Think "West Palm Beach" and conjure up images of sun-drenched beaches, palm-tree-lined avenues, luxurious condominiums, expansive golf communities, fine dining, exclusive shopping, lively nightlife, and plentiful recreational and cultural offerings – in short, tropical living at its best.
This city, which serves as a county seat for government and commerce and is located 65 miles north of Miami on Florida's East Coast, is more than fun and frills in the sun. From retail sales to tourism, and housing starts to job growth, business is booming. Authoritative business magazines have rated the city as Number One in the nation for entrepreneurial business and surrounding Palm Beach County as one of the top 10 places for business and career advancement.
With a permanent population of more than 85,000 and a daily influx of approximately 260,000 people, West Palm Beach is a thriving, vigorous place. And while residents, visitors and commuters go about their activities, their lives are protected from sudden cardiac arrest (SCA), thanks to the foresight and tireless efforts of community leaders.
AEDs are Abundant Throughout the City and Region
There are an estimated 500 public access and first response automated external defibrillators (AEDs) in Palm Beach County, one of the largest counties east of the Mississippi with an area covering 2034 square miles. And, according to Dr. Randall Wolff, medical director for West Palm Beach and five surrounding municipalities, many more privately-owned AEDs deployed throughout the region.
The city is indeed well covered and more AEDs are being added regularly. Today in West Palm Beach, large shopping areas, performing arts center, nightclub district, zoo, golf courses, country clubs, private residential communities, city and county buildings, some high schools, and other high-people traffic locations are equipped with life-saving AEDs. In addition, most police and firefighters carry them and they also are located in some private homes and places of worship. AED coverage is equally impressive throughout the county, in towns and cities such as Delray Beach.
The Importance of AEDs
A leading cause of death in the United States, SCA claims approximately one life every 2 minutes, for a total of nearly 600 lives per day or 250,000 people a year. Defibrillation, a shock to the heart delivered by a defibrillator, is the only effective treatment, but timing is everything. Rescue attempts are most often successful when defibrillation is administered within the first few minutes of onset. Beyond 10 minutes, a victim’s chance of survival is extremely unlikely.
Since SCA strikes randomly and suddenly, the more AEDs a community has in public areas, the better. Improving SCA survival is the key impetus behind Palm Beach County's AED program.
"The system of dialing 911 and waiting for the ambulance to arrive and assess someone in cardiac arrest and shock them, results in a survival rate in most areas of the country in less than five percent," said Dr. Wolff. "However, if one is able to assess the rhythm and shock a victim in three minutes or less the survival rate can be as high as 80 percent. So, the push is to have AEDs much nearer to a patient so that anyone who’s trained in defibrillation can shock the patient instead of waiting for the ambulance."
Thousands Trained to Respond with an AED
Having AEDs in strategic places is the first essential step to improving a person’s chances of surviving deadly SCA. The second equally important component is trained responders, skilled in both CPR and the operation of an AED. To that end, Palm Beach County has trained about 2,500 people.
Most of the people who take the four-hour AHA-certified CPR course with AED utilization component, the so-called "Heart Saver" program, work at locations where AEDs are deployed and are sponsored by their employers. Many others are trained in CPR only, people Dr. Wolff describes as "private individuals who wanted to learn CPR" and who paid for the training themselves.
For the past three years, the local chapter of the American Heart Association (AHA) has conducted mass CPR Days. During these large-scale events, about 1,000 people participate on a single day in a two-hour "Family and Friends" CPR course, free of charge. AEDs are demonstrated at these events but participants are not certified to use one until they take additional training.
Hoping to have a greater impact on survival rates, the AHA recently changed strategies, scaled back its mass CPR events, and started focusing on getting as many AEDs as possible into public access areas and police cars. The organization is still encouraging and advocating CPR and regularly sponsors smaller community-based CPR events.
