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A couple of comments here show confusion about who can use defibrillators and in particular whether a doctor is required. I thought I'd add my personal experien

A couple of comments here show confusion about who can use defibrillators and in particular whether a doctor is required. I thought I'd add my personal experience. Specifically, I was defibrillated by bystanders when I had an out-of-hospital Ventricular Fibrillation episode. The staff at the UK building I was visiting had a defibrillator in their office and one of them had been on a training course. When I collapsed with no warning, there was (according to my wife) about a minute of confusion and then one of the staff grabbed the defibrillator and used it. The device itself plays recorded instructions and itself conducts diagnostic tests to determine whether or not it should be used. If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it. If it can treat you, then it gives clear instructions to the users and delivers shocks as required. In my case, the visitor centre staff had saved my life before the air ambulance arrived with trained medics. I was then flown to hospital where the critical cardiac care team confirmed that the bystanders had done exactly the right thing. They had also administered manual CPR which had kept my brain supplied with oxygen at the cost of two broken ribs. So here I am today writing this comment, thanks to the immediate availability of a defibrillator to bystanders. I was lucky. My VF episode happened just as I had entered the lobby of the building that coincidentally contained the defibrillator. If I had been a 20 minute walk away, I would be dead (or brain damaged). Would a drone-based defibrillator have saved my life? Don't know, but it would certainly improve my chances.

