Chris Nefcy
Personal Interview
When did you first work on the defibrillator?
I first worked on the defib when I was working at Providence Hospital in the early/mid 80s. I worked on an ECG management system, which read and interpret ECG rhythms for doctors. Normally it would take a doctor about 15 minutes to interpret an ECG to see if a person had a heart problem. My program would interpret it a few seconds and learn as it more rhythms were put in the system. The doctors would learn how the computer would call certain things, and they would review and sign off on them in a much faster time frame.
A company was started at that time called First Medic, that was started by a couple of folks who had worked at Physio Control, who made the first defibrillator (the ones you see in hospitals and in ambulances). The company’s goal was to make a defib that first responders (fire, police) could use without a lot of training. At the time, the ONLY people who were allowed to use defibs were EMTs and specially trained doctors and nurses. But the first people called in emergency situations is usually fire and police, and when they arrive and saw a heart problem, they would call in the EMTs or doctors. However, as you can see, this caused a lot of delay. When you have a heart attack, every minute you do not get the heart back to normal, the less chance you have to survive (more than ten minutes and you pretty much have no chance). So First Medic wanted to shorten the time to defib.
The doctor I worked for was one of the first investors for First Medic. Since my computer had years of ECG rhythms contained in it, they came to me and asked me if they could use these rhythms to perfect the algorithms they used to determine if somebody needed a shock (so the defib could do it automatically). So I became a consultant for them and were able to use the rhythms. Two years later, First Medic hired me full time.
What did you do?
I was in charge of the information systems for the defib. Once hooked up, the defib would have records of all of the ECG rhythms and all of the actions performed during the defibrillation. I wrote the software that pulled all of the info off of the defib, and the software to store and report what had happened. This would allow the people doing the defib and then the doctors who worked on the person, once they got to the hospital, all of the info about the incident so that they knew how to care for them.
What is a semi-automatic defibrillator?
When we first developed our defibrillator, the laws in this and other countries only allowed EMTs and specially trained doctors and nursed do defibrillation (because they had to use their expertise to try and figure if a person need a defib or not). So when we finally got the laws changed (it had to be done state by state as they each had their own, but similar, laws concerning who could do defibrillation), they decided that there had to be personal involvement in the defib action. So we had to change the Automatic defibrillators we had invented (which meant that the defib itself, once hooked up, decided on its own if a person needed a shock and then would deliver the shock) to become Semi-Automatic defibrillators (which meant the defib would determine if a shock was needed, would tell the defib operator to ‘Press to Shock’ and the operator would make sure that nobody was touching the person having the heart attack, and then press a button to begin the shock).
The Semi-Automatic defibrillator evolved into the AED. It was mostly just a name change at first.
What was Medic One's goal for this defibrillator?
First Medic’s initial goal was to get defibrillators in the hands of first responders (fire, police) so that the time to bringing back a heart attack victim to normal rhythm would be shorter and their chances for survival would become much better. After that was successful, our goal was to get an AED into every public place where lots of people gather (companies, schools, gyms, theaters, etc.)
Did you ever think you might need a defibrillator?
No. I have always been in shape, ate well and worked out a lot. My heart was very strong, and was actually used in various medical studies of the heart because it was so strong. However, I have had diabetes my whole life, and it is a disease that eventually does a lot of damage to one’s body. In my case, even though all of my tests said I was healthy, my arteries were clogging up.
What happened when you did in fact need it?
I was playing basketball at the ProClub in a league. I had just made a 3 pointer, and then I collapsed on the court. Some attendants who worked there were college students and had just been trained on using an AED. They ran and got the AED, put the pads on me, and then followed the directions that were ‘spoken’ by the AED. It gave me a shock to revive me. Then the EMTs showed up and hooked me up to a bunch of things and took me to the hospital.
Do you believe that you achieved your goal of making defibrillation possible for average Samaritans?
As my experience shows, even young kids who were not trained as medical personnel were able to save me. When we first tried to get people to use the product, we trained a ten year old in about an hour on how to use a defib and he did a good job on a medical dummy. We managed to get the laws changed, and invented a product that the big companies (like Physio-Control, HP) at the time did not want to produce (though Physio-Control eventually bought First Medic and now makes their own AEDs).
Do you believe that enough defibrillators are readily available to the public?
There are not nearly enough. They are now in airports, some theaters, some companies, some gyms, some high schools, etc., but they should be in every place where lots of people congregate. A lot of major cities still have not bought into the importance of having AEDs in public places. Politics still plays a part in the acceptance of these valuable tools. For instance, I helped get a parent’s group buy 2 AEDs for the local high school, but the school keeps them behind locked doors (which could cause a delay in an emergency where every second counts, and someone may not remember where they are or can find the keys) because the Seattle School District has not bought AEDs for every school and claims they have not determined how liable they are for AEDs in their schools (which is a bit ridiculous, because they WILL be sued if someone, a teacher, spectator, athlete or other dies in their school). So there is still a lot of work to do to save even more lives.
How important is defibrillation as an integral part of the lifesaving process in comparison to CPR?
The latest AEDs have improved software that now tells the operator when to shock, and when to do CPR. They even count out the CPR rhythm that the operator should perform on the victim and tell them when to do breathing for the victim. So, if you do not have an AED, you should do CPR (after calling 911). But if you have an AED available, you should hook it up immediately and then just follow the defib voice that will tell you what to do.
