X-Message-Number: 5575 Date: 13 Jan 96 00:04:58 EST From: Mike Darwin <> Subject: emergency alerts NOTE: Cross posted, Cryonetters please excuse any overlap. Charles Platt writes: >A medical alert system could be very simple: a bracelet (or ankle >bracelet, or necklace) that senses pulse. Such sensors are already >available, built into gadgets that measure blood pressure. All that's >needed is the addition of a little radio transmitter that's linked with a >base station that can auto-dial for help. GOOD LUCK!!!!! You think motion sensors have problems! Wow! try using a radio transmitter. Do you have a cordless phone? Had any problems as you moved around? Considered the power supply problem? A transmitter takes a lot of juice. To be sure it is working properly it would have to send out test signals periodically. This means power, this means batteries. Transmitters are not to be confused with wrist-watch sized recievers like pager watches. They are bigger and they need bigger batteries. Ever owned a pulse detecting watch? Ever seen it give false readings or fail to read? These things are pretty reliable, but not reliable enough without a lot of fine tuning. All do-able. But not straightforward. I've seen several people try to tackle this problem of transmitters and these were the problems: 1) Compliance: if it is bulky and not actively useful like a pager or cell phone people will not wear it. If it requires electrodes or patches to be attached to skin compliance goes to near zero in "healthy" (i.e., not dying) people. Compliance was lousy in dying people too. 2) The proliferation of cordless phones, radio operated devices, pager transmissions, computers and other sources of noise is a major problem to use of a transmitter. The last two guys who tried this were driven crazy by false alarms. The answer was a digital siganture signal which greatly increased size, cost and complexity of the device. 3) Hospitals use a device called a radio Holter monitor which transmits EKG continuously to a recorder and the nurses' station. It is necessary to put antennae at 10 ft. intervals in the halls. You will have to have an antennae in every room of the home. If you go outside, it will alarm. Big nuisance=lousy compliance. 4) The point of the system I describe is that it requires nothing more than use of a conventional alarm system. When you come home you switch on, when you leave, you switch off. A simple light switch like on-off device would work as well as a keypad. It's simple and easy. 5) Any transmitter will be likely be removed for showering, bathing and some autoerotic activities. It will also be removed by some people who defecate before showering. These are very high risk times; falling in the tub is a common way to die. Passing stool is also a high risk activity (see below). When you take the transmitter off you must disable the system and re-enable it when you put it on. VERY inconvenient. Compliance will be very poor. 6) An AVID chip implanted in the nape of the neck or a card or necklace with a passive transmitter could make turning the switch off and on when leaving the home unnecessary. Cows have AVID chips in them now (as do all our dogs and cats here at the lab) and they can be tracked as they eat (and how much) and as they come in from pasture. Avid chips are inert, implant tested, cost about $15.00 each and can be inserted easily (I'll arrange for anyone to get one who wants one in Mexico for about $100 US). They carry virtually NO risk. For elderly or confused people this could be used to turn the system on and off when they leave home. 7) Ideally, a wrist heartbeat system hooked up to a GPS transmitter would be ideal. Just be prepared to pay about 1K for each false alarm. 8) "The BEST is ever the enemy of the GOOD." EVERY SINGLE PERSON who has died home and had long down times died alone and had no pets. Most fragile, ill older people do not have pets because they can't take care of them (to little energy). >Right now, there are alert systems that the wearer has to operate >manually. Even this would be better than nothing, since I believe most >heart attack victims would have ample time to press a button before >losing consciousness. Yes, there are such systems, but keep in mind that there are no transmitter systems that transmit pulse, EKG, etc? Why? Well, look at the points above. The commercial services would LOVE to offer such a system to heart disease patients, but bulk, cost and compliance have not made it economical. Are needs are not so demanding. 