How did the idea of putting automated external defibrillators (AEDs) in all Ohio schools come about? How did you get started? About eight years ago, Josh Miller, a 15-year-old high school football player from Barbarton, Ohio, ran off the football field on a Friday night and collapsed. He died of a sudden cardiac arrest (SCA). I had the unfortunate experience of watching the videotape of his death, and it was the most sickening thing I ve ever seen in my life. It was like going to a movie that you had seen a 100 times before and knew exactly how it was going to end, but you were hoping and praying it would end differently. In that normally boisterous stadium you could hear a pin drop, except for the wail of his mother it was a sound that reverberated in my soul. At the time, I was then President of the local chapter of the American Heart Association (AHA). I served on a panel with Josh s father several months later, and as we talked about how we could prevent this from happening again in our community, a TV reporter approached us and said Mr. Miller, these AED devices cost over $3,000 don t you think that s a lot of money? Mr. Miller, who is a man of few words, looked at me as he responded you know, it doesn t seem like a lot of money to me. It was like a bolt of lightening had gone through me. I thought, you know, he s right it s not a lot of money. So I went on a mission to raise money to put an AED in every junior high and high school in Summit County. We ultimately succeeded in that endeavor, and the AHA named me their National Physician of the Year as a result of that. I say that not as an accolade to myself, but as a testament to the mission. I then thought to myself Why are we stopping here? I joined a group called the National Center for Early Defibrillation, which was amalgamated with people who had done similar initiatives, although most of them were people who had lost their children to cardiac arrest. Some of the people I met were John and Karen Acompora, who lost their son Louis in 2000. Louis died from commotio cortis after being struck in the chest by a lacrosse ball during a game. The Acomporas turned their tragedy around when they helped create the Louis Law, which required that every high school in the state of New York have an AED. Later John Acompora and I went to Capitol Hill to discuss the issue of AEDs in schools, but it became clear to us that if we weren t one of the congressperson s or senator s constituents, they couldn t help us. The common thread was that this had to be done at a grassroots level. Even after what we accomplished in Summit County, nobody two counties over knew anything about our initiative. To have every community in the country have this manifest was a virtual impossibility. Usually when there is a death of a child, schools are more open to having AEDs; however, for those schools that haven t had that happen to them, it can at times be difficult to convince them to purchase an AED. I needed a plan. Were you aware of any other states that had similar AED programs for schools? The Acomporas created the first statewide AED program in the United States. Their NY mandate to place AEDs in all public schools (K-12) was unfunded. It included training as a requisite. Each school had to figure out which AED to purchase, so if one school was calling one AED company and another school was calling another company, they weren t going to get as good a price as they would have if they had bought in bulk. In the state of Pennsylvania, the Moyers, who lost their 15-year-old son Greg, got the state to purchase two AEDs for every school district not every school, but every school district. It was a great start, but one school district might have 30 schools. How does the Ohio AED program work? Which schools received AEDs, and how many were given to each school? How much did the Ohio AED program cost to implement? Was AED training provided as well? To create the program, I took the best of all the other statewide programs and came up with what I believed to be the first comprehensive AED program for the state of Ohio. The plan: 1) covers the cost of training of five individuals and makes sure that training occurs (the worst thing you could do is just plop an AED into a school); 2) covers the cost of the defibrillator; 3) aligns the local paramedics with the school so that they know there is an AED at the school; and 4) also notifies the local 911 service to be aware that if someone calls from a school saying someone has collapsed, the first thing the 911 operator will tell them is to go get the AED and where it is located in the school. The next task was to come up with the funding. The legislators in our state embraced this program with near unanimity, realizing that it was a very important thing to do. The first grant that we received from legislature was for $2.5 million. As we were proposing this to the various legislators, children kept dying from cardiac arrest in the state of Ohio. Unfortunately, Ohio has the second highest death rate among children in the U.S. In the first phase of this initiative we placed 2,270 defibrillators (which covered training, cost, etc.) in schools throughout the state. In fact, we oftentimes didn t have to pay for training because the local paramedics in the community saw this as a great community effort and embraced it as such. They would much rather arrive at a school and find an individual sitting up and talking to them who had been successfully shocked out of his or her heart rhythm disturbance, than see a child who is not responding and perhaps vegetative. The program was also accepted by