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ST. PAUL, Minn. -- Where can you go to fix a broken heart? An ambulance service based in St. Paul is working with a Florida company to answer the question with a map of all automated external defibrillators in the Twin Cities.
With the map and an electronic system for alerting good Samaritans, the emergency call center at Allina Medical Transportation hopes it will be able to quickly dispatch not just ambulances to cardiac arrest patients but also the nearest automated external defibrillator.
The local effort is just one example of how communities coast to coast are using crowd-sourcing and other means to develop registries that might harness the public health potential of the devices, called AEDs for short.
"This is a way to increase the functionality of the AEDs and make them a community resource," said Dr. Charles Lick, medical director of Allina Medical Transportation.
Automated external defibrillators are portable, lightweight devices that can deliver an electric shock through the chest to restart the heart. They help patients stricken by sudden cardiac arrest, a condition that causes death if not treated within minutes.
A patient's survival chance drops by 10 percent with every minute that passes, so emergency medical services are interested in using the thousands of AEDs that are scattered across Minnesota. If a volunteer can get a device to a patient even a few minutes before paramedics arrive, it can make a big difference, Lick said.
Over the past decade, AEDs have become commonplace in schools, shopping malls, workplaces and other public spaces. Even so, there are cases in which witnesses to cardiac arrests don't know that a machine is nearby. At other times, people with access to a defibrillator don't know of a nearby patient.
Across the country, many are trying to address the information gap.
Last year, the fire department in San Ramon, Calif., developed an iPhone app that people in the Bay Area town can use to find the nearest AED in an emergency.
In January, researchers at the University of Pennsylvania took steps toward creating a registry for Philadelphia by asking people to submit photos of AEDs as part of a contest. The participant who uses a contest mobile phone app to submit the most AED photos - tagged with location and other details about machines - could win $10,000.
Meanwhile, the New York-based nonprofit group iRescU recently concluded its own find-the-AED contest with an awards ceremony on Valentine's Day. Dr. Nadine Levick, the founder of the group, hopes to launch this year a mobile phone app in five cities that people can use to find AEDs.
"We're doing this as a public health project," Levick said. "Most AEDs are not in a database anywhere."
In the Twin Cities, Allina Medical Transportation and an emergency medicine group at the University of Minnesota have opted to develop an AED registry in conjunction with a Florida company called Atrus Inc.
Whereas the California and New York systems are designed for people to call up information about AEDs on their mobile phones, the Atrus program - which goes by the name AED Link - is meant to be a resource for 911 operators.
When 911 centers get cardiac arrest calls, AED Link automatically looks to see if a device has been registered within 300 feet of the patient. If so, the system sends a text message or cellphone call to an individual or individuals who have agreed to consider bringing the device to sudden cardiac arrest victims.
Whereas registry developers in New York and Pennsylvania are calling on the general public to find AEDs, the Minnesota system is asking the companies, governments, schools and individuals that own the machines to register their devices, said Kim Harkins, program manager for the Minnesota Resuscitation Consortium at the University of Minnesota.
Registration gives machine owners free updates from AED Link about when they should replace batteries and electrode pads.
"This has the ability to help the owner of the AED manage their device better," Harkins said. "There have been instances where AEDs have been pulled out and the batteries or electrodes have expired."
When device owners register their AEDs, they identify who should be notified in the case of a nearby emergency and during what hours. People who receive those messages are asked to reply to the 911 center and indicate whether they can respond.
If message recipients say they can't respond and a cardiac arrest victim dies, could the owner of the AED be held liable?
"I'm not a lawyer, but from what I understand there is no duty to respond," said Elliot Fisch, the chief executive officer of Atrus. Owners who register also can decline to receive notices; such information, though, could still be useful for communities to strategically place new machines.
Although the service is free to device owners, 911 centers typically must pay for it. A 911 center covering a city the size of St. Paul - with about 285,000 people - would pay about $34,000 to use the service for three years, Fisch said.
That works out to about 4 cents per person per year.
"The whole genesis of our system is that entry into pre-hospital cardiac arrest care by a layperson is simply: Call 911," Fisch said. "That's where we believe the information should be about where defibrillators are located."
"People say to us: Where's your iPhone app?" Fisch added. "I say: It's on every phone, and it's called 911."
Currently, the Minnesota registry includes about 400 AEDs, said the U's Harkins. She estimates there are thousands of unregistered devices across the state.
Allina Medical Transportation is not paying for use of the AED Link system during the first two years of operations, said Tim Burke, a spokesman for the Minneapolis-based Allina Health System. The Allina service does not dispatch ambulances in St. Paul but works from a call center in the West Seventh neighborhood to dispatch ambulances in parts of 10 counties, including Anoka, Dakota and Ramsey.
In the first two months of using the system, no sudden cardiac arrest events have occurred near a registered AED, Allina officials said. Even so, other ambulance services in the metro said they are interested to see how the program works.
"It makes good sense," said David McGowan, director of clinical and operation quality with HealthEast Ambulance. "The sooner you can get an AED on a patient, the better it is."
Organizers of the University of Pennsylvania registry hope to collect information by the end of this year and share it with local 911 centers. That way, call center operators can guide people phoning in an emergency to the nearest AED.
In the Twin Cities, organizers hope that registry information will be more reliable because device owners submit it while Atrus provides updates.
Fisch, the company's CEO, questioned whether crowd-sourced registries would quickly capture when AEDs either are relocated or unavailable. A crowd-sourced registry might send people searching for an AED that isn't actually an option, he said, because the doors to a school or workplace happen to be locked at that time of day.
Still, Fisch said there's room for the various registries to work cooperatively.
"Our mantra is: You can't get a defibrillator if you don't know where it is," Fisch said.
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