30 minutes is better than a day! Where ever did you get the notion that SCD victims have time to push a button? No way. Most SCD victims just fall over dead. Some have chest pain, of course, which they ignore or attribute to other causes (classic heart attack), or take nitro tablets for (how do you tell the difference between the beginning of a FATAL heart attack and a daily or thrice daily bout of angina? Answer: you don't.) but when the heart goes in V-fib or V-tach or some other nonperfusing rythm the only warning you get is a few very confusing seconds (about 1-3) of your visual field going away stasrting at the edges VERY FAST (like in an old movie from the '30s) followed by loss of consciousness. You couldn't press a button if your life depended upon it -- which of course it does. How do I know this: a) I've talked to people who had it happen and lived, many times in hospital, b) I had the unfortunate experiene of leaning over and INTO a patient dewar at age 17 and breathing 100% nitrogen. I woke up on the platform; my visual field collapsed just like in the old movies. I couldn't have done diddly squat. In fact, all I remember was a sort of surprise; like "what the hell is this?" I suspect that is the last thought of a LOT of people. Not much time to get in an Act of Contrition, huh? The panic buttons mostly old people wear are for "I fell down and I can't get up" situations, or situations where they are having severe chest pain, etc. Forget about them for SCD. You are dead before you know it. I've seen people fall over in midsenstence. Carlotta (our ICU nurse) once had a patient die with a spoonful of chocolate pudding just about to be put into her mouth; the patient said "My, that tastes so good." opened her mouth for the next bite and then went blank. It took Carlotta aout 10-20 seconds to realize she was dead. The lady never said a word. Still had the look of pleasant anticipation on her face. Then there was Nelson Rockefeller... A lot of people die in their sleep; they have so little reserve left that normal downregulation of breathing and normal slight period of apnea send them into decompensation and they die. >But even if an alert is sent as soon as the pulse rate falters, will this >really provide sufficient protection? Look, 30 minutes is better than 30 hours. By a LOT. Increasingly medical and paramedical personnel ARE following bracelet instructions. Alcor has had THREE EDs and ICUs give the patients heparin, bicarb and ice them in the last year or two; one apparently without even asking--just using the bracelet. These patients did not arrive grossly autolytic or clotted, *and were perfusable.* Much better off than someone who was dead on the floor for even and hour. When you get out to 6-12 hours it is really bad. Membrane structure is pretty stable to 4 hours, and a lot is left at 12. Simple heparinization and cooling help a lot. If you have heart disease and your records are in the cryonics groups' hands, and posted in you apartment or home in a conspicious place, plus cryo information (paperwork), chances are the ME will give a release number very quickly. This will be especially true in small towns and rural areas, and even in mid-sized cities. If you have a cryonics person or cooperative mortician there is no reason the patient can't be in a PIB or air shipper and iced within an hour or two with head icing occurring earlier. And let me tell you, head icing makes a difference. Even in dogs simple head surface cooling after arrest improves survival and outcome quality significantly as opposed to CPR alone (Weinrauch and Safar, STROKE, 1454-1462, 23:1992). I don't think cases where people are not immediately given the best transport are hopeless. Particularly if they are heparinized and can be perfused (and we know that even in fairly sudden death cases this is possible). Better methods of in-field cooling will help improve things even more, as will inexpensive minikits of just a few critical drugs which the member or coordinator could keep in hisd/her home and which the mortician could give the line put in by ED docs or paramedics, or even by a cut down of the saphenous by the mortician. To summarize: I think a transmitter system would be great. But I am pissed off that the desire for a transmitter system has effectively sapped the energy of two good people who could easily have put in place a "passive" system such as I describe. Were such a system in place, several people would possibly be frozen who are not. Finally, I would point out that I know of the THREE CC members at extremely high risk of dying unattended and not being founds for hour to a day or more. I put the risk for these people at about 50% per year (a guess). None have pets. One lives in a small apartment with a few rooms ( 2 or three at most). Alcor and CI have to be in the same position -- or worse! Is a 10% rate of long down-time rate acceptable to CC? I am willing to aggressively market and promote a system to detect SCD. But I need a product. No one seems interested in generating one. I certainly cannot, but have freely given good ideas for a starter system. No one seems interested! Very frustrating Mike Darwin Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=5575