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Interview
4 February 2018 0.00 h

Dr. Ramon Brugada

A PROJECT WITH HEART

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‘When you save the life of 14-year-old, for example, how much money is that worth?’‘The biggest achievement of our project is changing the law’
How is the pro­ject to in­stall de­fib­ril­la­tors in pub­lic spaces going?
The pub­lic ac­cess de­fib­ril­la­tion pro­gramme in Girona is one of the most im­por­tant in Eu­rope, and we now have 723 de­fib­ril­la­tors every­where, with around 500 with pub­lic ac­cess 24 hours a day. The other 200 are with se­cu­rity and emer­gency work­ers and are mostly mo­bile de­fib­ril­la­tors. We have saved 36 lives after five years of a 10-year pro­ject. After this time a de­ci­sion will be made on whether the pro­ject jus­ti­fies in­vest­ing more money. The gov­ern­ment is also wait­ing to see our re­sults, so it can de­cide whether to ex­tend pub­lic ac­cess de­fib­ril­la­tion pro­grammes all over Cat­alo­nia. The bot­tom line is that we are sav­ing lives. The de­fib­ril­la­tor records every­thing that hap­pens, so when I get the data I see what hap­pened to the pa­tient, I know which of them would not have lived if it hadn’t been for the de­fib­ril­la­tor.
It’s tough de­cid­ing whether to roll out such a pro­ject on the basis of cost.
When you save the life of 14-year old, how much money is that worth? I have a friend who today is cel­e­brat­ing his nine-year an­niver­sary of being saved by a de­fib­ril­la­tor. He’s now healthy and lead­ing a nor­mal life, work­ing at the uni­ver­sity, but how can you put a num­ber on that; it’s im­pos­si­ble. How much is a life worth? I can’t put a num­ber on it.
What ar­gu­ments can be made to ex­tend the pro­ject to the en­tire coun­try?
When we started the pro­ject, I told those against it they were fight­ing a los­ing bat­tle; you can’t argue against a ma­chine that costs €1,000, that can be put any­where and that saves lives. There is no ar­gu­ment against it be­cause these peo­ple would die oth­er­wise and you are sav­ing their lives.
What num­ber of peo­ple might need the help of a de­fib­ril­la­tor?
There are around 3,500 sud­den car­diac deaths a year in Cat­alo­nia. Re­mem­ber that deaths from car ac­ci­dents ac­count for be­tween 200 and 300 a year. Well, 80% of the 3,500 sud­den car­diac deaths are as­so­ci­ated with coro­nary dis­ease. These peo­ple are usu­ally over 40, and this is around 80%. The rest are usu­ally as­so­ci­ated with in­her­ited and ge­netic con­di­tions, and they can kill very young chil­dren under the age of one, sud­den in­fant death syn­drome, or peo­ple aged 15, 20 or 30. These may be very healthy in­di­vid­u­als who are func­tion­ing very well in so­ci­ety, but all of a sud­den they die. What’s more, if we can save these in­di­vid­u­als they can go back to en­joy­ing a nor­mal life.
It’s amaz­ing these peo­ple can go on with life as if noth­ing had hap­pened.
What hap­pens is that in­stead of beat­ing, the heart starts trem­bling. And so the blood is not pumped prop­erly and stays in­side the heart. So the brain doesn’t re­ceive any blood, and they lose con­scious­ness. You then have 10 min­utes to re­cover the in­di­vid­ual. You have to reset the heart with an elec­tric shock so that it starts beat­ing again. This is the crit­i­cal pe­riod and that’s why an am­bu­lance can­not reach the in­di­vid­ual; some­one has to use a de­fib­ril­la­tor on this per­son, and that’s why we rec­om­mend de­fib­ril­la­tors every­where. The longer this process takes, the more likely the in­di­vid­ual will suf­fer some sort of con­se­quence. The shorter the time, the more likely the in­di­vid­ual will re­cover com­pletely.
If I see some­one col­lapse, how would I know that they needed a de­fib­ril­la­tor?.
The biggest achieve­ment of our pro­ject is chang­ing the law. Be­fore, the law said you can­not use a de­fib­ril­la­tor if you have not been trained. When you ex­pose peo­ple to this men­tal­ity, they in­ter­pret it as : if I need train­ing it must be very dif­fi­cult. But now the law says that in the case of an emer­gency, any­one can use the de­fib­ril­la­tor, even with­out train­ing. The rea­son for this is that the equip­ment is very smart. You open the box, it’s al­ready con­nected and it gives you in­struc­tions, such as “re­move the shirt and place the patches as in the il­lus­tra­tion.” Once you’ve done that the de­fib­ril­la­tor starts in­ter­pret­ing the sit­u­a­tion com­pletely au­to­mat­i­cally; you don’t even need to push a but­ton. If the de­fib­ril­la­tor says that it can do noth­ing in this case, you couldn’t give that in­di­vid­ual an elec­tric shock even if you wanted to. So, you ask your­self when should I use it. Well, the pa­tient is un­con­scious on the ground, so give it a try. The worst thing that can hap­pen is that the ma­chine tells you it doesn’t need it. And that’s why we were able to change the law, be­cause you’re not ac­tu­ally doing a real med­ical in­ter­ven­tion.

ENG­LISH HOUR going na­tive

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