Defibrillators versus Tasers

The front page of my hometown newspaper, The Hamilton Spectator, carried a story today on a police services request for $1million for the purchase of Tasers. I was struck be the similarity between the price of an X26 Taser and a top of the line Automated External Defibrillator (AED), a virtual dead heat at $1,455. The 687 AED’s that could be purchased with $1 million would allow for an AED to be placed in every Hamilton Police Services vehicle with many left over to be placed strategically throughout the community. In the first eight years of carrying AED’s in their police cruisers and responding to cardiac arrest calls Ottawa Police saved 20 lives. In Rochester, Minnesota a small city of 100,000 people police have been carrying AED’s since 1990 and have been credited with 127 lives saved.

In the Fall of 2012 every Ambulance Service in the Ontario submitted their new response time commitments to the Ministry of Health and Long-term Care. Hamilton EMS agreed to “endeavour” to achieve the Ministry established benchmark of having a trained responder equipped with an AED arriving on scene at 75% of all cardiac arrest calls within 6 minutes of EMS receiving the 911 call. The 6 minute benchmark is a worthy target and taking any longer to arrive at the side of a cardiac arrest victim will not likely result in a life saved. However several Ambulance Services have indicated to the Ministry that, while it is desirable, it is unlikely that responders will be arriving on scene in 6 minutes at or near the 75^th percentile. Historically this target has been difficult to achieve and increasing demand and scarce resources suggest it is unlikely to improve significantly as long as EMS is the sole responder to cardiac arrest events.

The communities that will meet or exceed the standard when the 2013 reports are submitted to the Ministry in March of next year will be those with deep and wide Public Access Defibrillation (PAD) programs and excellent Police and Fire tiered response protocols for cardiac arrest. Any event where an AED arrives at the patient’s side within 6 minutes whether it is manned by a teacher, a hockey coach, a co-worker, a family member, a firefighter, a paramedic or a police officer contributes to achieving the benchmark.

Why is the 6 minute standard so critical? The key statistical factor for improving outcomes is time, specifically the time from when the patient collapses to the time when they receive the first shock from a defibrillator. The places with the highest survival rates for Out-of-Hospital Cardiac Arrest (OOHCA) have the shortest time to first shock. Each year in Ontario over 7,000 people experience OOHCA and overall survival is less than 8%.  In Hamilton that translates to roughly 400 events per year with less than 32 survivors.

Across North America there are a growing number of communities committed to improving cardiac arrest response protocols that are achieving survival rates in excess of 20%. Large urban areas such as Seattle WA and Tucson AZ are reporting at 20%, Halton Region reported a 30% survival rate in 2010 and Rochester Minnesota reports a 42% survival rate. If survival rates for cardiac arrest in Hamilton doubled to 16% that would represent 32 additional lives saved each year and if they tripled to 24%, a lofty but realistic target, it would represent more than one additional life saved every week of the year.

Even $500,000 would purchase over 300 AED’s, more than enough to put one in every frontline police vehicle. Police officers are currently required to be trained in Basic Life Support/CPR so there is no additional training burden. The ability of police to be first on scene at most serious medical calls has been proven in dozens of urban centres including Ottawa. Equipping police with AED’s would go a long way to assisting Hamilton EMS achieve the benchmark of 6 minutes at the 75^th percentile.

It’s popular and easy (although not always productive) to suggest alternative uses for budget lines. In this instance one can’t help but see the irony. Hamilton Police are requesting $1 million to purchase hundreds of high energy devices that are used to debilitate and even "accidentally" kill people. That same dollar amount, or less, could just as easily be applied to the purchase of  high energy devices that police forces around the world are using daily to save lives.