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November 10, 2009

Boston trains without defibrillators called safety risk

By Richard Wronski
The Chicago Tribune

BOSTON — James Allen, his heart beating wildly out of rhythm, collapsed shortly after he boarded a commuter train.

Despite pleas from passengers and from a doctor who performed CPR on the 61-year-old Wellesley scientist, the conductor refused to halt for emergency help at the next station, or even two more after that as precious minutes ticked off.

If the Boston-bound train had carried an easy-to-use device that restores the heart's regular beat to those stricken with sudden cardiac arrest, Allen's chances for survival on that summer morning in 2002 would have been good, medical experts said.

But it didn't, and Allen died.

More than six years later, the Massachusetts Bay Commuter Railroad Co. in February became the first major commuter line to install portable automated external defibrillators, or AEDs, on all its trains. But it took a campaign by Allen's widow — who also filed a lawsuit — to make them more readily available in the Boston area.

Similarly, the death of a 64-year-old Barrington Hills financial executive onboard a commuter train last month has prompted Metra to consider installing the devices on all trains.

Experts say the defibrillators are so simple to use that anyone can operate them, even without training. They can cost $1,000 to $1,200 apiece. To put one on every Metra train — there are 317 locomotives and electric-propelled cars in Metra's rolling stock — could cost $300,000 to $400,000.

In Illinois, state and local laws require them in airports, gyms and some malls. Federal law requires them on passenger airliners, but they're not on commuter trains. Advocates wonder why not.

"It's easy to say we should have them on every train, but the question is more complicated than that," Metra Chairman Carole Doris said. "We're educating ourselves, we're looking at this carefully and we want to do the right thing for everybody on our trains."

Metra officials said onboard emergencies involving cardiac arrest or heart attacks are rare, perhaps occurring once or twice a year. But the commuter railway does not keep a record of their occurrence, officials said.

A 47-year-old Melrose Park man died Aug. 18, 2008, after suffering what is believed to have been a heart attack while riding a Milwaukee District West Line train.

Carol Cummings, a registered nurse from Bartlett, performed CPR on the stricken passenger. Afterward, she called on Metra to install AEDs on trains, saying that having one onboard might have helped the victim.

In a letter to Cummings, Metra Executive Director Phil Pagano wrote that the agency had evaluated whether to install AEDs on trains but determined there were "inherent difficulties" in doing so.

"Given the environment in which we operate, we have serious concerns about our ability to maintain a sensitive medical device onboard," Pagano wrote.

Experts, however, insist AEDs are reliable and sturdy enough to be used outdoors and on moving trains, airplanes and boats.

Sudden cardiac arrest strikes nearly 300,000 Americans a year, statistics show, and has a survival rate of less than 8 percent. But nearly all of those who survive do so because they received CPR and the shock of an AED or an implanted defibrillator, the Sudden Cardiac Arrest Association said.

Studies show the use of AEDs by police in Rochester, Minn., and by security guards at O'Hare International and Midway airports and at Las Vegas casinos have achieved a 50 percent to 74 percent survival rate for adults with sudden cardiac arrest, the American Heart Association said.

Known as the "beach doctor," Allen was a prominent scientist for the U.S. Geological Survey, and an adjunct professor at Rutgers University. His specialty was studying coastlines.

Appropriately, Allen was carrying pencil sketches of beach projects in his suit pocket when he set off for work on July 20, 2002.

Shortly after boarding the train, he collapsed. For at least 20 crucial minutes after he was stricken, his heart "jiggled" out of rhythm, said his widow, Marlene. Inexplicably, the conductor refused to stop for emergency responders until the train arrived at Boston's Back Bay station. There, paramedics treated Allen with a defibrillator, but by then it was too late. He was pronounced dead at a hospital.

Allen probably would have survived had he received emergency help or a defibrillator treatment at any of the three stations that were passed up, said lawyers for Marlene Allen. Each stop was close to police and fire personnel with the devices, as well as to a hospital.

In 2004, Allen's family sued the Massachusetts Bay Transportation Authority and Amtrak for wrongful death. The next year, the agency agreed to a $3.9 million settlement.

The MBTA also apologized, saying it had been "placed in the extraordinarily difficult position of having to defend the despicable conduct of the Amtrak train crew." Amtrak no longer runs the commuter rail line.

In February, with Marlene Allen in attendance, officials from the Massachusetts Bay Commuter Railroad Co., which took over management of the commuter rail operation, announced defibrillators were being placed on all 84 of its commuter rail trains.

The transit agency spent about $200,000 for equipment, upkeep and training, said John Hogan, the commuter rail's director of safety and security.

Two weeks after the commuter line began installing the defibrillators, bystanders used one for the first and, so far, only time, successfully reviving a 53-year-old man who had collapsed in a train station waiting area.

Since her husband's death, Marlene Allen has become a vocal advocate of equipping trains with defibrillators. She also works to educate others about the difference between a heart attack and sudden cardiac arrest, which her husband experienced.

"You don't have time to screw around with sudden cardiac arrest," Allen said.

A heart attack is caused by a blockage of blood to the muscle, while sudden cardiac arrest is caused by an electrical irregularity of the heart. However, a heart attack can lead to sudden cardiac arrest, experts said.

Michelle Crowe isn't sure a defibrillator would have saved her father, Michael, who collapsed Oct. 8 aboard a Union Pacific Northwest Line train while riding to work at Mesirow Financial in Chicago. She said her father had a pre-existing heart condition.

Two nurses went to his assistance and performed CPR, according to witnesses and police and fire reports. Paramedics treated Crowe at the Palatine station and took him to Northwest Community Hospital, where he was pronounced dead.

Michelle Crowe, who is trained in using defibrillators, said having a device onboard would have provided valuable diagnostic information to the medical responders.

"We fully support the idea of Metra installing AEDs on trains," she said.

The Sudden Cardiac Arrest Association has urged Metra to place defibrillators on trains.

Marlene Allen believes the day is coming when defibrillators will be as common as smoke detectors.

"They're easy to use; there's no liability," she said. "The only problem is if you don't try anything. The person's going to be dead."

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