Credit: Anusha Subramanian
Dr. Daniel S. O’Connor was at an uptown diner with his kids when an elderly man sitting nearby abruptly slumped in his chair and lost consciousness. O’Connor, a critical care and outpatient cardiologist, immediately recognized the signs: the man was in cardiac arrest.
“I ran over and then another man ran over – he was actually a 911 EMS responder – and we performed CPR/AED. When we shocked him, he actually came right back to life,” O’Connor said, referring to automated external defibrillators. “He was unconscious and by the time the ambulance arrived, he was conscious again.”
Since 2014, EMS response rates have risen in Harlem, averaging 5.5 minutes for heart-related emergencies in 2023 – a 21-second increase from 2022— data from the New York City Fire Department shows. One in five New Yorkers who suffer out-of-hospital cardiac arrests die due to slow emergency medical responses, according to the biannual Mayor’s Management Report released in September.
Andrew Ansbro, president of the Uniformed Firefighters Association, the union representing firefighters, worked in Engine 58 in Central Harlem for 14 years. He blames high response times on staff shortages and the increasing number of emergency runs each fire company makes.
“FDNY hasn’t put any new additional units out there in decades,” Ansbro said. “When you increase the population of the city by over a million people in the last 20 years, don’t add an engine company and people are still having heart attacks – what do you think is going to happen? The fastest response time in 2024 is 1:50 minutes slower than five years ago.”
In 1996, when the fire department took over emergency medical responses, each engine company in Harlem had five firefighters and an officer, Ansbro said. Now, because they are understaffed, more companies are assigned to each run, leaving fewer available to answer EMS responses.
“Keeping engine companies open and having more additional engine staffing is paramount, because we’re the ones that get there first,” said Ansbro. On average, engine companies get to medical emergencies two minutes faster than ambulances.
Dr. Myron Weisfeldt, former study chair of the Resuscitation Outcomes Consortium — focusing on drugs, devices and other therapies for out of hospital cardiac arrest — thinks that ordinary people who witness a sudden cardiac arrest play a huge role in patient survival.
“The more delay there is in the EMS system, the more valuable it is for a bystander to find a defibrillator and shock the patient,” he said. “Ideally, you’d want one volunteer to start the CPR/AED and the other to call 911.”
Automated external defibrillators analyze the heart’s rhythm and deliver an electric shock only when necessary to re-establish an effective heartbeat. Non-medical bystanders can use them without any training, and such intervention within the first few minutes can increase survival by 90%. But many people are unaware of this. Bystanders use AEDs in only 2% of out-of-hospital cardiac arrests, according to a 2010 report by the city health department on public access defibrillator use.
In September, the health department released self-reported data on locations and quantity of all publicly available defibrillators in New York City, as mandated by the HEART Act of 2023.
City laws require defibrillators in certain public places, like parks and city-operated buildings, as well as health clubs, spas, gyms, senior care facilities and nursing homes. However, these regulations are strictly enforced only in public schools. In April, a bill introduced in City Council would mandate AEDs in private schools and police cars.
The data show a scarcity of public defibrillators in Harlem, where most AEDs are in public schools or senior care facilities, compared to the rest of Manhattan. That partly reflects the higher number of commercial buildings in the rest of the borough.
Moreover, many Harlem locations with defibrillators have not reported them to the city’s branch of the Regional EMS Council, responsible for aggregating the information. For example, most government buildings on West 125th Street in Central Harlem, like the Adam Clayton Powell Jr. State Office Building, follow AED regulations but do not appear on the regional council’s map. Because the building isn’t managed by the Department of Citywide Administrative Services, it isn’t required to report its defibrillator stock.
“It wasn’t meant as a stick, more as a carrot,” said Scott Chiang, executive director of the city branch of the Regional EMS Council.
Sumana Harihareswara, whose father died of a heart attack years ago, led the push to release AED location data, eventually culminating in the HEART Act. She acknowledges that this self-reported data needs to be more robust and reliable; once that happens, she wants to work with civic tech volunteers and public health workers to create print and interactive defibrillator maps in several languages.
Weisfeldt and O’Connor point out that patient survival is lower in poorer neighborhoods. For Harlem, Weisfeldt stressed distribution of defibrillators and raising awareness among building staff and other locals to use them.
“Every building of a given size should have a defibrillator near the door and be accessible to somebody who comes in,” he said. “It’s like fire extinguishers. We have a mandate for fire extinguishers, and they are very rarely used compared to the millions of dollars that are spent on them. So why not spend on AEDs?”
Harihareswara also emphasized the importance of an educational campaign, so that community members can confidently use public defibrillators, leading to wider distribution and to improved cardiac arrest survival.
“If people know where these things are but they don’t feel up to using them, then it’s just like knowing where fire hydrants are,” said Harihareswara. “Interesting, but not useful.”
About the author(s)
Anusha Subramanian, originally from Mumbai and San Francisco, is a data journalist at the Columbia Journalism School.