many different organizations in the state, such as the Department of Health and the Department of Education. I even got the trial lawyers to send me a letter that they were in support of the AED program, because one of the biggest stumbling blocks is the liability concern, that is, it s not my job we ll just wait for the paramedics. We all know that doesn t work, because for every minute that someone is in cardiac arrest or ventricular fibrillation, his or her chance of survival drops by up to 10 percent. Nationwide the average response time is about 8 to 12 minutes, depending on where you are, which is why so precious few people survive a cardiac arrest. We went back to the state a year later and told them we had some great responses and a number of saves, so the rest of the money was granted a total of $5 million. This was enough to put at least one AED in every single school in the state from kindergarten through twelfth grades of all public, private, parochial, charter, and vocational schools. We ultimately placed 4,574 AEDs. We finished the first phase in 2005 and the second phase in 2007; in the first phase we used Medtronic s Physio-Control unit, and in the second phase we used Cardiac Science AEDs. Have you encountered any opposition about the AED program? It was very difficult finding out which schools did not have an AED there was no registry and no one was required to notify anyone whether or not they had an AED. We sent out about four batches of postcards to every principal and superintendent announcing the next phase. Many schools jumped on board, but there were some schools that we really didn't have information on about whether or not they had AEDs, so I called every single one of them, and we re talking about hundreds of schools! Many of them already had AEDs, which is why they didn t apply. However, there were some that didn t have an AED, and despite our encouragement, decided not to get an AED, which to me was very disappointing. I would guesstimate about 300 schools in Ohio still do not have an AED because of this. So my goal of putting an AED in every single school met with a few that were just very resistant. I just hope and pray that nothing ever happens in one of those schools, because I believe the liability now is in not having an AED. Every school day 20 percent of the adult and child population are in schools, so it s very important that we get AEDs in these locations. Having said that, when we announced a couple of weeks ago that this initiative was complete, several schools requested a second AED, so we provided them with a second one with the state funding that we had left over. In fact, we still have some schools that didn t meet the deadline that are now calling on a daily basis saying we ve finally done it, where is our AED and we ve had to tell them that the initiative is complete. Fortunately, Akron General Medical Center, which administered both phases, has been very gracious. They used as little of the administrative fee as possible, and with the money left over, the hospital is purchasing AEDs for those schools. I m hoping that we can use Ohio s AED program as a template for other states; it would be silly to reinvent the wheel at this point. I proudly admit that I plagiarized from the great successes of the New York and Pennsylvania AED programs. They are to be commended for forging the path for the rest of us to follow. How many people have been saved in Ohio from AEDs now located on a school campuses? We ve had 12 saves in the state of Ohio since this initiative started. In the past three months there have been three children in Ohio who have had a sudden cardiac arrest; sadly, one of them did not make it, but the other two did. Perhaps the greatest story is from one school that received their AED one day before a 13-year-old suffered from SCA. Now tell me you don t believe in divine intervention! When you hear a story like that, it s all worth it. We ve had four children from Summit County who have died. We really don t know why these incidents seem to be increasing. We know we ve done a great job decreasing the number of sudden deaths in adults, but those in children seem to be increasing, though many of them are due to undiagnosed congenital heart defects. My mission in life now is to save our most precious resource: our children. There is no reason why we can t do that. What would you say to convince people of the need for AEDs in schools? We ve always told people that if they have an emergency to call 911. It is a very important thing to do, no doubt about it. CPR is also an important thing to do, but CPR alone doesn t work as well as CPR combined with an early shock from a defibrillator. CPR can increase your chances up to eight percent (compared with no CPR), but with an AED anywhere from 33 to 50 percent of people will survive, and that has been well documented. A good study was done in a casino where they were monitoring people all of the time. The casino had about a 50 percent survival rate or more because these were observed events, the staff were able to get to the people right away, and they had the defibrillators on site. This is significantly important to note for schools located in rural communities; those children and individuals are at risk without an AED nearby, especially considering that many schools also double as community centers in rural communities. There was an elementary school in Ohio that decided during the first phase that they didn t need AEDs in their elementary schools it s a well-known fact that more often it is in middle schools and high schools where children have cardiac