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Department of hmm....
People who suffer a life-threatening alteration in heart rhythms are more likely to survive if they are in a casino or airport than if they are in a hospital, researchers have reported.
Doctors already knew that more than half of those who suffer such attacks in airports and casinos survive. But a new study in hospitals shows that only a third of victims there survive, primarily because patients do not receive life-saving defibrillation within the recommended two minutes.
Posted by Tyler Cowen on January 6, 2008 at 08:56 AM in Medicine | Permalink
Comments
I'm a frequent casino visitor, and I'm not convinced at all you'll find higher status individuals there on average, perhaps the opposite (with the exception of perhaps the ritzier Vegas casinos). Granted this is just my anecdotal evidence, but even in theory one usually thinks of gambling as a lower class pastime in the context of lotteries for example...
Posted by: John Phillips at Jan 6, 2008 9:05:35 AM
One would hope that the health status of someone in a casino is at least better than your average hospital in-patient..
Posted by: Anders at Jan 6, 2008 9:09:40 AM
I think it has to do with the fact that if you are in a hospital they will try to diagnose the problem to figure out what is wrong, try to get your health history, etc. so they don't unnecessarily electrocute you. While if you are in a casino or airport somebody is going to do the only thing they "know" how to do. This is not a defense of hospital's, I still think they should be better, but a possible explanation.
Posted by: Kinney at Jan 6, 2008 10:26:29 AM
That's not true. In a hospital, someone will immediately call Cardiac Arrest, and the crash team will waste no time figuring out if the patient is in a shockable rhythm (Ventricular Fibrilation) and defibrillate if they are. This rhythm can be picked up by many defibrilators, and these machines just won't shock if the patient is in a form of cardiac arrest where defibrillation won't work (Asystole or Pulseless Electrical Activity).
The Crash Team will certainly not waste time going through your chart to get your complete history
Posted by: Anders at Jan 6, 2008 10:44:32 AM
every single death in a hospital is probably counted for in a study on hospital mortality rate. every single death in an airport/casino accounted for in that study?
Posted by: at Jan 6, 2008 11:14:51 AM
My father died of a heart attack in the hospital. One key variable would seem to be how long before the victim is noticed. In a crowded room, the collapse of a person suffering a cardiac episode is going to be noticed quickly. If the victim collapses in a washroom or a private room, they would be less likely to be noticed immediately.
My father was recovering from hip surgery and did not have a heart monitor. The staff did not notice in time to revive him.
Posted by: Sophie at Jan 6, 2008 12:38:13 PM
Having used an AED (auto defib device) on a cardiac arrest victim in a public place, it is very unlikely responders would find the device, establish an airway, cut or rip off the victim's clothing, attach the sensors, activate the machine, and do all of that in two minutes or less.
I'm not a clinician but with decades of CPR and related training I couldn't do it.
Worst 8 minutes of my life (until paramedics arrived), but successful. Paid for all of those Red Cross courses.
Posted by: save_the_rustbelt at Jan 6, 2008 1:27:57 PM
Go back to the days of huge halls lined with hundreds of sick patients. Easier discovery, single focal point of attention and quick response equates higher survival.
Posted by: anon at Jan 6, 2008 2:55:47 PM
It might just boil down to which place has a physician on the premises.
Many smaller hospitals do not have emergency-room physicians. In our small town, a doctor is "on-call", which means that if someone shows up with, say, chest pains and graying clammy skin, it might be 15 minutes before the doctor arrives. The ER staff might know what to do and how to do it before s/he arrives, but the odds are much lower.
At the same time, the mini-casino in our town (slots only) also has no physician on staff. The odds of surviving a heart attack there are probably no better than in the hospital.
Posted by: EclectEcon at Jan 6, 2008 6:35:25 PM
One time on a plane, I sat next to an emergency room physician who worked in Las Vegas. He told me about the work he had done in providing training for security guards in casinos. This is one of the few (?) places in the US where you are constantly watched --- in fact, are often filmed --- so those who suffer a heart attack can be helped quickly. And casinos have every incentive to do so --- after all, they want people to keep gambling!
Posted by: Hal Varian at Jan 6, 2008 7:48:13 PM
Please don't confuse single doctor perspective with research. Research requires quite a bit more than biased anecdotal notes. The NYT article I read about this, which confused heart attacks with cardiac arrest, was incredibly inaccurate.
And has anybody noticed the complete absence of nurses in news coverage lately? Only doctors get interviewed, cited, or quoted when it comes to health care issues. Nurses don't seem to exist in the news even though they are the primary care givers and health managers.
Posted by: The other Eric at Jan 6, 2008 9:14:42 PM
Sounds right to me - the fact that's it's a ton easier to get sleep around a casino or even airport might have something to do with it.
We recently had a kid by c-section, and I was yelling for people to let us sleep well before it ended. It was terrible watching what it did to my wife. More at the linked post.
Posted by: Jon Kay at Jan 6, 2008 9:15:59 PM
Maybe, just maybe, it has something to do with the fact that someone who has been walking around at an airport or a casino before experiencing this problem generally has fewer other contributing health complications than someone already in a hospital who goes into arrest.
Of course the AEDs in casinos and airports (and more and more places) are wonderful things--but EMTs tell me the main reason AEDs don't work is that people are too afraid to use them! There is no chance of using them improperly: if the AED does not sense a problem with the heart's rhythm, it won't discharge. So don't hesitate! Grab the AED and let it walk you through what you need to do.
Posted by: XiaoXi at Jan 6, 2008 9:34:03 PM
Time we got back to an area of core competency. There is a bit too much speculation. Time to get back to economics.
Posted by: Sophie at Jan 6, 2008 11:47:50 PM
Why not an easy technical fix? Give every hospital patient a simple, battery powered pulse monitor. Siren goes off if it loses a heartbeat. Minimize false alarms by a gentle beep if no signal for 5 seconds, which the patient can cancel. Heart rate monitors are $49 at sporting goods stores.
Posted by: TomHynes at Jan 7, 2008 5:05:42 PM
And the more cheap cabal gold is very good for you.
Posted by: cabal gold at Jan 1, 2009 7:25:57 PM
