Reporting on pedestrian life in the D.C. area

When heart attacks strike, what should riders expect of Metro?

April 20, 2012 - 03:01 PM
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(Photo: Jay Westcott)

This week, a 51-year-old man died on WMATA from a Yellow Line heart attack, and Metro was unable to attempt to save him with one of its 46 automated external defibrillators (AEDs) because the batteries were dead.

WMATA immediately responded to the criticism and ominous thought ("Wait, could Metro have saved his life if their AEDs worked?") by announcing the transit agency would check all defibrillators within 24 hours and "complete the work it has underway to place AEDs at all station kiosks, including replacing older existing models with state-of-the-art devices" by April 30. WMATA has confirmed they checked out the AEDs by Friday morning. It's a shame that a death is what prompted the response, in large part because these projects with AEDs have been ongoing for years. In the United States, meanwhile, about 785,000 people will experience a first heart attack in a given year, according to the American Heart Association, and about 470,000 will have a recurrent heart attack. An American dies from one about once a minute. What are the real circumstances surrounding transit defibrillators? Should the batteries be working? Who was responsible? Do other transit agencies keep much of a stock of AEDs?

Let's examine.

Earlier this year, WMATA began deploying a batch of newer AEDs — there are now 122 total, 46 of which are in 32 Metro stations (out of 86 stations total) and with others in railyards and other facilities. Some stations like Bethesda and Dupont Circle have received defibrillators for the first time ever in recent months. 40 Metro stations lacked any at all. WMATA received its original defibrillators more than a decade ago, all the way back in 2000 in a partnership with Arlington County. In 2006, Metro General Manager Catoe praised an employee for successfully using one of the AEDs on a Red Line rider who experienced a heart attack.

But 46 isn't enough, and Metro has known this for years. Among the items in its Capital Needs Inventory for 2011 to 2020 were 110 additional AEDs, a number calculated in late 2008 and since estimated to be nearly double that number. Each defibrillator costs about $2,200 to replace (which should happen every eight years), the inventory says, and the batteries about $250 (which should happen every five years). Even the original batch of defibrillators aren't considered up to national standards, WMATA notes. WMATA's 12-year-old AED devices "need software updates to be in compliance with 2005 provisions [the 2005 American Heart Association Guidelines, FYI]," the agency wrote based on fall 2008 calculations. "MTPD would like to standardize all of the AED units within all rail yards, bus divisions, facilities, MTPD, and rail kiosks throughout Metro. The goal is to have a 10% AED unit reserve (20) for replacements and calibration. Since each of these units will potentially save someone's life, procurement of the additional 110 units should be considered a priority." One breakdown lists the cost of those 110 AEDs as $1 million out of $170 million worth of safety and security projects. It's the least expensive item out of the nine listed, and these needs were calculated in September of 2008 — three and a half years ago. Is that what "priority" looks like?

Yet numbers shifted and by May 2010, WMATA hoped to acquire not merely 110 but 204 AEDs for bus, rail, and MTPD cars for about half a million dollars with a required date of award of September 1, 2010 ... nearly two years ago. More than a year ago, WMATA finally engaged in the bidding process for these 204 AEDs (complete with, WMATA adds to bidders, "a single source, long-life lithium extended life battery" with a 3.5-year minimum warranty). Contractors were also required to give WMATA 10 spare batteries. The winning bidder, it seems, was Heart Smart Technology.

But on Monday a Yellow Line rider died without those 204 new AEDs in place. The Pentagon Metro station miraculously happened to contain one of the 46 AEDs but the battery charge was "insufficient." The $250 battery simply wasn't strong enough. Whose responsibility was it to ensure a working battery? "Employees will be responsible for ordering their batteries and the maintenance of their units," WMATA writes. So presumably the neglect falls to the Pentagon workers. Yesterday's announcement indicates that station managers "have been trained to inspect defibrillators, procedures for conducting inspections and maintenance are being strengthened to include required signed daily inspection reports to prevent a recurrence." WMATA spokesperson Dan Stessel explained that station managers will begin checking AEDs "multiple times a day" as part of a daily checklist of duties. Soon enough, all stations will feature AEDs. But have the functioning 204 new AEDs, bid on more than a year ago, been sitting at WMATA unused in recent months? WMATA received those 204 at some point in the last year, Stessel confirmed, but he didn't know precisely when they arrived. The process of replacing older AED devices began in January 2012, he told me, and "the timeline has accelerated" given recent circumstances.

Let's see how Metro compares to other transit agencies. In New York, a law has been proposed mandating that every train on the MTA and the LIRR come equipped with AEDs. Their transit systems already appear to be equipped with several, given this 2009 report of a life saved with one. MTA was certifying employees in 2004 and AEDs were added to bus facilities by 2007. In 2004, San Francisco's Office of the Legislative Analyst was encouraging the BART to include AEDs on BART and MUNI vehicles, which reflects an earlier report noting that every BART train and station was required to include AEDs by 2003. NJ Transit had added 70 AEDs in its stations around 2006. A 2002 death prompted Boston to add 84 AEDs to its trains in 2009. Chicago also experienced a rider heart attack death before considering AEDs, according to Cardiac Science in 2009, which also called Amtrak's defibrillator program "ground-breaking ... in terms of size, scope, and complexity," with 700 AEDs in its trains and facilities and about 7,000 Amtrak employees trained." The details vary, but a pattern of cardiovascular awareness emerges over the last decade as more and more transit agencies integrated this technology into the transit — in multiple cases prompted rather tragically by heart attack death.

WMATA appears to have followed the trend in its past acquisition of 46 defibrillators and employee training but failed to follow through on AED maintenance or the proper stock of AEDs to serve the entire region of 700,000 daily rail commuters. Within 10 days, however, Stessel assures there will be AEDs at all Metro station entrances.

Update, 6:52 p.m., April 23: The Tri-State Oversight Committee, which oversees issues of safety on the Metro, has learned of the incident and expressed concern in a statement released today. "The functionality of emergency equipment within Metrorail facilities is of critical importance and with that in mind," the group announced, "the TOC plans to review the proposed inspection procedures and independently evaluate their adequacy."

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