arrests but in this particular school the principal decided they didn t need AEDs there. One of the parents gently coerced the principal into getting one, and reluctantly he did. Then on December 15 they were having a Christmas party and all 750 elementary schoolchildren were anxiously waiting for the arrival of Santa Claus, who jumped up on stage and had a cardiac arrest right in front of all these children. The paramedics arrived over 15 minutes later, and the AED that they really hadn t wanted had in fact saved Santa. Describe the legislation being introduced that would expand access to AEDs in schools nationwide. What does the legislation propose? How much would it cost to equip schools nationwide with AEDs? U.S. Rep. Betty Sutton (D-Copley Township) is crafting legislation as we speak; the goal is to obtain funding to place AEDs in every U.S. school (kindergarten through twelfth in all public, private, parochial, charter, and vocational schools) across the country. The legislation will be introduced in late December 2007. Of course, there are a number of schools that already have AEDs; certainly in the state of Ohio they wouldn t have to spend as much money! I believe the state of Texas has come up with $12 million to do the same thing, and I believe New York now has AEDs in all of their public schools. It will certainly be an arduous task but manageable, much as we ve proven in the state of Ohio. Would each school have their choice of where to place the AED, or is there a particular location recommended for AED placement? We suggest that the AED be accessible to everyone in the school. The worst case scenario actually happened in one of our Ohio schools. A magnanimous philanthropist donated an AED to a couple schools and also to the local police vehicles. At one of the school s basketball games, one of the players collapsed, and unfortunately the AED was locked in the principal s office, still in its box, and no one had been trained in its use. Fortunately one of the cops who was on the scene ran out to his police car and got the AED that he had been trained on. Most AEDs are like a laptop in that when you open it, it starts talking, and when you shut it, it turns off. There were two nurses tending to this young man; the cop kept opening the AED and the nurses kept slamming it shut because it was making too much noise! Finally the cop implored the nurses to place the defibrillator patches on the kid and shock him, and save his life. Therefore, the worst thing you could do is place an AED in a school and not have it accessible or have awareness in the community that it s there. What do you think will be the next step? Is there a similar program already in place to put AEDs in all public places in Ohio? There are public access to defibrillation (PAD) initiatives in place across the country. However, our goal is to get AEDs everywhere. The belief is if you can t get to a patient and give them a shock within five minutes, then you need to have an AED on hand. That is why more schools certainly need them. In Summit County we ve also raised money to put AEDs in every police, highway, patrol and sheriff s vehicles; the reason this is so important is that 80 percent of law enforcement responds to medical emergencies, and 60 percent of the time they arrive first. Therefore, they are often able to deliver the life-saving shock three and a half minutes quicker than the paramedics. What this extrapolates into is that a person who is shocked by a police officer on scene has a 10 times greater chance of walking out of a hospital than if they were to wait for the paramedics. Of course this is no affront to the paramedics we have the best paramedics in the world! The problem is that there are so few of them, so sometimes they might be on the other side of town, stuck in traffic, on another run, etc. Since there often are many more police vehicles on the streets all the time, it makes sense to put the AEDs in these vehicles. Smoke detectors, which are mandated to be in every building, save 6,000 people every year; we could save 10 times that if not more if we had AEDs everywhere. In addition, AEDs are so easy to use. There was a study that trained seventh graders and paramedics at the same time in the use of an AED, and I believe it took the seventh graders a whopping 29 seconds longer to figure it out. The algorithms that are in the AED are the same ones we use in the hospital, so if you don t need a shock, the AED won t deliver it. It s a very safe device. How can others get involved in support of this bill? My advice is not to wait until the cardiac arrest occurs don t wait for a child to die and then go out and get the AED. I truly believe this program has to come from the national level. Certainly it will take a national mandate and funding, because schools cannot financially afford AEDs, nor can they afford to be without AEDs. When I first appeared before the Ohio Board of Education I told them this will only cost 1 penny per student and they almost laughed me out of the room, because they don t have that penny. They are already cutting corners so much trying to give our children the best education possible with limited funds. Therefore, funding is an absolute, we must have the funding in order for this program to work on a national level. As a physician, one of the truly toughest things that I have had to do is look into the eyes of a parent who has lost a child to SCA. We must do something about these tragedies. AEDs definitely save lives, it s that simple. As it is written in the Old Testament and the Koran, if you can save one life, you can change the world.