Department of hmm….

by on January 6, 2008 at 8:56 am in Medicine | Permalink

People who suffer a life-threatening alteration
in heart rhythms are more likely to survive if they are in a casino or
airport than if they are in a hospital, researchers have reported.

Doctors
already knew that more than half of those who suffer such attacks in
airports and casinos survive. But a new study in hospitals shows that
only a third of victims there survive, primarily because patients do
not receive life-saving defibrillation within the recommended two
minutes.

Here is one summary, here are others. Note of course the results do not adjust for the lower quality of patient in the hospitals.

John Phillips January 6, 2008 at 9:05 am

I’m a frequent casino visitor, and I’m not convinced at all you’ll find higher status individuals there on average, perhaps the opposite (with the exception of perhaps the ritzier Vegas casinos). Granted this is just my anecdotal evidence, but even in theory one usually thinks of gambling as a lower class pastime in the context of lotteries for example…

Kinney January 6, 2008 at 10:26 am

I think it has to do with the fact that if you are in a hospital they will try to diagnose the problem to figure out what is wrong, try to get your health history, etc. so they don’t unnecessarily electrocute you. While if you are in a casino or airport somebody is going to do the only thing they “know” how to do. This is not a defense of hospital’s, I still think they should be better, but a possible explanation.

Anonymous January 6, 2008 at 11:14 am

every single death in a hospital is probably counted for in a study on hospital mortality rate. every single death in an airport/casino accounted for in that study?

save_the_rustbelt January 6, 2008 at 1:27 pm

Having used an AED (auto defib device) on a cardiac arrest victim in a public place, it is very unlikely responders would find the device, establish an airway, cut or rip off the victim’s clothing, attach the sensors, activate the machine, and do all of that in two minutes or less.

I’m not a clinician but with decades of CPR and related training I couldn’t do it.

Worst 8 minutes of my life (until paramedics arrived), but successful. Paid for all of those Red Cross courses.

EclectEcon January 6, 2008 at 6:35 pm

It might just boil down to which place has a physician on the premises.

Many smaller hospitals do not have emergency-room physicians. In our small town, a doctor is “on-call”, which means that if someone shows up with, say, chest pains and graying clammy skin, it might be 15 minutes before the doctor arrives. The ER staff might know what to do and how to do it before s/he arrives, but the odds are much lower.

At the same time, the mini-casino in our town (slots only) also has no physician on staff. The odds of surviving a heart attack there are probably no better than in the hospital.

The other Eric January 6, 2008 at 9:14 pm

Please don’t confuse single doctor perspective with research. Research requires quite a bit more than biased anecdotal notes. The NYT article I read about this, which confused heart attacks with cardiac arrest, was incredibly inaccurate.

And has anybody noticed the complete absence of nurses in news coverage lately? Only doctors get interviewed, cited, or quoted when it comes to health care issues. Nurses don’t seem to exist in the news even though they are the primary care givers and health managers.

XiaoXi January 6, 2008 at 9:34 pm

Maybe, just maybe, it has something to do with the fact that someone who has been walking around at an airport or a casino before experiencing this problem generally has fewer other contributing health complications than someone already in a hospital who goes into arrest.

Of course the AEDs in casinos and airports (and more and more places) are wonderful things–but EMTs tell me the main reason AEDs don’t work is that people are too afraid to use them! There is no chance of using them improperly: if the AED does not sense a problem with the heart’s rhythm, it won’t discharge. So don’t hesitate! Grab the AED and let it walk you through what you need to do.

TomHynes January 7, 2008 at 5:05 pm

Why not an easy technical fix? Give every hospital patient a simple, battery powered pulse monitor. Siren goes off if it loses a heartbeat. Minimize false alarms by a gentle beep if no signal for 5 seconds, which the patient can cancel. Heart rate monitors are $49 at sporting goods stores.

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