matheusmoreira 5y ago
Defibrilators really should be as ubiquitous as fire extinguishers!
- bodge5000 5y ago
  (Also in UK) unless I've just become so accustomed to seeing fire extinguishers that I ignore them, it seems they are, and in some cases even more so. The bus stop near me (not a building, just a metal shelter that maybe 5 people can fit under) has a defib. I think our offices used to as well.
  - radlad 5y ago
    In the US, many housing codes require that every apartment be furnished with a fire extinguisher. I keep two in my house: one on each floor. (One stays under the kitchen sink.)
Tor3 5y ago
At $work we all (or nearly all) get trained in CPR and the use of a defibrillator, and re-trained (and tested and certificated) every second year. We have a defibrillator (and scissors etc) on site where we can easily find it if it's ever needed.
fortran77 5y ago
> The staff at the UK building I was visiting had a defibrillator in their office and one of them had been on a training course. I have a Philips HeartStart at home. None of us are high risk (we're not obese, fit), or had family history of heart disease. We just like gadgets, and why take a chance? The last company I worked as an employee at had defibrillators on every floor. While I had to take diversity training, and sensitivity training, I was never required to take -- or offered -- a class in defibrillator training.
- belter 5y ago
  It seems they go around 2000 dollars with some very worn out second hand on Ebay for 400. Sounds ripe for disruption by a Startup doing either: - Defibrillators on Lease or - Crowdfunding prototype ;-)
  - fortran77 5y ago
    We bought it new. It’s not the type of thing to take a chance on!
jgrahamc 5y ago
They had also administered manual CPR which had kept my brain supplied with oxygen at the cost of two broken ribs I did CPR on an elderly man I found having a heart attack in an alley in London. He was conscious when I found him. I called 999 and stayed with him. He "died" in front of me (no pulse, breathing, motion, loss of urine control). I did CPR until the ambulance arrived; I remember the sound of breaking ribs very clearly. They used a defib on him and he survived and until I moved away from the area I'd see him walking around from time to time. Was a slightly odd feeling seeing him because I literally saw him "stop".
- flubflub 5y ago
  Were you scared when you broke his ribs? Of course you'd have to but I'd be too apprehensive to do it properly I think.
  - jgrahamc 5y ago
    I was not at all afraid. I got on with the job and I was so focused that I had no idea that the ambulance had arrived until a crew member touched me.
    - flubflub 5y ago
      That's interesting, thank you. It is different to what I would have expected of myself in that position.
mod 5y ago
> at the cost of two broken ribs Sorry about the ribs, but I'm glad they were trained well. Proper CPR breaks ribs. I helped rescue a drowning man once. I pulled him from the water (he had been under a few minutes), and long story short, other folks did the CPR, and later a defib. The man died, but I had the impression his ribs survived. Very glad to hear your outcome was different.
- bsder 5y ago
  People also don't realize how difficult CPR is. I did CPR on an elderly man for almost 10 minutes when I was 22; I was completely exhausted afterward.
  - geoduck14 5y ago
    I have a similar story. It was like doing weird cardio, to a rhythm, while panicking that if your form is bad you will kill someone. Oh, and I stopped every couple of seconds to expell my entire breath into his mouth
    - mod 5y ago
      FYI, in case it ever becomes relevant (hopefully not!), the standards for breath to compression ratios have changed. Last I heard about a decade ago, they had moved to 30:1 (compression:breath). Turns out it's vastly more important to circulate blood than to give breaths, and additionally many people fail to deliver any breath, as it's trickier.
      - geoduck14 5y ago
        I appreciate that reminder. And for clearly pointing that out to future readers of this post. For context, this was before the standards changed. I'm glad the standards reduced the amount of breathing (to make room for more heart pumping). Either way, it wouldn't have made a difference in my situation: the patient had a brain aneurysm with a "<1% chance of survival even it it happened in the ER" ---------------- Also, for future readers: The probability that an amateur using CPR saves someone's life is 1:10,000 For paramedics, it is 1:1,000 So if your person dies, go easy on yourself and get some therapy
sebow 5y ago
It's kind of crazy how much we rely on ambulances that most often than not feel like they're too slow.Now i know the feeling of time slowing down due to emotional involvement in the heat of the moment, but that doesn't mean there are not a lot of variables from the person needing help to the nearest 'trained medical expert'.The solution imo can be improved by having both more people know basic medical procedures and also more useful devices around.
traceroute66 5y ago
> If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it I was taught how to use one on a course where the instructor said he used to enjoy teaching students this fact by allowing them to take turns attempting to use a live defibrillator on him. He got away with it for many years until his boss found out and put a stop to it because the company insurance wouldn't cover the company (despite clear witnessed consent being given by the instructor). On the plus side, the company didn't ban his teaching method of NPA (Nasopharyngeal Airway) insertion. ;-) > manual CPR which had kept my brain supplied with oxygen Manual CPR done correctly is critical, and yes if done correctly you WILL end up with broken ribs. Mouth-to-mouth is not deemed particularly necessary these days (since the act of correct CPR will draw oxygen in anyway), better to focus on proper CPR and wait for the ambulance to turn up with high-flow oxygen from a tank. > If I had been a 20 minute walk away, I would be dead (or brain damaged) Yes. The most effective time for defib use is in the first 5 minutes. That's not to say you should not have a go after that time, but its effectiveness does drop away quite quickly.
- iso1631 5y ago
  > Mouth-to-mouth is not deemed particularly necessary these days (since the act of correct CPR will draw oxygen in anyway), better to focus on proper CPR and wait for the ambulance to turn up with high-flow oxygen from a tank. Mouth-to-mouth isn't critical, but clearing the airway is. I remember one story from a first-aid refresher a few year, the guy doing it said he arrived at a car crash (doing a stint on an ambulance). A girl had been hit and was lying on the floor. Nobody had touched her in case they broke her neck or something. She wasn't breathing. The ambulance had arrived within about 5 minutes, which was too late. Tilting her head back would likely have saved her life.
  - LorenPechtel 5y ago
    I remember reading of one--kid ran behind the car that was backing out. *Minor* injuries, but fatal because the people were afraid to mess with a head wound. The kid was knocked unconscious and had a nosebleed--he drowned on the sidewalk.
  - 5y ago
jacquesm 5y ago
Wow, that's quite an experience. Just that much happier to see you posting here!
- KineticLensman 5y ago
  Thank you! I'm happy to be (still) posting here too :-)
  - jacquesm 5y ago
    I'll bet. Seriously, that gave me pause to consider a refresher first aid course, it's been 15 years and I haven't had any use for it in all that time but it could make all the difference.
    - KineticLensman 5y ago
      Do it! Do it! Booking the defib course was almost the first thing I did afterwards. That and arrange to meet the people who'd CPR'd me. That was a positive and powerful experience and good for them because they'd been much more traumatised than I was.
      - jacquesm 5y ago
        I will. Thank you for the very vivid reminder. See also the thread about procrastination...
        KineticLensman 5y ago
        > See also the thread about procrastination... Yes. Tomorrow.
        jacquesm 5y ago
        Hehe. LOL'd, and now I'm getting all kinds of funny looks.
padolsey 5y ago
> The device itself plays recorded instructions and itself conducts diagnostic tests to determine whether or not it should be used. If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it To expand on this a bit, defibs will only deliver a shock if they detect VF (ventricular fibrillation) or VT (ventricular tachycardia). These are considered shockable rhythms. Both involve malfunction of the electrical conduction system usually due to lacking oxygenated blood supply to the heart muscle itself. A shock seeks (usually up to 300 joules depending on patient size) to reset the hearts' rhythm so the body's natural pacemaker (called the SA node, positioned in the top-right of the heart) can kick back in. If there's no shockable rhythm, the defib machines will usually instruct you to continue CPR (chest compressions) and then will ask you to stop after a cycle of 30 so it can re-analyze the rhythm. Otherwise CPR must continue until medics arrive. If the defib detect a normal rhythm (sinus rhythm) then that's good news and means the defib has been effective. Pad placement is very important if you're administering defib. The pads are positioned so that the depolarization travels approximately down the septum of the heart, to emulate the normal electrical cascade. Note: there are many types of heart malfunctions that can't be remedied by a defib but that doesn't mean you should do nothing. Always do CPR. Always call the emergency services. Possibly of interest to HNers: It is a common misconception that a defib can bring a heart back from 'flat-lining' (asystole). Hollywood movies don't help. If there is asystole, medics will usually continue CPR until the rhythm changes whild trying to reverse any underlying causes of the heart failure (e.g. massive hemorrhaging or hypothermia).
- infinet 5y ago
  A 30 Kg object drop from 1 meter onto one's foot will unleash around 300 Joules. The heaviest barbell plate is usually 25 Kg. So 300 Joules is a lots of energy. And I once heard a story, not sure how true it is, that someone put the defrib pads over the thigh and on activation the muscle contract so violently that breaks the bone.
  - geoduck14 5y ago
    >And I once heard a story, not sure how true it is, that someone put the defrib pads over the thigh and on activation the muscle contract so violently that breaks the bone. I'm skeptical of this. for the Americans out here: 30 Kg is ~66lbs 1 meter is about 3 feet If an adult male (about 150 lbs) jumps off of a kitchen counter (about 3 feet) - each leg will absorb 75 lbs from 3 feet. I have done this many times and even my thin feet bones held the force. I'm pretty sure my thighs (our strongest bones) would be just fine.

