Many North Jersey schools have lifesaving defibrillators, but they often aren't accessible after hours and they are seldom found at sports practices or camps.
Legislation that would make the devices more available remains stalled, nearly four years after being introduced, because state lawmakers say they don't want to force a local mandate without providing the funds for it.
Janet's Law, A781, which would require every public school, recreation field and youth camp to have an automated external defibrillator, or AED, is sitting in the Assembly and Senate waiting for a vote.
"This is a much, much needed piece of legislation and there is a lot of support for it," said Sen. Robert Singer, R-Mercer, who sponsored it in the Senate. "But in this economy, how do we fund it? Unfortunately, it comes down to dollars and cents."
Jim Zilinski, whose 11-year-old daughter Janet died in 2006 after collapsing at a cheerleading practice from a previously undetected heart defect and whom the bill is named after, said most schools can get an AED for about $1,000. "I understand there are financial difficulties at schools in New Jersey, but I think it's worth $1,000 to save a child's life," the Warren Township father said.
Chance for Survival
Defibrillators, which shock the heart into beating again, are the best chance for survival after a patient has gone into cardiac arrest. The device is especially needed for those who suffer commotio cordis, a condition that occurs when a blow to the chest wall happens precisely at the millisecond the heart is between beats. The force stops the heart from beating and leaves it quivering, unable to pump blood to the organs. Cardio-pulmonary resuscitation alone isn't effective because it can't get the heart beating normally again. Even with defibrillator, survival rates hover between 20 and 35 percent.
Commotio cordis is most likely what recently killed 16-year-old Garfield baseball catcher Thomas Adams after he was hit with a pitch and collapsed at a practice in Paterson. Though the cause of death is pending autopsy results, doctors say the description of the incident points to commotio cordis, which requires that a defibrillator be used within three minutes of the blow to prevent brain-damage or death.
"If you can't get the blood flowing to the organs, they just stop working," said Dr. Robert Monaco, director of sports medicine at Rutgers University. "It's not so much about the force of the blow as it is the timing."
A defibrillator wasn't used on Adams until emergency workers arrived at Blessed Sacrament, the private school were Adams was practicing Dec. 3. with a travel team. He died about an hour after arriving at St. Joseph's Regional Medical Center in Paterson. "I was shocked when I heard this bill has been stalled," said Tim Adams, Thomas' uncle. "What's a person's life worth? Even with only a 20 percent chance of surviving, we could have laid him to rest knowing that everything was done that could have been done."
Commotio cordis also left 12-year-old Steven Domalewski of Wayne with permanent brain damage after he was hit with a line drive off an aluminum bat in 2006. He was given CPR until emergency workers showed up with a defibrillator, but his brain was without oxygen for an estimated 15 to 20 minutes. The odds are better when an AED is used for other causes of cardiac arrest. "I was told if a defibrillator had been used on Janet, she would have had a 75 percent chance of surviving," Zilinski said. "She would have needed a transplant or some other type of treatment but she would have had a chance."
Acquired by Schools
In the past few years, many schools have gotten AEDs, Zilinski said. This summer, the foundation his family started, the Janet Zilinski Memorial Fund, queried the state's 2,505 public schools asking if the school had a defibrillator, if someone was trained to use it and if the school had an action plan to deal with an emergency that requires the use of an AED. "We received about 800 surveys back and out of them, 95 percent of the schools have defibrillator," Zilinski said. "It's just that they may be locked in a nurse's office or the principal's office," he said. "Or, during an emergency, they don't have a plan as to who would call 911, who would go wait for the ambulance -- those types of details that should be spelled out."
But many poorer districts, including all the public schools in Paterson, don't have AEDs.Most of the city's Catholic schools, including Blessed Sacrament, also don't have any, according to Richard Sokerka, spokesman for the diocese. That will not change with the new law -- the bill doesn't include private schools. New York and more than a dozen other states have a similar law in place.
"We certainly recommend defibrillator be available, but almost every high school has different sports practicing each day on public fields that may be a distance from the school," said John DuBois, assistant director of the New Jersey State Interscholastic Athletic Association. "Normally, the AEDs are kept with an athletic trainer or nurse, but what happens when you have practices going on off-campus?"
Despite the costs, the heartbreak of Thomas Adams' death may serve as an impetus to get the law passed, said Assemblyman Jon Bramnick, R-Essex, who first introduced the bill in 2007. I hate to use any type of tragedy, but sometimes that's the only thing that gets momentum going," Bramnick said.
"Ten years ago this would have flown through -- no one is opposed to it -- but now everyone is gun-shy about local mandates when the economy is the way it is. This might be what gets this bill passed."