Modest Beginnings Evolve into Full-fledge AED Program
West Palm Beach's AED program began in 1992 when six AEDs were placed on basic life support fire units. In 1998, EMS officials, led by Chief Dave Dyal, the EMS Division Chief for West Palm Beach Fire and Rescue, put Forerunner AEDs in city-run entities, such as the public library, city hall and municipal golf course.
Public access efforts then received three huge boosts. The first came in 1997 when an AHA-sponsored bill passed in the state legislature. It extended the “Good Samaritan” law on the books in Florida to include protection from liability for first-responders using an AED on a SCA victim. The bill also reduced the AED training requirements from 40 hours to four.
After the law passed, there was a "big boom and people started getting a bit more aggressive about getting AEDs placed in public areas," according to Chief Dyal, who carries an AED in his car and has responded to emergencies with it.
The second AED wave came in 2000 when the AHA sought and successfully received a $425,000 donation from a local hospital charity, the Quantum Foundation. The money was earmarked for a program dubbed, "Operation Heartbeat." Dr. Wolff, who has served as medical director since 1983, was tapped as chairperson. "The goal of Operation Heartbeat is to certify as many people in CPR/AED deployment and place AEDs in as many public places as possible," he said.
The third lift came in 2001. Florida’s Good Samaritan law was enhanced to provide limited immunity to businesses that acquire AEDs for their premises.
Operation Heartbeat's Noble Mission
According to the local AHA chapter, Operation Heartbeat is well on its way to improving the Chain of Survival in the county. The taskforce committee, chaired by Dr. Wolff and consisting of representatives of the county's 15 EMS systems, medical directors, emergency room physicians, cardiologists and community leaders, works relentlessly to provide free CPR training to the general public, get more public access AEDs in place, and equip all police cars with AEDs.
One way the committee conducts educational outreach to the community at large is through panel sessions.
PAD Breakfasts: Public Access Defibrillation Over-easy
The AHA has assembled a panel of medical, EMS and legal professionals who speak regularly to community and business leaders on the importance of having public access AEDs in their facilities.
Discussions take place at "PAD Breakfasts" PAD stands for public access defibrillation. The audience typically consists of individuals who manage, oversee, own, or supervise locations with high concentrations of people, for instance, condo managers, building supervisors, representatives of golf and gated communities, development officials, etc.
Each panel member delivers crucial information for public access AED deployment. "The EMS official demonstrates the actual function of an AED and shows people how easy it is to use, the lawyer addresses the issue of liability, and the medical director covers the clinical efficacy of PAD," said Chief Dyal, who often is the EMS representative on the panel.
Most attendees, according to Chief Dyal, are sold immediately on the benefits of the compact AEDs. "Ease-of-use absolutely surprises people," he said. "The sessions alleviate anxiety and people jump on the bandwagon."
In the chief's opinion, "legal liability is the greatest hindrance" for people contemplating a public access AED program at their sites. He said people "fear shocking someone who doesn’t need it," but clearly this is not an issue with an AED. The machine is entirely automated and, after reading a patient's heart rhythm, gives voice prompts to the user to administer or not to administer a shock. In addition, there are the protections afforded by the state’s Good Samaritan law.
"The legal discussion is the most important and successful part of the whole program," he said. "It alleviates people’s fears about liability."
Other Funding Sources Tapped for AEDs
Additional – and some non-traditional – sources of funding are amplifying West Palm Beach's AED program. Many private entities, such as places of worship and the zoo, have purchased AEDs and trained their people with money raised through fundraising activities. Chief Dyal notes that at a price of about $3000 or less for a ForeRunner model, AEDs are attainable for non-profit organizations through such means.
Other groups, such as country clubs, recreational facilities, golf courses, gated communities, condominiums, and shopping areas, have purchased AEDs for their facilities and trained employees with their own budgets.
Several AEDs in the city, such as those in the public library and City Hall, were purchased with funding provided through a County EMS Grant Program. Each county in Florida is eligible to apply for the grant, which is funded through traffic violations fines.
"Counties apply for and get a share of dollars based on the size of the county and the amount of fines collected in the respective locales in any given fiscal year," said Bob Butterfield, the EMS Manager for Palm Beach County's Public Safety Department. Money is then funneled to municipalities within the County.