matheusmoreira 5y ago

Defibrilators really should be as ubiquitous as fire extinguishers!

bodge5000 5y ago
(Also in UK) unless I've just become so accustomed to seeing fire extinguishers that I ignore them, it seems they are, and in some cases even more so. The bus stop near me (not a building, just a metal shelter that maybe 5 people can fit under) has a defib. I think our offices used to as well.
- radlad 5y ago
  In the US, many housing codes require that every apartment be furnished with a fire extinguisher. I keep two in my house: one on each floor. (One stays under the kitchen sink.)

Tor3 5y ago

At $work we all (or nearly all) get trained in CPR and the use of a defibrillator, and re-trained (and tested and certificated) every second year. We have a defibrillator (and scissors etc) on site where we can easily find it if it's ever needed.

fortran77 5y ago

> The staff at the UK building I was visiting had a defibrillator in their office and one of them had been on a training course. I have a Philips HeartStart at home. None of us are high risk (we're not obese, fit), or had family history of heart disease. We just like gadgets, and why take a chance? The last company I worked as an employee at had defibrillators on every floor. While I had to take diversity training, and sensitivity training, I was never required to take -- or offered -- a class in defibrillator training.

belter 5y ago
It seems they go around 2000 dollars with some very worn out second hand on Ebay for 400. Sounds ripe for disruption by a Startup doing either: - Defibrillators on Lease or - Crowdfunding prototype ;-)
- fortran77 5y ago
  We bought it new. It’s not the type of thing to take a chance on!

