Around the country, portable devices that can diagnose and treat life-threatening heart rhythms have been installed in shopping malls, arenas, offices, gyms, schools, and other public places.
These automated external defibrillators (AEDs) have step-by-step audio instructions, so even an untrained bystander can become a lifesaver.
Unless, of course, no one can find an AED when it's needed.
Next month, University of Pennsylvania researchers will launch a project aimed at averting that horrifying situation.
The first step will be a monthlong contest in which participants will hunt down AEDs, then use their smartphones to transmit photos and locations to the researchers. As an incentive, the grand prize for finding the most AEDs will be $10,000.
"We guess there are 5,000 AEDs in Philadelphia," said Penn emergency physician Raina Merchant, who is leading the project, called MyHeartMap Challenge. "Some are easy to find, some not. So it's quite a task."
The second step will be creating an interactive AED registry. It will become part of the city's 911 call system and be accessible through a smartphone application that is being developed.
"That will put the lifesaving devices in the hands of anyone, anywhere, anytime," declare the project's leaders.
MyHeartMap is part of broad efforts to improve the safety and effectiveness of public-access defibrillators.
Along with the chest compressions of cardiopulmonary resuscitation, defibrillation is a vital step in responding to cardiac arrest. More than 300,000 Americans a year suffer the sudden heart stoppage, often because of a deadly arrhythmia. Only about 6 percent of them survive because the window of time for preventing catastrophic brain damage is about four to six minutes.
Public access to AEDs has improved survival, saving an estimated 500 lives a year. But quality control and oversight of the devices are variable.
Ideally, a medical professional makes sure that AEDs are properly maintained and that personnel are taught to use them; airports typically have such programs. Other AED programs, however, may involve little more than getting a doctor's order for the device and raising $1,500 to $2,000 to buy it - as Penn interventional cardiologist John W. Hirshfeld discovered.
"I had an experience in my own church, which proudly bought two defibrillators," said Hirshfeld, who is chairman of a U.S. Food and Drug Administration advisory committee on AED improvement. "I took one off the wall to look at it and discovered it wasn't charged. I realized it was purely cosmetic."
In addition, the FDA says it has received reports of safety problems "with all types of external defibrillators, across all" eight manufacturers.
Between 2005 and last year, makers issued 68 product recalls, while the FDA received more than 28,000 reports of problems, including malfunctions, patient injuries, and deaths.
"The FDA picked through these reports," Hirshfeld said. "A fair amount of device malfunctions were attributable to the AED design, or to manufacturing quality-control problems."
The FDA is now working with manufacturers to improve the reporting and handling of complaints. The agency is also seeking advice from industry and medical experts about how to make the next generation of defibrillators even more sophisticated. With designs that tie in computers, the Internet, and satellite technology, AEDs could be tested and fixed remotely, used to track patient outcomes, and integrated into 911 and hospital systems.
"It raises some interesting philosophical questions about the manufacturers' responsibility," Hirshfeld said. "Is an AED like a microwave with a warranty? Or are they selling a service" like a burglar-alarm system?
Although AED technology is still evolving, MyHeartMap Challenge is not waiting. The collaborators - including Penn's Center for Resuscitation Science, Children's Hospital of Philadelphia, the University of Washington, and the Massachusetts Institute of Technology - ultimately hope to create a national AED registry using the same "crowdsourcing" techniques as in Philadelphia.
Participants will be encouraged to use social media such as Facebook and Twitter to enlist friends in the hunt for AEDs.
Participants "should start strategizing and forming teams now so that can be first out of the gate to win," the website urges.
More information about the challenge is on its website: www.med.upenn.edu/myheartmap