I first worked on the defib when I was working at Providence Hospital in the early/mid 80s. I worked on an ECG management system, which read and interpret ECG rhythms for doctors. Normally it would take a doctor about 15 minutes to interpret an ECG to see if a person had a heart problem. My program would interpret it a few seconds and learn as it more rhythms were put in the system. The doctors would learn how the computer would call certain things, and they would review and sign off on them in a much faster time frame.
A company was started at that time called First Medic, that was started by a couple of folks who had worked at Physio Control, who made the first defibrillator (the ones you see in hospitals and in ambulances). The company’s goal was to make a defib that first responders (fire, police) could use without a lot of training. At the time, the ONLY people who were allowed to use defibs were EMTs and specially trained doctors and nurses. But the first people called in emergency situations is usually fire and police, and when they arrive and saw a heart problem, they would call in the EMTs or doctors. However, as you can see, this caused a lot of delay. When you have a heart attack, every minute you do not get the heart back to normal, the less chance you have to survive (more than ten minutes and you pretty much have no chance). So First Medic wanted to shorten the time to defib.
The doctor I worked for was one of the first investors for First Medic. Since my computer had years of ECG rhythms contained in it, they came to me and asked me if they could use these rhythms to perfect the algorithms they used to determine if somebody needed a shock (so the defib could do it automatically). So I became a consultant for them and were able to use the rhythms. Two years later, First Medic hired me full time.
What did you do?
I was in charge of the information systems for the defib. Once hooked up, the defib would have records of all of the ECG rhythms and all of the actions performed during the defibrillation. I wrote the software that pulled all of the info off of the defib, and the software to store and report what had happened. This would allow the people doing the defib and then the doctors who worked on the person, once they got to the hospital, all of the info about the incident so that they knew how to care for them.
What is a semi-automatic defibrillator?
When we first developed our defibrillator, the laws in this and other countries only allowed EMTs and specially trained doctors and nursed do defibrillation (because they had to use their expertise to try and figure if a person need a defib or not). So when we finally got the laws changed (it had to be done state by state as they each had their own, but similar, laws concerning who could do defibrillation), they decided that there had to be personal involvement in the defib action. So we had to change the Automatic defibrillators we had invented (which meant that the defib itself, once hooked up, decided on its own if a person needed a shock and then would deliver the shock) to become Semi-Automatic defibrillators (which meant the defib would determine if a shock was needed, would tell the defib operator to ‘Press to Shock’ and the operator would make sure that nobody was touching the person having the heart attack, and then press a button to begin the shock).
The Semi-Automatic defibrillator evolved into the AED. It was mostly just a name change at first.
What was Medic One's goal for this defibrillator?
First Medic’s initial goal was to get defibrillators in the hands of first responders (fire, police) so that the time to bringing back a heart attack victim to normal rhythm would be shorter and their chances for survival would become much better. After that was successful, our goal was to get an AED into every public place where lots of people gather (companies, schools, gyms, theaters, etc.)
Did you ever think you might need a defibrillator?
No. I have always been in shape, ate well and worked out a lot. My heart was very strong, and was actually used in various medical studies of the heart because it was so strong. However, I have had diabetes my whole life, and it is a disease that eventually does a lot of damage to one’s body. In my case, even though all of my tests said I was healthy, my arteries were clogging up.
What happened when you did in fact need it?
I was playing basketball at the ProClub in a league. I had just made a 3 pointer, and then I collapsed on the court. Some attendants who worked there were college students and had just been trained on using an AED. They ran and got the AED, put the pads on me, and then followed the directions that were ‘spoken’ by the AED. It gave me a shock to revive me. Then the EMTs showed up and hooked me up to a bunch of things and took me to the hospital.
Do you believe that you achieved your goal of making defibrillation possible for average Samaritans?
As my experience shows, even young kids who were not trained as medical personnel were able to save me. When we first tried to get people to use the product, we trained a ten year old in about an hour on how to use a defib and he did a good job on a medical dummy. We managed to get the laws changed, and invented a product that the big companies (like Physio-Control, HP) at the time did not want to produce (though Physio-Control eventually bought First Medic and now makes their own AEDs).
Do you believe that enough defibrillators are readily available to the public?
There are not nearly enough. They are now in airports, some theaters, some companies, some gyms, some high schools, etc., but they should be in every place where lots of people congregate. A lot of major cities still have not bought into the importance of having AEDs in public places. Politics still plays a part in the acceptance of these valuable tools. For instance, I helped get a parent’s group buy 2 AEDs for the local high school, but the school keeps them behind locked doors (which could cause a delay in an emergency where every second counts, and someone may not remember where they are or can find the keys) because the Seattle School District has not bought AEDs for every school and claims they have not determined how liable they are for AEDs in their schools (which is a bit ridiculous, because they WILL be sued if someone, a teacher, spectator, athlete or other dies in their school). So there is still a lot of work to do to save even more lives.
How important is defibrillation as an integral part of the lifesaving process in comparison to CPR?
The latest AEDs have improved software that now tells the operator when to shock, and when to do CPR. They even count out the CPR rhythm that the operator should perform on the victim and tell them when to do breathing for the victim. So, if you do not have an AED, you should do CPR (after calling 911). But if you have an AED available, you should hook it up immediately and then just follow the defib voice that will tell you what to do.