"The amount of money we get fluctuates from year to year, however, the last few years we have done very well. In fiscal year 2001 we received more than $300,000 and in 2002 we received a little over $500,000," he said.
EMS officials from Palm Beach County apply by submitting grant applications to Butterfield's department, indicating why they want the money and how it will be used. All funds are designated for "anything that will enhance or expand EMS in the county," according to Butterfield. "It could be AEDs, EMS vehicles, communications equipment, CPR mannequins, or training/education, but lately many officials applying for the grant have requested funds for AEDs."
A committee reviews and evaluates the applications using a point system before distributing the money. "There have been a few years where everyone didn't get what they wanted because there wasn't enough grant money," he said. "However, in fiscal year 2001 everyone got what they wanted. 2002 holds the same promise, depending on how much money each county ultimately seeks."
Bigger counties obviously get more money, but, according to Butterfield, no locale is overlooked. "The state makes allowances for the smaller counties so that they receive their fair share," he noted.
Seven Lucky People Saved
As the focus intensifies on public access placements and AEDs are established in diverse venues throughout the county, the life-saving benefits are becoming unmistakably clear. In the past two years alone (2001-2), seven lucky people who suffered SCA owe their lives to an AED.
The most recent rescues happened on a tennis court and in a car dealership in Delray Beach, which has more than 70 AEDs deployed. In both cases, men in their 60s collapsed and were successfully resuscitated with AEDs on the premises and within minutes reach of them.
At Delray Beach Tennis Center, a privately managed city-owned facility, a 64-year-old man was stricken while playing tennis. As soon as the frightening news came into the Pro Shop, an employee grabbed the center’s ForeRunner AED and rushed to the court. When he arrived the victim was not breathing and had no pulse. The employee, a retail clerk who had been trained to use the life-saving unit, applied the defibrillation pads to the victim and the AED advised him to deliver a shock. The fallen man soon began to regain consciousness and was in stable condition by the time he was transported by rescue to the local hospital.
And, according to the tennis center, if not for his wife's admonishments, he would still be playing tennis there today!
AEDs in Schools: "Wave of the Future"
Public safety is expanding beyond where people live, work, shop and play. In an innovative move, a third of the high schools in Palm Beach County secured their own sources of funding and then deployed AEDs. Driving the initiative is Dr. Wolff:
"I made a presentation to the medical advisory committee of the school board," he said. "The essence of which was that sudden cardiac arrest occurs in schools and that having AEDs was the wave of the future in schools. I urged them to begin the process and they did."
Dr. Wolff pointed out that with 14,000 employees, the county school district is the largest employer in Palm Beach County. AEDs are in place to protect the lives of many of these employees, as well as people attending adult education classes at schools equipped with AEDs.
High school students are protected, too. "Even youngsters can suffer SCA either as a primary event because of an undiagnosed heart problem, or as the result of getting hit in the chest," Dr. Wolff said. "These children, as well as adults who suffer this abnormal rhythm, would die without being shocked quickly."
AEDs are being added to the entire school system "in phases as the budget allows," according to Dr. Wolff. "The plan is to put them in all the high schools and work our way through the school system. AEDs now are available with pediatric defibrillation pads that can be used to shock children under age eight.
Prior to this, the AED was not recommended for children under eight," he said. "Pediatric pads decrease the amount of energy delivered to the hearts of young children and make AEDs safe and effective to use."
Future Plans Call for More AEDs
Palm Beach County's public access defibrillation program is "moving in the right direction," according to Dr. Wolff, but he's not satisfied yet. "Many more AEDs need to be deployed in the community to see a substantial decrease in SCA deaths."
So, in addition to having full AED coverage at all the school in the county, plans are underway to add more AEDs to public access sites and to continue to encourage private entities to acquire AEDs.
Interest in public safety is extremely high. "There isn't a week that goes by without someone calling me, or others in the county, with questions about AEDs," Dr. Wolff happily points out.
