Redesigning Defibrillation Under V=N/D: Wave-Coherent Shock Delivery, AMSA as N_c Proxy, and the End of Fixed-Interval Protocols

Current defibrillation practice delivers brute-force Generation layer reset without Wave layer priming, without N_internal state awareness, and without KOKU scaffold geometry consideration. Four redesign proposals are derived from V=N/D: (I) KOKU-aligned electrode placement minimizing D_EMI (grounded in Sepulveda 1989, Trayanova 2011); (II) AMSA as measurable proxy for N_internal relative to N_c threshold — enabling real-time optimal shock timing replacing fixed 2-minute intervals (grounded in Callaway 2015, Freese 2007); (III) wave-coherent shock waveform design replacing biphasic rectangular with KOKU-resonant energy profiles (grounded in Walcott 2003); (IV) three-phase protocol: Wave priming (CPR + sub-threshold resonance pacing) → N_c detection (AMSA monitoring) → Wave-coherent KOKU-aligned defibrillation. V=N/D unifies 30 years of defibrillation optimization research under a single physical principle. Global cardiac arrest survival (8-10%) is a ceiling imposed by pump-model design, not biology.