Heart of the Matter: Indiana’s AED Debate

On this episode of Going Under: Anesthesia Answered, we unpack why AEDs in schools are non-negotiable, how survival changes with early defibrillation, and what it takes to make policies real on fields and in gyms. We share practical costs, training paths, and legal protections so staff and volunteers can act fast and save lives.

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Transcript

Sponsor And Ultrasound Tech Overview

SPEAKER_01 0:16

This is Going Under. Anesthesia answered with Dr. Brian Schmutzler. A very happy Hoosier, Dr. Brian Schmutzler.

SPEAKER_00 0:24

Who, who, who, Hoosier?

SPEAKER_01 0:26

Got the job done. I am Vahid Saderzade, and this episode of Going Under as All of Them Are are brought to you by the Butterfly Network. Not by IU.

Football Banter And Set Up

SPEAKER_00 0:36

I mean, if we want to get Upland Brewering Company in here, yeah, sure. All right. I'm going to let you in on something that's completely changed the way that I practice. I've been using Butterfly probes for years. It's a portable ultrasound that plugs right into my compatible smartphone or tablet, so I can start scanning at the bedside in seconds. If you've used the older versions, or even if you're new to the handheld ultrasound game, let me tell you something and why this new IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster. Whether it's vascular access, procedural guidance, or just getting real-time insights from my patients. And the tech inside this tiny device is pretty incredible. Biplane imaging lets me see short and long access simultaneously, which is huge for procedural guidance and honestly a great tool for learners. The new needle out of plane preset even shifts the scan plane digitally. So I can see the needle tip sooner, which makes a real difference when precision matters. And the image quality, honestly, the IQ three holds up against some of the high-end card systems I've used. That's impressive for something this portable. If you're looking for a device that supports your practice, I can't recommend the Butterfly IQ three enough. And right now they're running a special offer. You can get$750 off the latest IQ three. Check it out at butterfly network.com.

SPEAKER_01 1:50

The Hoosiers get it done. Who who who Hoosiers? I was right on a low scoring affair, but not really. It was 2721.

SPEAKER_00 2:00

That's not really low scoring.

SPEAKER_01 2:01

I guess so. The the over-under was like 46 points. So it ended up. It was very close to the overunder.

SPEAKER_00 2:08

But they did not beat the spread. I think the spread was eight and a half. Correct. Yeah. And I did say under the spread. I was right there, but And no offense to Carson Beck because I think he is a very good quarterback, but Carson Beck, Carson Becked that last play. I when we talked about it. When is he getting Carson Beck? When's it going to happen? It was on the last play. And I saw a meme today that said that uh of his six losses as a college starter, four of them came on an interception he threw in the last like minute or two minutes of the game.

SPEAKER_01 2:39

Well, congratulations to Hoosiers everywhere, to IU fans, graduates, and the like.

SPEAKER_00 2:45

Shout out to my dad who had passed almost six years ago now, but loved IU. He would have he would have loved this. 2026 would have been wonderful for uh for IU for him.

The School AED Debate Emerges

SPEAKER_01 2:55

Yeah, that's awesome. Uh shout out is awesome. Um and and today on the podcast, we are dealing with school policy. Uh-huh. Yep. Yeah. Uh but not this school. Not that school policy. Indiana. Yeah, but schools in general. Public schools. Public schools. And I and I'm not sure why it's uh much of a debate. Um, but it it is in front of the state house as we speak. Money, right? I mean money, yeah.

SPEAKER_00 3:22

The answer is money. Now tell me what the question is. It's always right.

SPEAKER_01 3:24

You always say that. Right. You always say that. And it probably is about money, but right now in front of the state house is a bill that, if passed, would give schools, each school, an AED machine, a life-saving device.

SPEAKER_00 3:41

So I th I think it's already law. I think they're going back and trying out to amend that law in a bigger bill. And I I don't I don't know exactly what I mean, it's House Bill 1004, but I don't know exactly how how it's being laid out. But right now, every school, and I'm reading this off the the website here, has to have an AED, CPR trained staff, and a plan for cardiac arrest. So and that's not just the school, that's like the sports fields and the you know, gymnasium and the you know, performing arts center and all that kind of stuff.

SPEAKER_01 4:19

We're gonna get into a lot of the specifics here. Um, but how generally speaking, how much is that to have a person on staff, yeah, training, and like do you have to change out the AED every once in a while?