Meanwhile, the AHA still has money to allot from the original $425,000 Quantum Foundation donation. Eleven AEDs, for instance, will soon be purchased for West Palm Beach police cars.
The city also is in the process of planning and building a convention center, which is expected to open in 2004 and will draw even more people to this welcoming and dynamic place. Dr. Wolff will advocate for AEDs in this new facility, as well as more placements throughout the entire city and county. His goal, like most who are entrusted with the public's well being in Palm Beach County, is to ensure that residents and visitors conduct their activities in good health and for a long time to come.
AEDs Counter Sticker Shock
John Odoardo is no ordinary salesman and Loren Sheffer is no ordinary boss. Luckily for them, these two exceptional gentlemen are both affiliated with Borton Volvo and Volkswagen, a leading car dealership in Delray Beach, Florida. Odoardo has been the top salesman there for the past three years. Sheffer is the owner and president, a man who takes employee and customer care steps beyond the norm.
Sheffer runs his successful business with input from his ten managers. He values their wisdom and rarely goes against group consensus. But when his best salesman collapsed in the showroom in the spring of 2002, Sheffer was glad he had exercised executive privilege and for once bucked the consensus of his team.
With the backing of only one of his managers, Sheffer made the fateful decision to equip both his Volvo and Volkswagen sites with ForeRunner AEDs and to train his 100-plus employees on how to operate them. So, when 62-year-old John Odoardo suffered sudden cardiac arrest one busy Saturday afternoon at work, he was fortunate to be where he was.
"The couple I was delivering a car to that day were both CPR instructors," Odoardo said. In addition, one of his colleagues, a former Marine, jumped in to help and there was a paramedic in the showroom. While CPR was being performed, Odoardo's colleagues were at his side within minutes with the AED. He was shocked three times in the showroom before paramedics arrived, and twice after. He now wears an implantable defibrillator and is back to his normal routines.
"John is a tremendous individual, first-class person, and excellent salesperson," Sheffer says. "Without doubt he would have been gone. The paramedics that were here, the people in the emergency room, his own physician, and his intensive care nurse all told him that if we did not have the defibrillator that he would not be alive today."
Sheffer was not at the showroom the day Odoardo suffered SCA but says the episode was overwhelming and "very difficult to deal with." Sheffer experienced "the sense of complete joy that you made that decision to have the defibrillator, along side the feeling of complete terror that one of your staff has experienced this."
Losing Odoardo would have had taken a huge emotional and financial toll, Sheffer said. "The untold expense emotionally on our company would have been enormous, just enormous," he emphasized. "And that's what people don't think about.
"There's a rule in our business that if you lose your best salesperson, it will cost you three times his salary to replace him." In comparison, the ForeRunner AED used to save Odoardo's life cost about $3000. Sheffer called that "the best return on an investment that you could possibly make."
The incident changed the hearts and minds of Sheffer's staff and had a positive effect on the culture overall. "I had so many people come up to me over the next two weeks after that event and thank me for getting those defibrillators and saving John."
When Sheffer purchased the two ForeRunner AEDs, he was showing obvious concern for his staff and customers, but he didn’t stop there. He also purchased a third unit and donated it to the local fire department, which had trained all his people free of charge. He said "it seemed like a good idea . . . and it just might save someone's life, so it was a pretty worthwhile thing to do."
Sheffer, who became familiar with the benefits of AEDs through his work on the Board of Directors of the local American Heart Association, believes having the pair of centrally located AEDs in his two showrooms, is excellent customer service, too. He has become an even more insistent advocate for AEDs in the workplace:
"When you ask any owner or any CEO of any company, 'What is the single most important thing to you,' if they don't respond by saying 'The safety of our staff and guests,' then they need to be reeducated."
He wholeheartedly and unabashedly admits that he is sold on AEDs. "I am, I am," he says enthusiastically. "Any time you can produce a product that is affordable and it will save untold lives, that's a winner."
No doubt Sheffer's entire team unanimously agrees with him this time!