jgrahamc 5y ago

They had also administered manual CPR which had kept my brain supplied with oxygen at the cost of two broken ribs I did CPR on an elderly man I found having a heart attack in an alley in London. He was conscious when I found him. I called 999 and stayed with him. He "died" in front of me (no pulse, breathing, motion, loss of urine control). I did CPR until the ambulance arrived; I remember the sound of breaking ribs very clearly. They used a defib on him and he survived and until I moved away from the area I'd see him walking around from time to time. Was a slightly odd feeling seeing him because I literally saw him "stop".

flubflub 5y ago
Were you scared when you broke his ribs? Of course you'd have to but I'd be too apprehensive to do it properly I think.
- jgrahamc 5y ago
  I was not at all afraid. I got on with the job and I was so focused that I had no idea that the ambulance had arrived until a crew member touched me.
  - flubflub 5y ago
    That's interesting, thank you. It is different to what I would have expected of myself in that position.

mod 5y ago

> at the cost of two broken ribs Sorry about the ribs, but I'm glad they were trained well. Proper CPR breaks ribs. I helped rescue a drowning man once. I pulled him from the water (he had been under a few minutes), and long story short, other folks did the CPR, and later a defib. The man died, but I had the impression his ribs survived. Very glad to hear your outcome was different.

bsder 5y ago
People also don't realize how difficult CPR is. I did CPR on an elderly man for almost 10 minutes when I was 22; I was completely exhausted afterward.
- geoduck14 5y ago
  I have a similar story. It was like doing weird cardio, to a rhythm, while panicking that if your form is bad you will kill someone. Oh, and I stopped every couple of seconds to expell my entire breath into his mouth
  - mod 5y ago
    FYI, in case it ever becomes relevant (hopefully not!), the standards for breath to compression ratios have changed. Last I heard about a decade ago, they had moved to 30:1 (compression:breath). Turns out it's vastly more important to circulate blood than to give breaths, and additionally many people fail to deliver any breath, as it's trickier.
    - geoduck14 5y ago
      I appreciate that reminder. And for clearly pointing that out to future readers of this post. For context, this was before the standards changed. I'm glad the standards reduced the amount of breathing (to make room for more heart pumping). Either way, it wouldn't have made a difference in my situation: the patient had a brain aneurysm with a "<1% chance of survival even it it happened in the ER" ---------------- Also, for future readers: The probability that an amateur using CPR saves someone's life is 1:10,000 For paramedics, it is 1:1,000 So if your person dies, go easy on yourself and get some therapy

sebow 5y ago

It's kind of crazy how much we rely on ambulances that most often than not feel like they're too slow.Now i know the feeling of time slowing down due to emotional involvement in the heat of the moment, but that doesn't mean there are not a lot of variables from the person needing help to the nearest 'trained medical expert'.The solution imo can be improved by having both more people know basic medical procedures and also more useful devices around.

traceroute66 5y ago

> If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it I was taught how to use one on a course where the instructor said he used to enjoy teaching students this fact by allowing them to take turns attempting to use a live defibrillator on him. He got away with it for many years until his boss found out and put a stop to it because the company insurance wouldn't cover the company (despite clear witnessed consent being given by the instructor). On the plus side, the company didn't ban his teaching method of NPA (Nasopharyngeal Airway) insertion. ;-) > manual CPR which had kept my brain supplied with oxygen Manual CPR done correctly is critical, and yes if done correctly you WILL end up with broken ribs. Mouth-to-mouth is not deemed particularly necessary these days (since the act of correct CPR will draw oxygen in anyway), better to focus on proper CPR and wait for the ambulance to turn up with high-flow oxygen from a tank. > If I had been a 20 minute walk away, I would be dead (or brain damaged) Yes. The most effective time for defib use is in the first 5 minutes. That's not to say you should not have a go after that time, but its effectiveness does drop away quite quickly.

