Dozens of photos of people whose lives were saved by bystanders using cardiopulmonary resuscitation (CPR) or automated external defibrillators (AED) in Hawaiʻi adorn the entrance to the AED Institute of America Inc. office in Honolulu. Pamela Foster told Aloha State Daily that every saved life motivates her to teach more and keep going.
“I want a room of one thousand cardiac arrest survivors that are still here on earth because of something that somebody did,” Foster said on Tuesday. “There’s nothing like meeting a responder or a cardiac arrest survivor. They’re so happy to be alive.”
Sudden cardiac arrest occurs when the heart stops beating and blood stops flowing to the brain, according to the National Library of Medicine.
“Heart attack versus cardiac arrest is like calling the plumber compared to the electrician,” Foster said. “Heart attacks have symptoms and the person is awake. Cardiac arrest has no warning and the person is unconscious.”
Under Foster’s leadership, AED Institute of America has distributed more than 10,000 AEDs in Hawaiʻi over the past 22 years and maintains contracts with the Hawaiʻi Department of Transportation for airports and harbors, Hawaiʻi Department of Accounting and General Services, Hawaiian Electric and several schools and hotels.
Foster recalled a woman who in 2007, went from struggling to pass a CPR class to using CPR to save her dad’s life days later.
Foster Botanical Garden staff pulled an AED and saved a tree trimmer’s life 10 minutes after AED Institute of America installed the AED and trained the staff in 2017.
“I started this whole thing not believing that AEDs would make a difference or switching the CPR training would make a difference, but it does,” Foster said. “Each saved life feeds another one. One save makes you want to teach more which leads to a second save, which makes you teach more.”
Honolulu Mayor Rick Blangiardi recognized Foster for her work improving survival rates from sudden cardiac arrest last week and named Oct. 20 “Pamela Foster Day.”
At a ceremony recognizing Foster last week, Brian Lee told ASD that he felt lightheaded after testifying in support of a housing project at a Honolulu City Council meeting in January 2024. The next thing he knew, he was in an ambulance.
Honolulu Emergency Management Services Department Director Jim Ireland was waiting to testify at that same meeting when he saw the commotion after Lee collapsed. A council staffer called 911, Fire Chief Sheldon Hao started chest compressions and Ireland followed the instructions from the AED, restoring Lee’s pulse in one shock.
“I’m fortunate to be here today and have a second chance,” Lee said. “AEDs save lives and if it weren’t for this machine and for this administration, the mayor, having it around this government building, I wouldn’t be here today.”
Pamela Foster Day marked the 86th time a person was saved with an AED at a Hawaiʻi airport.
Foster performed CPR on hundreds of people as an Emergency Room nurse for 20 years but didn’t use her own training as a bystander until 2008 when she gave a Home Depot employee compressions for eight minutes and saved his life, she told ASD. She quickly became known as the “CPR lady.”
“You never know when or where it’s going to happen,” she said.
Stories from survivors and bystanders taught her that not everything is in our control, and coincidences like traffic, a delayed flight or a change of venue puts people in the right place to save a life.
“The thing that resonates from each story is that the responder shouldn’t have been there,” she said.
CPR/AED education was never in Foster’s own plan.
Foster was a single mother working as a waitress in Northern California when she went to nursing school to support her family. She got her start in the Intensive Care Unit, and later moved to the ER, where she worked for 16 years.
“I learned that for me, I can’t do anything routine, and the ICU is very routine. In the ER, every day is different,” she said.
Foster was teaching an Advanced Cardiac Life Support course when a story from a student inspired her to distribute AEDs. The student, a cardiologist, was sportfishing off the coast of California when a man on his boat died of a cardiac arrest. Foster knew that an AED on that boat could have saved that man’s life.
She started the Southern California AED Institute, now AED Institute of America, in March 2004 to distribute AEDs and teach people how to use them.
This was Foster’s “retirement plan,” she said, but all that changed when she was forwarded an email from then Hawaiʻi Airports Fire Chief Martinez Jacobs who was looking to establish an AED program at Hawaiʻi airports.
In 2006, Foster signed a contract with Hawaiʻi DOT for what she said was then the “largest, most complex AED program in the country” to install 100 AEDs at 13 airports on six islands.
“Everybody in Hawaiʻi uses an airport,” Foster said. “You don’t know who the responder’s going to be, so the more people we can teach, the more people who, when they’re in the airport, they’ll know what to do.”
According to Foster, the airports had a 0% cardiac arrest survival rate before the AED program, and it didn’t take long for the program to make an impact, first saving three people in March and April 2007.
The cardiac arrest survival rate is around 70-80% at the airports due to ongoing training and easy to find AEDs, but remains around 13% in Hawaiʻi communities. AEDs are often “out of sight, out of mind,” Foster said, and people at home are afraid to perform CPR.
“You have more power to save this life than any firefighter. Why? Because you’re there when they collapse.”
Foster said that she never met survivors of sudden cardiac arrest when she worked in the ER, but that changed after the American Heart Association updated CPR guidelines in 2005 and CPR became more accessible.
“There was no scientific basis for how we used to do CPR,” she said. “It was very scary. It was a long, drawn-out process to try to save somebody’s life back in the 80s, 90s and early 2000s. CPR was saved for professionals.”
The first time a community member who took Foster’s CPR class told her that she saved a life was in 2006. Foster taught CPR/AED to employees from a health insurance company and later that week, a woman saved a 2-year-old who had drowned at a pool party.
When people told Foster that it was impossible to teach kids CPR, she responded that she likes a challenge.
“I’ve always thought that everybody should have the ability and the knowledge to save a friend or family member,” she said.
She taught her first CPR class to kids at ʻIolani School in 2005 and now, CPR is integrated into the school’s curriculum. Hawaiʻi Heart Foundation, a nonprofit Foster established to improve cardiac arrest survival rates, holds a contract with the state Department of Education to teach students CPR. One 9-year-old boy who learned CPR at Wai’alae Elementary Public Charter School saved his dad in Hawaiʻi Kai Marina, Foster said.
While October is National Sudden Cardiac Arrest Awareness Month, AED Institute of America offers classes year round. AED Institute of America is hosting free Health and Safety Institute CPR/AED certification courses in November and December.
Haley Lehman can be reached at haley@alohastatedaily.com.
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