Phoenix Sky Harbor International Airport may be one of the best public places in the country to survive a sudden cardiac arrest (SCA). Indeed, thanks to an innovative public AED program initiated 10 years ago at the airport, the rate of people surviving witnessed cardiac arrests and being released from a hospital neurologically intact is a stunning 75%.
“If you want to have your heart stop beating, have it [occur] at the Phoenix Sky Harbor airport,” says Debbie Thomas, RN, a paramedic training coordinator for the Phoenix Fire Department.
The pioneering public-access-defibrillation program in place at the airport was the brain child of Phoenix Fire Department EMS Medical Director John V. Gallagher, MD, FAAEM, FACEP, and Chief Bob Khan.
“The success rate has been astounding,” Gallagher says, “greater than my highest expectations.”
The program to outfit the airport with AEDs began in 2001 when Gallagher and Khan lobbied the Phoenix City Council to strategically place the devices throughout the city-owned facility. The airport was an ideal location because millions of people travel through there annually.
However, getting the program going took some work on the part of Gallagher and his team. “In the beginning there were some administrators at the airport who thought the liability of having AEDs out there would be too great,” Gallagher says. “We found that to be totally not true.”
Gallagher viewed the Sky Harbor International Airport as a small city—and one that could benefit from an intense AED and CPR training program. The airport, which sits on 3,000 acres, has three terminals. An estimated 100,000 passengers travel through the facility every day. Add to that another 125,000 of their friends, families and drivers, and employees, and you have one busy airport. In fact, Phoenix Sky Harbor International Airport had more than 38.5 million passengers in 2010, according to the city’s aviation department.
The facility has its own police unit, a cadre of volunteers and fire department units staffed by paramedics. Add in bystanders willing to do CPR and use an AED, and the likelihood that some medical professionals would be passing through, and Sky Harbor seemed like a perfect incubator for the program.
Gallagher got the inspiration for the Sky Harbor International Airport program after reading a study of AED usage for cardiac arrest patients in Nevada casinos conducted by Terence D. Valenzuela, MD, MPH.
Valenzuela’s study, conducted in the late 1990s and described in the New England Journal of Medicine in 2001, tracked casino security guards who were trained to use AEDs. The guards observed nearly 150 cases of SCA and used AEDs on 105 that had ventricular fibrillation. More than half of those patients survived to hospital discharge.
Valenzuela maintained that if more AEDs were available and more non-medical personnel were trained to use them, an increased number of people would survive cardiac arrests.
“Both the size of the study and the clarity of its conclusions suggest an urgent, immediate course of action,” Valenzuela noted in a prepared statement issued at the time of the casino study. “We all should work to ensure that each community has a targeted first responder defibrillate program that makes AEDs more easily and quickly available. AEDs should be as handy as fire extinguishers in all public places.”
Valenzuela’s research also found those who were defibrillated within three minutes had a 75% survival rate, while only about half of those who got it after three minutes survived.
Gallagher took Valenzuela’s research to heart.
“I hoped we could get something close to the casino study,” Gallagher says. “Something between 50% and 60% would have been a good result. This result [75%] is better than I could have expected.”
Gallagher’s research counts only SCAs witnessed on the ground in the airport, not those that happened on airplanes aloft that land there.
As in the casinos, the thinking at the Sky Harbor International Airport was that getting nonprofessional rescuers involved as the key first link in the chain of survival was critical to success. Even under the best circumstances, the response time of professional rescuers reduces the ability to successfully resuscitate SCA victims.
“We have an average response time of four to six minutes,” says Thomas. “Hopefully that person is defibrillated before we get there.”
Thomas says the push toward hands-only CPR also helps in getting people to assist when they might otherwise not.
“It’s the early intervention that helps,” she says.
The program started with 55 AEDs at Sky Harbor. Today, 90 devices are strategically located throughout the facility. Each is mounted in a large, white box with a glass front and a heart with a lightning bolt through it. Each unit is only about a two-minute walk from the next.
Since the program started, 34 incidents of witnessed v-fib SCAs have happened at the airport, with 26 of those patients surviving and being released from the hospital without neurological deficits. There were two AED uses alone in April, according to Gallagher.
“All of our police officers there have been trained in CPR and how to use the AED,” Gallagher says. “And the nice thing is, in all of the cardiac arrests that have been witnessed we’ve had bystander CPR in 100% of the time, and [they have] used the AED.”
In each of the cases, the patient had an AED attached within four minutes of the arrest, according to Gallagher.
“The biggest part is the bystanders,” he says. “Usually there are one or two healthcare providers around. Plus, the police officers and the aviation staff are trained.”
At the airport alone, more than 2,000 people, some volunteers, have been trained to use the AEDs and perform CPR. In one save, an off-duty paramedic was standing in line behind one of the people who collapsed while suffering SCA. The paramedic and an emergency medicine resident started CPR on the patient, who was neurologically intact on discharge from the hospital.
Extending the Reach
Since the airport project started, the public access AED program has been extended to five public golf courses, as well as all city senior centers and office buildings.
The fire department has 350 Philips HeartStart AED units in service in Phoenix, counting those in the airport, public facilities and on-board fire apparatus and ambulances.
Members of the Phoenix Fire Department maintain the publicly mounted AEDs on a monthly basis. Some of those units, according to Gallagher, were put into service a decade ago and are still functional.
When an AED is used in the airport, Gallagher’s team is notified and he tracks each patient. He has also personally interviewed all but one of the survivors since the program started.
Just a few months after one of the resuscitations in 2006, Gallagher was invited to the patient’s birthday party. “They were all very grateful,” Gallagher says. “Otherwise, they wouldn’t be around.”
When Gallagher recalls how he and Khan approached the Phoenix officials in 2001 to start the program, and how council members trusted him and Khan, he realizes the bet paid off with the successes they’ve produced.
“When I see these people, it’s another person who is alive because of those efforts by the fire chief and others involved, and seeing that result is a tremendous personal satisfaction,” Gallagher says. “The biggest thing is to see them interact with their families. Often they’re going back to work, whatever it is, and there definitely is a significant reward.”
The cost of the AED program and maintenance is covered as part of the Phoenix Fire Department’s annual budget. The initial expense is about $2,000 per unit, but given that some have been in place for a decade already, Gallagher sees that as a small price over time.
“For each person we’ve saved, obviously, it’s priceless,” he says. “But it’s an investment. If your city is looking to improve survival rates from cardiac arrests, it’s worth it.”
He also gets a level of personal satisfaction out of the program. “Personally,” he says, “I see this as kind of the goal we should have for all of our cities.”
Because of the Sky Harbor International Airport experience, Gallagher can’t walk through another airport or public place without looking for the positioning of AEDs.
“I’m always looking,” Gallagher says. “If someone goes down, I want to know where [the AEDs] are.”
Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.
This article originally appeared in an editorial supplement to the September 2011 JEMS as “Surviving SCA at Sky Harbor: Airport AED program boasts 75% survival rates.”