Costs, Logistics, And Staffing Needs

SPEAKER_00 4:33

Is it so I think you just have to test it and change the batteries? So I mean, man, the last time I bought an AED was probably a couple of years ago, and it was maybe, I don't know, three or four thousand dollars. I mean, that's it's not that's not the thing that's gonna take a lot of the cost. Yeah, I mean you get to have somebody always trained in CPR, you're gonna have to have to have somebody there. Um I mean, should the school nurse be already trained in CPR? You can't ask the school nurse to be at all events at all times, right? So so somebody's gonna have to be there. So that that may be part of the logistical problem of it. Um, and I and I have you know, you would imagine that somebody that's at the school would have some sort of CPR training, whether it's a parent or a you know, somebody who's there. Um, I guess my bigger issue is why not have the AEDs, right? It's a one-time cost. And and you and I even kind of talked about this earlier. Like I I guarantee that I could get together a fair amount of physicians to to pay for this for you know a lot of these schools, or at least raise the money somehow to pay for this for the schools because AEDs are critical, they're life-saving. So, I mean, that part, there's some costs on the front end, but not recurring costs. The having a plan for cardiac arrest doesn't cost you anything aside from a little bit of time to make that plan. I maybe the cost comes in with the the CPR trained person available at all times. And and I I haven't, in full transparency, I haven't read all of the bill. So some of this I may be not totally accurate on, but at least this is this is the evaluation of the bill that I've read from a couple different sources.

SPEAKER_01 6:06

So what let's just go back to the basics here.

What An AED Does And Why It Matters

SPEAKER_00 6:09

What is an AED? Yeah, an automated uh uh geez. I just call it an AED. A defibrillator, basically, right? Automated external defibrillator, yeah, yeah, yeah. So um, so what that means, and and you've seen this on like, you know, all the TV shows, ER and whatever. Um, you know, we don't use big paddles anymore and shock you, right? We we tape them on. But basically, when the heart stops, there are certain rhythms when that heart stops, meaning what the heart's doing or stops pumping, um, that we can use this device. And the device basically provides a shock on the outside portion of the skin or the body that then shocks that heart. And so, so cardiac arrest, outside of hospital cardiac arrest with only CPR intervention, right, has about the the studies vary, but three to seven percent survival rate. Okay, you add an AED in there and the survival rate skyrockets. You just said heart attack in general? Uh cardiac arrest. Cardiac arrest. Yeah, not just heart attack, any sort of cardiac arrest, out of hospital cardiac arrest. Now, if you're in the hospital, that you have a much better chance because you got a bunch of people around who know what they're doing and a bunch of devices, but out-of-hospital cardiac arrest, witness cardiac arrest with CPR only has a much lower rate of survival than if you have an AED. Because oftentimes, especially in young kids, right? So, or young young adults even, um, it's not usually a plumbing problem, meaning they don't have a heart attack because they have a blockage in the arteries in their heart. They have an arrhythmia that causes the heart to either beat inappropriately or to not beat at all. Okay. So that's typically what happens with kids. And the best way to fix that is not to make the heart you know pump with your hands. The best way to fix that is to reset the electrical system in the heart, and the way that you do that oftentimes is an AED. So um it just it looks like so. This was um all all stemmed from Jake West, who was a teenager who collapsed at a high school practice and died in Laporte, Indiana, I believe. Jake's Law. Yeah, so it's called Jake's Law, it was the original. Um, so yeah, and I there's been a lot going on in the media. There's been a lot from the American Heart Association supporting this. Um, you know, as a physician, I 100% support having an AED. As many AEDs as you possibly can have anywhere, right? Like we have AEDs in the airport. If you have a gym, you have to have an AED. You know, you walk into Walmart, there's a couple AEDs on the wall. Like we should we should have an AED in schools so that kids are able to to you know have a better chance of survival if they have a problem. And again, I understand if it's a cost thing. I I think you know, and I would call any physician out right now that we put together a a group of physicians who say we're gonna pay for these AEDs, right? So if it's a cost issue and that's the problem, I'm willing to spearhead a group to try to get those forever.

SPEAKER_01 9:11

You sound like you're ready to run for office over there. Just stop it. Just stop it. But it is citizen. It is more than an issue, though, of just healthcare, right? It's correct. It is uh an education issue, uh, it's a policy issue. Yeah, it's a financial issue for sure. And if you're the American Heart Association, right? I mean, we have talked many times about these associations, right? What is the job of the American Heart Association?

