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Technology vs. peril: Raising the bar on safety

September 18, 2013

It’s a wonder we’ve made it this long with all the chances we take with our lives, and it can be frightening to think of what the world would be like if we hadn’t occasionally done so. For example, we have Automatic External Defibrillators (AEDs), the first prototype of which was basically two spoons attached to an extension cord that was plugged into a wall outlet. Oh, and the spoons had to be placed directly on your heart.

The FDA is giving increased attention to AEDs due to failures that have occurred during some attempts to restart victims’ hearts. It is suspected that in some cases the electronics design was the cause. One possible outcome is that AED manufacturers may be required to submit a Pre-Market Approval (PMA) for products which are already on the market and in use. They would still be allowed to manufacture and sell the devices, which is an endorsement of the “Something Is Better Than Nothing” principle.

There is naturally some tension between the FDA, AED manufacturers and other parties about this issue: how many device failures vs. operator errors have actually occurred, how serious are the recalls that have been issued, the costs of the enormous amount of work involved in preparing and submitting a PMA, what that might do to prices and subsequently, the number of AEDs installed in the field. There are jobs, lives, time and money at stake and the tradeoffs are more complicated than you might think. It’s a prickly debate, but I have faith that it will all get worked out.

I think a little reflection and gratitude are in order: what these devices can achieve is nothing short of miraculous. I submit that if your heart has stopped, the scales have tipped in favor of there being waaaaaay more wrong with you than right. In fact, you're mostly dead. If you stay that way very long (more than about 10 minutes) you’re not ever going to get better. Using an AED is a last-ditch effort at saving a life.

We are betrayed by our collective expectation that there should always be something that can be done to save us.

Back when I was growing up, all we had was CPR or pounding on the victim's chest with both hands clasped together, yelling, "Live, damn you! Live!" (Ah, the precordial thump … Those were the days.) Nowadays it’s at least possible that if you have a sudden cardiac arrest in a public place, there may be an AED somewhere nearby that a kindly passer-by or schoolchild could fetch and operate, which just might enable you to post about your brush with death on Facebook the very next day. In fact, there is an AED on every U.S. commercial flight, where medical emergencies can be very difficult to respond to quickly.

It’s also worth noting that AEDs are unique: they are highly sophisticated pieces of emergency medical equipment that are placed much like fire extinguishers, drinking fountains or phone booths. (No, I will not explain what a phone booth is. Look it up in an encyclopedia, kiddo.) Usually if there is a serious medical emergency, you need an EMT or doctor along with equipment that you can’t afford to buy and don’t understand how to use. There are some notable exceptions: some diabetics keep a candy bar or other source of sugar with them at all times, and people who have really bad allergies carry epi-pens.

There is a very old saying about protecting your feet from sharp rocks and tree roots as you walk on the ground: it isn’t possible to cover the entire Earth with leather, so the more sensible thing to do is to instead wrap our feet with leather. If we do that, our feet are protected wherever we go. (This was before the Streets Department started pouring cement sidewalks, which was a major advancement for pedestrians.)

Technology can be used like leather to protect us from harsh conditions. (Come to think of it, leather is technology!) I think we stub our metaphorical toes, trip and fall when we believe that the world is actually covered in leather and that we can walk barefoot everywhere. Or when we insist that there just shouldn't be rocks allowed, no matter what those silly geologists say. We are betrayed by our collective expectation that there should always be something that can be done to save us; that there is always a sufficiently effective and robust technological defense at our fingertips. Even as our throat swells shut during an allergic reaction or as our heart twitches uselessly during cardiac arrest.

You see, we haven't really changed the world all that much: we still have jagged rocks, gravity and ventricular arrhythmia. Our ability to manage the risks associated with those things continually changes and improves though, even to the point of appearing to cover wide swaths of the planet with hi-tech leather.

We constantly raise the bar on safety and emergency equipment in part because we constantly raise our expectations of activities and experiences. It's an upward spiral of speed, distance, maneuverability and longevity. We like to go faster, further and longer, with less planning and nothing in our pocket but an Internet connection. And so I have every confidence that in the long term AEDs will become cheap, plentiful and even more reliable. It’s just what we do: we push boundaries. We push back against gravity, sharp edges and death. Sometimes we do it with a sense of entitlement, sometimes contempt and sometimes adventure. But perhaps we could do it more often with childlike wonder and a sense of humor.