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Many nursing homes lack device to restart heart

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Robert Boerst, a registered nurse and patient-care supervisor at the Lake Park nursing home in Sylvania, says nurses there have used the defibrillators seven or eight times since adding them about a year ago, including the three times he s used them. Mr. Boerst said some of those patients were saved whootherwise could have died had the defibrillators not been used.


Automatic external defibrillators, portable devices used to jump-start a heart beating erratically, can be found in a lot of places. Fifth Third Field has one; so does Toledo Express Airport.

But if you suffer a heart attack in most nursing homes in Lucas County, or other areas of the country, you won t find one.

Dr. David Lindstrom, medical director for Lucas County Emergency Medical Services, was stunned to discover that especially when he looked at where all the cardiac arrests in Lucas County were occurring.

Nearly 1 in 4 cardiac arrests last year and in 2004 happened in nursing homes.

I was shocked, Dr. Lindstrom said. I thought big doctors offices would show up the most and they didn t. I mean, good grief!

And don t assume that most people in nursing homes have do not resuscitate, or DNR, orders, Dr. Lindstrom said. No, the 1-in-4 number is for those who don t have such orders, meaning they expect everything to be done to revive them, he said.Automatic external defibrillators, also known as AEDs, are small devices that are hooked up to an individual who has had a heart attack. The machines automatically detect whether the person s heartbeat is erratic in medical terms, suffering from arrhythmia which is quite common.

Cardiopulmonary resuscitation (CPR) alone will not save these patients. If the heartbeat is irregular, the device instructs the user to press a button and an electric current is discharged.



Because many nursing homes lack defibrillators which cost $1,500 to $3,000 and are becoming the standard of care for treating

many heart-attack patients Dr. Lindstrom argues that too many nursing home patients could be dying who otherwise might be saved.

Essentially, all that s happening is there s a delay built in right now if they don t have a device, he said. Their expectation is that the fire department or county life squad will bring the device they need. But that s an unnecessary delay in care. For every minute we lose, you lose a 10 percent chance of survival.

Most nursing home officials interviewed, as well as elderly advocates, told The Blade that no one has ever raised the issue before. This is really the first time in my 25 years I ve ever really heard it brought up, said Stephen Mould, spokesman for the Ohio Health Care Association, a trade group representing about 750 long-term care facilities in the state.

After doing some research on the issue, Mr. Mould said that while some facilities have defibrillators, many others choose not to for a variety of reasons. Because many nursing home patients have do-not-resuscitate orders, he said some nursing home administrators feel such a device is likely unnecessary.

Some facilities have told us, We ve got them and they re sitting

on the wall and we ve never used them because of the DNR request, Mr. Mould said.

Dr. Lindstrom s response is simple: What about those who don t have such orders in place?

Rey Nevarez, administrator of the Orchard Villa nursing home in Oregon, said his organization is definitely discussing placing a defibrillator in the building, where Dr. Lindstrom s statistics indicate there were five reported cardiac arrests last year.

Mr. Nevarez said many issues have to considered. It s not as simple as just putting one up. There s training involved, he said.

Dr. Lindstrom counters that portable defibrillators have become very easy to use. That s why they stick them in airports, casinos, and other public locations, he said. The standard of care in America is moving toward public access to defibrillation. It s like having a fire extinguisher. You pull it off the wall and push one button, he said.

This is a simple device and it should be used. The issue is having one available to be used. Dr. Lindstrom said he s speaking out now because his earlier efforts to convince nursing homes to get defibrillators have mostly failed. In 2003, he and Kris Pupos, regional director of community initiatives of the northwest Ohio division of the American Heart Association, quietly approached nursing homes in Lucas County. They chose Lucas County because it s the only county Dr. Lindstrom said he is aware of in Ohio that has analyzed where cardiac arrests are occurring though Ms. Pupos said it s likely many other counties have about 25 percent of cardiac arrests happening in nursing homes.

Dr. Lindstrom and Ms. Pupos showed Lucas County nursing home officials some of their preliminary data showing that 25 percent of cardiac arrests were occurring in their facilities.Those who suffered cardiac arrests are people whose loved ones expect everything will be done to keep their loved ones alive, Ms. Pupos said.

These are often people that still have a lot of living left to do ... and long-term care is not just about going somewhere to die, but rehabilitating them to go home.

Though some nursing homes were receptive to adding defibrillators,

We haven t seen much of a response, Dr. Lindstrom

said.Lake Park, a large six-story nursing home on the campus of Flower Hospital in Sylvania, placed three defibrillators in its building after its parent company, ProMedica Health System, agreed to buy them.It was an easy call, according to Mark Mullahy, administrator for Lake Park.

Many of our residents are sicker, but many are younger. We get 50 or 60-year-olds here [recovering] from hip replacement and who need rehab, he said. It just made a lot of sense. Before, we d call 911 and it only took two or three minutes [for help to arrive], but Dr. Lindstrom said that two or three minutes makes a difference.

Robert Boerst, a registered nurse and patient-care supervisor

for Lake Park, said nurses have used the defibrillators seven

or eight times since adding them about a year ago, including the three times he s used them.He said the device was simple to use: It tells you everything you need to do.

Mr. Boerst said he didn t know the outcomes for all the patients but added that he knows that some of those patients were saved who otherwise could have died had they not been shocked with the defibrillators.

Arbor Health Care at Toledo added a defibrillator about a year ago. Apparently a wise decision if one goes by Dr. Lindstrom s statistics: Arbors of Toledo reported 17 cardiac arrests last year, the most of any long-term care facility in the county.The facility is owned by Milwaukee-based Extendicare, which also owns facilities in Sylvania,

Oregon, and Waterville.

Shawna Haering, a registered nurse and regional director of operations overseeing the local Arbor facilities, said her company

has ordered a defibrillator for its Sylvania facility and eventually wants to add them in Oregon and Waterville too.

Still, Ms. Haering said defibrillators in nursing homes are the exception, not the rule. For example, of the 30 long-term care facilities Extendicare owns in Ohio, Toledo s Arbor facility is the only one that has a defibrillator.

It s acting as a pilot program for the entire company, she said.

She said she s glad the trend toward acquiring them appears to be catching on, at least for her organization. I m a nurse by trade and it just made sense, she said. Even though Arbors of Toledo is so close to the hospital, it just made sense to give us a little more time.

No state or federal rules require defibrillators in nursing homes, according to Mr. Mould.Beverly Laubert, Ohio s long-term care ombudsman, said that s not necessarily a bad thing. As ombudsman, Ms. Laubert acts as an advocate for the state s long-term care residents, fielding concerns and complaints from residents and their families.

Ms. Laubert said it might make sense to add defibrillators in some facilities, but she said it depends on the facility.Some nursing homes have hospice patients; others are facilities geared more toward rehabilitating younger patients. And, like some nursing home officials, she said it wouldn t be wise just to add a device without proper training.

Ms. Pupos, echoing Dr. Lindstrom s complaint about that rationale, disagreed. Most of these devices are simple to use, she said. If they are a true AED, they re designed to be used by someone with a third-grade education.

Contact Luke Shockman or 419-724-6084.

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