, I did all the Red Cross advanced lifesaving stuff, learned CPR, learned a version of it that maybe is a little bit outdated. And in the building here, when the AED arrived, we did a training program. I've forgotten most of it. I know the basics. I know the pads go here and here, right? So I guess we should do a qualifier, right? This is not an ACLS or BLS course, right? So this is just basic common sense knowledge. So you have an employee that goes down in front of you. The first thing is making sure they've lost consciousness, right? So you're tapping them and saying, Bob, Bob, are you up? If you can't wake the person up, there are two things that you, Jeff, can do right now that increases chance of making it out alive. Number one, activate the EMS system, right? So you're going to pick up your phone. You're going to call 911. I'm here at MPT, lost consciousness. I don't know what's going on. Send ambulance, right? Number one. Number two, you're going to ask somebody in the room, there's usually another person, go find the AED. So they're going to go to the wall and they're going to look at that. And the first thing you think is a bystander, especially if you don't have EMS training, is I'm not touching that thing. That looks very scary to me. And alarms definitely going to go off. Alarms are going off. It looks like that, right. But again, bring it over here and we can open it up, right? So I'm going to give it to you. You're going to open up the box and it, again, is for a fifth level education. So if we're able to read these things and it even talks to you, you turn the device on. There's the on button. And again, somebody's called 911. It's going to start talking to us. It gives you the first thing to do. So we're going to fly those pads next to flashing light. And sometimes you can have somebody helping. Sometimes you don't. There is a picture of where to put these. So you don't have to remember where to put them. So I'm going to put them on the chest. The location matters because you're shooting across where the heart is. Correct. So you're trying to get two different sides so the electricity crosses the heart very simply, right? So and then we're going to put these pads, the connector in. It knows that the connector is in. And now it's going to start analyzing this. So the first question we all have is, am I going to shock this person inappropriately? Am I going to give them electricity when they shouldn't? Do no harm. This computer can tell you whether or not you're supposed to. And now it's analyzed it and it says they need a shock. It's charging up. It's talking me through this. There's instructions right here. And it's going to tell you to shock. So what you're going to do is make sure I'm not touching, right? And you're going to say everybody clear. Clear. And then you can hit that. Shock delivered. And it'll deliver a shock. It just saved his life, right? And then it's going to talk you through CPR. And we're going to start CPR. Why would you start CPR after a successful defibrillation? Yeah. Again, so even if the defibrillation worked, right? In ACLS or BLS, you still need to provide about two minutes of effective CPR because that heart's not pumping well at that point. So in those situations, we usually do two minutes of CPR. Under the rare circumstance, they immediately wake up. They will tell you to stop doing CPR. They will, they grab your hand and tell you not to do it. But again, this looks and can sound scary, but it's very simple. So the two things you and the public can do when this happens, call 911. They will talk you through it when you get them on the phone. Get this device and open it. Don't be scared to follow these instructions. You will save a life. What's the role for CPR in the AED era? It used to be all we had. Yep. And that's a good question. That's is equally as important as an AED. So providing good blood flow to the different organs is extremely important. So being able to do high quality chest compressions is important. It's part of that chain link of survival. That's a little bit more nuanced. People are even more scared to put their hands on somebody and start pumping on their chest. That does require a little bit of training, but anyone can do it. We all can do CPR. There will be people talking you through that on the phone. But getting this device is really, really important. Phone call from Montgomery County. This is Richard. Richard, thank you for calling. Go ahead. For the average Joe, coming up on a situation on the street, say, how is one to tell the difference between cardiac arrest and a heart attack, and therefore maybe move forward with assistance? Thank you. Thank you. And that's Richard, right? Richard, that's a fantastic question. So number one, you on the street, right? You are not meant to recognize whether or not the person is having cardiac arrest or the reason for that cardiac arrest. None of us are going to expect that of you. What I want you, Jeff, to recognize is they have lost consciousness. So how are you going to tell that, right? You can't wake them up. They are on the ground. You are trying to wake them up either hitting them on the chest or moving them and you are getting no response. You have to consider if you can't wake them up and act like that's a cardiac arrest. So that's when you are calling 911, getting an AED if you have it. Whether or not the cardiac arrest is due to a heart attack is not relevant in that point in time. It is down the road 10 to 15 minutes later, but right now to save his life or her life, make sure that they are unconscious. Do you have to bother trying to check for a pulse before firing this thing off or that's the job of the AED? Yeah, exactly right. So checking for a pulse, I will tell you as a cardiologist in an emergent situation, it is not as easy as you think to feel a pulse. So if the person has lost consciousness, you treat it like a cardiac arrest and they train us too as medical professionals. Don't be trying to, do I feel that? Is that a pulse? Is that something I don't know? Is that my pulse? Is that my finger? I don't know. We are debating and meanwhile the heart is not working, right? Again, if they are awake and they are just kind of sleeping or they are not totally lost consciousness, if you start CPR on that person, they will wake up and tell you they are awake. So always go and err on the side of caution. Take away from this, based on what happened to Mr. Hamlin and his recovery, based on the technology now, the price points come way down. Somebody has an organization, they have a building of some kind, they don't have one of these. What is the argument to go get it? Because they may be afraid of liability. Somebody is going to get sued. Maryland has a good Samaritan law. They do, yeah. Jeff, that is a great point. There is no reason as a public institution or a private institution that you should not have an AED in your building. I believe it is no longer cost prohibitive to have one in the building. I am not a lawyer but I do not think there is any legal liability to having one in your building. And if you haven't had this happen or know someone that has had it happen to them, around them, you will. It will happen. It is not as rare as we think. So having that device here is important. Dr. Jeremy Pollock with the University of Maryland St. Joseph Medical Center. Dr. Thank you. Jeff, thanks as always for having me on. I appreciate it. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.