iso1631 5y ago
> Mouth-to-mouth is not deemed particularly necessary these days (since the act of correct CPR will draw oxygen in anyway), better to focus on proper CPR and wait for the ambulance to turn up with high-flow oxygen from a tank. Mouth-to-mouth isn't critical, but clearing the airway is. I remember one story from a first-aid refresher a few year, the guy doing it said he arrived at a car crash (doing a stint on an ambulance). A girl had been hit and was lying on the floor. Nobody had touched her in case they broke her neck or something. She wasn't breathing. The ambulance had arrived within about 5 minutes, which was too late. Tilting her head back would likely have saved her life.
- LorenPechtel 5y ago
  I remember reading of one--kid ran behind the car that was backing out. *Minor* injuries, but fatal because the people were afraid to mess with a head wound. The kid was knocked unconscious and had a nosebleed--he drowned on the sidewalk.
- 5y ago

jacquesm 5y ago

Wow, that's quite an experience. Just that much happier to see you posting here!

KineticLensman 5y ago
Thank you! I'm happy to be (still) posting here too :-)
- jacquesm 5y ago
  I'll bet. Seriously, that gave me pause to consider a refresher first aid course, it's been 15 years and I haven't had any use for it in all that time but it could make all the difference.
  - KineticLensman 5y ago
    Do it! Do it! Booking the defib course was almost the first thing I did afterwards. That and arrange to meet the people who'd CPR'd me. That was a positive and powerful experience and good for them because they'd been much more traumatised than I was.
    - jacquesm 5y ago
      I will. Thank you for the very vivid reminder. See also the thread about procrastination...
      - KineticLensman 5y ago
        > See also the thread about procrastination... Yes. Tomorrow.
        jacquesm 5y ago
        Hehe. LOL'd, and now I'm getting all kinds of funny looks.

padolsey 5y ago

> The device itself plays recorded instructions and itself conducts diagnostic tests to determine whether or not it should be used. If it can't detect a treatable condition it doesn't just blat you with electricity for the sake of it To expand on this a bit, defibs will only deliver a shock if they detect VF (ventricular fibrillation) or VT (ventricular tachycardia). These are considered shockable rhythms. Both involve malfunction of the electrical conduction system usually due to lacking oxygenated blood supply to the heart muscle itself. A shock seeks (usually up to 300 joules depending on patient size) to reset the hearts' rhythm so the body's natural pacemaker (called the SA node, positioned in the top-right of the heart) can kick back in. If there's no shockable rhythm, the defib machines will usually instruct you to continue CPR (chest compressions) and then will ask you to stop after a cycle of 30 so it can re-analyze the rhythm. Otherwise CPR must continue until medics arrive. If the defib detect a normal rhythm (sinus rhythm) then that's good news and means the defib has been effective. Pad placement is very important if you're administering defib. The pads are positioned so that the depolarization travels approximately down the septum of the heart, to emulate the normal electrical cascade. Note: there are many types of heart malfunctions that can't be remedied by a defib but that doesn't mean you should do nothing. Always do CPR. Always call the emergency services. Possibly of interest to HNers: It is a common misconception that a defib can bring a heart back from 'flat-lining' (asystole). Hollywood movies don't help. If there is asystole, medics will usually continue CPR until the rhythm changes whild trying to reverse any underlying causes of the heart failure (e.g. massive hemorrhaging or hypothermia).

infinet 5y ago
A 30 Kg object drop from 1 meter onto one's foot will unleash around 300 Joules. The heaviest barbell plate is usually 25 Kg. So 300 Joules is a lots of energy. And I once heard a story, not sure how true it is, that someone put the defrib pads over the thigh and on activation the muscle contract so violently that breaks the bone.
- geoduck14 5y ago
  >And I once heard a story, not sure how true it is, that someone put the defrib pads over the thigh and on activation the muscle contract so violently that breaks the bone. I'm skeptical of this. for the Americans out here: 30 Kg is ~66lbs 1 meter is about 3 feet If an adult male (about 150 lbs) jumps off of a kitchen counter (about 3 feet) - each leg will absorb 75 lbs from 3 feet. I have done this many times and even my thin feet bones held the force. I'm pretty sure my thighs (our strongest bones) would be just fine.