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Elizabeth Aiello flips open a red plastic case that looks like a laptop computer, plugs it in, pushes a button and listens as it begins a series of robotic commands she hopes she'll never hear in a real emergency.
"Apply pads to patient's bare chest," it orders. "Plug in pads connection next to flashing light."
But something's wrong here this rainy night at the East Cobb YMCA.
"Pads have not made a connection," the machine says. "Reapply pads." She does, on the chest of a blue foam rubber dummy named Annie.
If Annie were a person, the automated external defibrillator, known as an AED, would keep giving orders, telling 24-year-old Aiello exactly what to do to save the victim of a sudden cardiac arrest, an unpredictable event in which the heart flutters wildly and then stops.
The condition kills 340,000 Americans a year, according to the American Heart Association.
But hundreds of people who would have died on the spot are being saved because health clubs, office buildings, airports and even golf courses are increasingly buying AEDs. And these public outlets are requiring folks like Aiello --- a YMCA employee with a degree in sports management --- to learn to use them.
A recent study released by the AHA showed that public access defibrillation has more than doubled in the past four years. In Atlanta, they're in many businesses, and even in a new fleet of 10 shuttle buses --- part of a system called "the buc" --- that run up and down Peachtree Street,
At the two dozen YMCAs in metro Atlanta, all 2,500-plus employees must complete six hours of lifesaving training within a few weeks of their start-date, which also requires passing a course on cardiopulmonary resuscitation, or CPR. Most larger health clubs in Atlanta have the same requirements.
"We hope it never happens, but if it does, everyone will be ready," says Maureen Nipaver, branch director of the East Cobb Y.
Technology advances in the past year or two have brought down prices of defibrillators while making them easier to use, sparking a national movement to have them placed in more public places, according to the AHA, which estimates 40,000 lives could be saved a year with broader deployment.
"They are inexpensive and pretty easy to use," says Dr. Winston Gandy Jr., a cardiologist at St. Joseph's Hospital and a board member of the AHA who was instrumental in the installation of 200 AEDs at Hartsfield-Jackson International Airport. "When a person goes into sudden cardiac arrest, you don't have but a few minutes to shock their hearts back into rhythm. People should be trained on them, of course, but most have easy instructions and voice commands that would allow just about anybody to use them in the worst possible scenario."
About 25 percent of sudden cardiac arrests occur in public places where victims could potentially be kept alive by AEDs, at least until professionals arrive.
A University of Washington study found that even sixth-graders following oral instructions could complete the defibrillation process in 90 seconds, compared with 67 seconds for people who'd received training. And after a sudden cardiac arrest, every second is precious.
But most facilities that buy AEDs --- ranging in price from $1,200 to $4,000 --- require training.
Training is important for another reason, says Dr. Steven Manoukian, director of interventional cardiology at Crawford Long Hospital. Operators of AEDs should know, as Aiello does, the difference between sudden cardiac arrest and a heart attack.
A person who's gone into sudden cardiac arrest needs an electrical jolt, but someone who's had a heart attack --- often caused by a heart blockage that disrupts flow --- may not, unless his heart's rhythm has stopped, Manoukian says. The machines are designed to tell their operators to stop using AEDs if a heartbeat is detected.
Gandy says Hartsfield-Jackson has been saving an average of two lives per month with the AEDs since they were installed last March.
Knowing their clubs have defibrillators makes members happy, especially those who've been working harder in the past few weeks to shed extra pounds gained in the holidays or who've simply recognized that they're not getting any younger.
"Every time I'm here, I look around at some people, or see myself in a mirror, and it always strikes me that many look like they're candidates for a heart attack," says Len Pagano, 51, president of the Safe America Foundation, a nonprofit group aimed at injury prevention. "They're sweating, out of breath. It worries me."
Mitch Mouchabeck, head of risk management for 16 branches of the Metro Atlanta YMCA with over 100,000 members, said it's important to know that just keeping people alive for a few minutes can be enough to give them back their life.
The AHA says only 5 percent of people who suffer sudden cardiac arrest live to make it to a hospital, but that 79 percent who are given an electrical jolt within two minutes survive. "There is no reason these things should not be everywhere," says Mouchabeck.
The White House designated February "American Heart Month" to raise awareness that heart disease kills more people than breast cancer, prostate cancer, AIDS, house fires, handguns and traffic accidents combined, Manoukian says.
"Sudden cardiac arrest can happen without any warning, any pains, anything," Manoukian says. "It is a silent killer."
Along with the AHA, the International Health, Racquet & Sportsclub Association is pushing for more of its 3,600 member organizations to buy AEDs if they haven't already. Also, the University of Pittsburgh has recommended that AEDs be placed in county jails, industrial sites, homeless shelters, nursing homes, doctors offices, sports centers and businesses --- areas its research says are most likely spots for sudden cardiac arrests.
Ted Daywalt, head of Vetjobs.com, a Marietta-based company that helps veterans find employment, says "it's good to know" that his Y has an AED.
"I turn 55 this week," he said. "I'm fine now, but you never know."
Copyright 2004 The Atlanta Journal-Constitution