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The recent death of a commuter who suffered a heart attack on a train once again highlights the importance of greater access to automated external defibrillators. When 61-year-old James Allen boarded the morning train near Boston, he did not know the ride would be his last. And if commuter trains were equipped with AEDs--like airplanes, casinos, cruise ships, and many shopping malls--the story may have had a different and happier ending.
Unfortunately, Allen, a nationally recognized scientist for the U.S. Geological Survey, fell unconscious during his first minutes on the train. After sudden cardiac arrest, the chances of survival drop 10 percent each minute without a shock from a defibrillator. While a crew member began immediately administering CPR, the train continued its regular service for about 17 minutes. Instead of stopping at the next scheduled stop and seeking immediate emergency medical assistance for Allen, the train made two additional stops to pick up commuters, then proceeded to Boston. When Allen reached Boston's Back Bay station, paramedics rushed him to a nearby hospital, where he was pronounced dead.
"It was an unfortunate event," said Neighborhood Heart Watch editor Dr. Douglas Zipes, a world-renowned cardiologist, distinguished professor of medicine at Indiana University School of Medicine, and longtime proponent of greater access to AEDs. "Whether there should have been an AED on the train is the big issue. Obviously, in the best of worlds, the answer is yes."
The Allen family is now struggling with a death that could possibly have been avoided. And his sister, Jeanne Peterson, hopes that the incident forces changes in training and safety equipment aboard commuter trains. Peterson said in an interview that her brother would want something positive to emerge from his death, such as required CPR training for crew members and mandatory defibrillators on trains.
"Jim was a very logical person, a patient, down-to-earth thinker," said Peterson. "I have to think the logic here means training in CPR and defibrillators."
Other lines have added the lifesaving devices to their emergency safety chest. At Virginia Railway Express, which serves commuters in the Washington, D.C., area, trains are equipped with heart defibrillators, thanks in part to the federally funded Operation Heartsaver program. Ironically, Amtrak, whose crews operated the train that Allen boarded, played a major role in initiating the program after determining that about 40 percent of all medical "events" on its trains were cardiac related, according to Dr. Cheryl Opalack, former corporate medical director for Amtrak. In fact, the Federal Railroad Administration, which updates safety guidelines, considered mandating all passenger rail carriers to keep defibrillators on board, but the railway industry argued that the ruling would not be cost-effective. The requirement was shelved. Cost-effectiveness is one of the major issues facing industries' response. In the long run, Dr. Zipes believes that the issue is a societal issue.
"One has to weigh the cost-effectiveness with deployment of AEDs, since they are still somewhat expensive," commented Dr. Zipes. "My feeling is that if you can require that they be on airplanes where you might have 350 people, I suppose you could say that they ought to be on trains as well. It is the same kind of logic."
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