SPEAKER_00 9:37

Well, it's supposed to be to educate to well to educate and to promote cardiac health. And so that not only means you know, re recommendations for diet, recommendations for exercise, recommendations for for all kinds of things heart related, but it also means recommendations and the and they actually put out the guidelines for CPR and it's called ACLS or acute cardiac life support, right? That's what happens when you have a highly trained person, you know, nurse or some somebody in healthcare who's using AED and knows all that stuff. That's more than CPR, more than basic life support. It's advanced cardiac life support. So if you're a citizen though, right?

SPEAKER_01 10:17

Like let's say I go to the games or whatever, right? And I'm the announcer.

Survival Rates: CPR Alone Vs With AED

SPEAKER_00 10:21

Just do CPR with your hands. Could I be trained in this device? You could. I mean, you could do ACLH, ACLS training, and and people get trained in ACLS. Most people in the general population do not do not, right? If you're gonna get trained in anything as a general, right, you you you don't have a medical background, you you are announcing at an event. If you're if you're trained in anything, you're probably trained in BLS, basic life support. And what that really can consists of is chest compressions, that's the most important thing, and then um, you know, mouth to mouth are providing some sort of oxygen. Although now the AHA is recommending just hands-only CPR, so just doing compression. Gotcha. And what that does is it compresses the heart enough to push blood out and then releases it and brings blood back into the heart and then pushes the blood out and releases it and lets it back in. And so that pushes that blood, even though it doesn't have a ton of oxygen in it, it pushes that blood to the brain, to the organs, all the things that the reason the heart even is present in the body is to pump blood, which carries oxygen to all the critical organs. Is there a danger in that as a as a citizen? Doing basic life support? Yeah, I mean Yeah, I mean, uh no, not really. Um, you know, you uh m older frail people sometimes have broken ribs, but that's usually not a problem. But not for the person trying to administer it in terms of you know No, I I mean I you know, maybe you get some sort of like carpal tunnel from it or something.

SPEAKER_01 11:52

I think I'm talking more along the lines of law-abiding citizens, right?

SPEAKER_00 12:00

Like sue you, is that what you mean? Right. Yeah, so so the if you're a law-abiding citizen, you go to help somebody, I don't think that there's any way that you can be sued for that if you do it in good faith. Um, depending on the state, there are good Samaritan laws. So some states, um, if a let's say I'm a physician in what one of these states and I don't remember, it changes all the time. But let's say I'm a physician in one of these states and I go to help somebody and for some reason they don't survive. In a lot of states, I'm protected because I was a good Samaritan. I was just out on the street trying to help somebody. In in many states, though, I'm not protected. So that person could then say, Oh, that's a physician. He should have saved me and done blah, blah, blah, blah, blah. I'm gonna sue him. Now, does that mean I don't go help? No, of course not. I go help, right? But there's some risk for me. There's really no risk for you.

SPEAKER_01 12:45

Okay.

SPEAKER_00 12:46

Um, maybe the other only other risk, and the reason they went to hands-only CPR, is there is a very, very minute risk that if you were to do mouth to mouth, you could catch some sort of illness from somebody's saliva. It's incredibly rare. I don't know that it's ever happened that I've ever seen in the literature, but people are afraid of that.

SPEAKER_01 13:03

So I think the the most shocking stat though is the difference if you have this device, whether it's what or if you don't have this device.

SPEAKER_00 13:15

Especially in a a teenager or a young adult where it's most likely an electrical problem, not a plumbing problem. Well, we see this in sports, right? Right, correct. Yes, yes. And so that's key. If you can shock the heart with an AED, a lot of times you can get somebody who's otherwise young and healthy but just has an electrical problem in the heart back.

SPEAKER_01 13:34

So not just Indiana, though. I think this is I mean, from hearing about this, I mean, shouldn't every school across the country have something like this?

SPEAKER_00 13:45

I mean, is this I mean, I would argue that they should, right? And and again, I haven't dug in deeply to the cost of any of this sort of stuff, but if you're talking about one of the most potent things to help somebody survive a cardiac arrest, the AED is that it's like having epinephrine if you have an allergic reaction, right? I mean, it's is these are just things that you should have around. Um Narcan, right? Narcan became over the counter, right? So so all the police officers, all of the um ENT, EMTs and paramedics, they carry now it's nasal, but used to be, you know, um an injection, but they carry Narcan with them. You can I you can I can go to the store right now and get Narcan if we wanted to, right? To help somebody out if they were having uh a um opioid overdose. So, you know, just like Narcan, AEDs are very, very, very important.

