BOSTON (AP) -- A man's deadly heart attack on a train has become the latest rallying point of people who advocate putting more portable defibrillators in public places. James Allen went into cardiac arrest last week and had to wait for proper medical attention while the train made two more regular stops. Medical experts said his chances of survival were slim without access to a portable defibrillator.
"This should be a wake-up call," said Dr. Steven G. Miller of the American Heart Association.
Defibrillators are required on airliners and in public places such as sports stadiums and large office buildings. But many places don't have them because of cost, liability fears or concerns that not enough people know how to use them.
Advocates for wider use of the lifesaving machines hope falling prices and cases like Allen's will cause more places to install them.
Allen's sister, Jeanne Peterson of Eau Claire, Wis., raised the issue soon after her brother's death.
"Jim was a very logical person, a patient, down-to-earth thinker," she said. "I have to think the logic here means training in CPR and defibrillators."
Amtrak, whose crews run the commuter trains for the Massachusetts Bay Transportation Authority, said in a report that the conductor of Allen's train was wrong to continue making scheduled stops. The conductor said he continued because he thought medical help would be best provided in downtown Boston.
During cardiac arrest, the heart quivers and stops pumping. A defibrillator restores the normal rhythm with an electric shock, but it must be used quickly. Once a patient enters cardiac arrest, chances of survival decrease by 10 percent for every minute treatment is delayed.
Defibrillators allow members of the public to provide urgent care until professionals arrive, said Dr. Vince Mosesso, medical director of the National Center for Early Defibrillation in Pittsburgh.
"You can have the greatest cardiologists in the world ... most of the time these people aren't going to be in the immediate vicinity in enough time to make a difference," he said. "You have to have bystanders that are willing to act."
About 250,000 people die from sudden cardiac arrest annually in the United States -- more than from breast cancer, prostate cancer, AIDS, handguns and traffic accidents combined, Miller said. The survival rate for sudden cardiac arrest is 5 percent.
But if a portable defibrillator is nearby, the odds dramatically improve, said Dr. Vinay Nadkarni, a Philadelphia pediatrician and chairman of the heart association's emergency cardiovascular committee.
For instance, after portable defibrillators were installed at Chicago's O'Hare airport, the survival rate for sudden cardiac arrest jumped to about 69 percent, compared to about 2 percent in greater Chicago, he said.
Defibrillators were invented in the 1980s, and the Food and Drug Administration approved a model for public use in 1996.
Portable machines weigh less than five pounds and have automated verbal commands that make them easy enough for a sixth-grader to handle. A 1999 University of Washington study found 15 sixth-graders delivered defibrillation only about 20 seconds slower than rescue professionals.
They cost about $3,000, but the price is falling, Nadkarni said.
Some have concerns that they could be held liable if something goes awry while people use defibrillators. But Mosesso said Good Samaritan laws offer significant protection from lawsuits.
The Federal Aviation Administration mandated the use of defibrillators in airplanes last year, but they aren't common on other transportation systems. Amtrak has started a pilot program and the Metro subway system Washington, D.C., has portable defibrillators.
Since Allen's death July 30, the Massachusetts Bay Transportation Authority has hired an outside consultant to review safety policies. Defibrillators are being considered for the trains, regardless of cost, agency spokesman Joe Pesaturo said.
State legislators have approved a bond bill that would fund grants for public defibrillation programs and equipment.