SPEAKER_01 14:34

I mean heart disease, heart attacks, the number one killer?

SPEAKER_00 14:38

Yeah, I think it's still number one. Yeah.

SPEAKER_01 14:41

Yeah.

Youth Cardiac Arrest And Arrhythmias

SPEAKER_00 14:41

So I think it's important. Very, yeah. Very. Um, and so I I guess what's happening right now, you know, it was tagged on the the changes were tagged on to some house bill. I think there were some changes to it that kept those rules in. It's hard to tell exactly what's happening, but I guess and then the changes passed. Uh well, something passed today. I think I think the bill went out of committee with the the keeping things the way they were for the AED and the CPR. I could be wrong on that. I I it's hard to tell exactly based on what I'm reading, but uh I think that they're I think that the the House or whoever whichever committee it came out of understood that this is a critical, critical thing for for high schools. And so I mean, you know you know, big bigger issue is like w what what kind of things are we as a society kind of required to have around, right? Um so and and I don't know the answer to that, but at least I know that AED is a good thing to have. And it's not that expensive, right? It's I mean it's not it's not hundreds of thousands of dollars, it's thousands, maybe tens at the most.

SPEAKER_01 15:52

Some important things going on at the statehouse right now, some important discussions being had. Uh so we encourage you to go look at that bill uh and what's being presented there because I think it is important that uh every school have one, or at least have the conversation about having one because have you ever done CPR on anybody?

SPEAKER_00 16:11

Uh personally, no.

SPEAKER_01 16:13

I have so I was a lifeguard. Okay, yeah, yeah, yeah. You probably had to have the training. And then uh I did receive my uh certification to be a USA triathlon coach and swim coach. Yep. So I have done it, um, not on a live human being before. And I hope I never really have to, yeah, but if I have to step in and do it, you would I would.

Jake’s Law And Public Access AEDs

SPEAKER_00 16:37

Yeah, so they changed the they changed the uh the book like every two or three years or four years or something. So they changed like ratios of um compressions to breaths and all that kind of stuff. They changed that constantly. But it's something if you have certificate, you gotta get it re-certified. You have to recertify every two years, yeah. Correct. So um, yeah, there's some interesting change. And I and I complain every time I have to take it, right? Like this is what I do for a living, so it's not like I don't know how to keep somebody alive. But anyway, it's good to have that training. It's good to have that training. I mean, there's some other stuff out there too, aside from just so BLS is that basic life support, just CPR. Uh ACLS, acute cardiopulmonary life support, adds the AED and some other drugs that you can give and that sort of stuff. Then you have PALS, which is pediatric acute life support. Um, there's some different things with with kids. You know, oxygen is the biggest thing. When a when a let's say a five-year-old or a younger has a cardiac arrest, it's usually because they are not getting enough oxygen. So a lot of things we do for kids is just get them more oxygen. Um, then they have ATLS, acute trauma life support, which is a whole nother level. I'm not even ATLS certified, but you know, the ER docs and the and the trauma docs and the general surgeons a lot of times who do trauma are are trained in this where it's additional things, right? It's additional layers of okay, how do you stabilize somebody's injuries? What do you you know, when do you send her the CT scanner, blah, blah, blah all that sort of stuff. So um, so yeah. So awesome. Yeah, very interesting. So well, we are brought to you. We'll keep track of this, uh, because I think it's a big deal. And I I I mean, I don't I don't have any I don't have any skin in this game aside from just being a concerned physician. So that's enough.

SPEAKER_01 18:20

That that's a that's a lot of skin in the game. I'll I will say that. Fair enough. Uh, we are brought to you by the Butterfly Network. And uh if you have a question or comment, link it below, and uh Dr. Brian Schmutzler will answer your question.

SPEAKER_00 18:32

Yeah.

SPEAKER_01 18:33

All right. Thank you. Thank you so much, Dr. Brian Schmutzler. Thank you. Going under Anesthesia Answered, brought to you by the Butterfly Network. I'm Vahid Saderzade, and we'll see you in the next one. We will. Go Hoosiers. I mean, it's already over.

SPEAKER_00 18:45

Yeah, so we're Go Hoosers. It's nice job, Hoosier.

SPEAKER_01 18:48

Yeah, nice. They won one before Notre Dame.

SPEAKER_00 18:51

Oh, yeah.