AED use in businesses, public facilities and homes by minimally trained first responders
Introduction
Automated external defibrillators (AEDs) have become increasingly available outside of the Emergency Medical Systems (EMS) community for the treatment of sudden cardiac arrest (SCA). SCA has been described as a major clinical and public health problem resulting in 250 000–450 000 deaths per year [1], [2]. Early defibrillation has been shown to be effective in improving survival from out of hospital cardiac arrest. However, most communities and areas have limited rapid access by EMS, and response times are fundamentally limited to several minutes or more. One approach has been to expand emergency medical services via widespread deployment of AEDs. AEDs have been demonstrated to be reliable and intuitive to use, and advancements in technology have resulted in reductions in size, weight, cost and maintenance [3], [4]. The AHA Automated External Defibrillation/Public Access Defibrillation (PAD) panel has called for the establishment of PAD programs under some circumstances where training and equipping laypersons to function as first responders in the community is likely to be beneficial [5]. This has resulted in programs with trained first responders using AEDs in addition to traditional paramedics and firefighters [6]. AEDs have been successfully used by police officers [7], flight attendants in airplanes and airports [8], [9], and by security guards in casinos [10], to name a few. There have also been some programs that target the home, where 70% of all SCAs occur [11], [12], [13], [14].
Although widespread availability of AEDs holds promise for improving survival from SCA, questions remain regarding where AEDs should be placed and the level of care lay responders will provide in an emergency situation. The placement of AEDs in public settings, office buildings and homes is largely untested. To our knowledge, safety problems or adverse events associated with AED use by minimally trained responders have not been reported in the literature. Thus, we hypothesized that there would be no safety problems specific to lay responder use of AEDs. This survey sought to study the use of AEDs in the home, businesses and public settings by minimally trained first responders. The frequency of AED use, type of training offered to first responders, and outcomes of AED use were investigated. In addition, minimally trained responders were asked if they had encountered any safety problems associated with the AED.
Section snippets
Methods
We conducted a telephone survey of businesses and public facilities (2683) and homes (145) owning at least one AED for at least 12 months. The sites were identified using the customer database of a single AED manufacturer (Philips Medical Systems, Seattle, WA, USA). Sites identified as part of emergency medical services or employing non-lay responders were excluded (e.g. medical doctors, nurses, firefighters, police officers, and ambulance personnel). Military sites and sites that were outside
Homes
The manufacturer's customer database contained 145 home contacts meeting the inclusion criteria of owning an AED for at least 12 months. Of these, 54% (78) were contacted successfully, 46% (67) were not reachable by telephone or refused to participate. Among those successfully contacted, three reported they had purchased an AED but no longer had it and two reported there was no one able to answer questions about an AED purchase. This resulted in 50% (73) of homes remaining in the survey. Of the
Discussion
This study investigates the use of AEDs in non-EMS settings and the results of allowing laypersons to use AEDs. The survey of business and home AED purchasers revealed a high percentage of the devices had been used. Respondents reported that 13% (209/1581) of businesses and 5% (4/73) of homes had brought the AED to a suspected cardiac arrest. The usage rate for the AEDs was highest in residential buildings, public places, malls and recreational facilities with an overall usage rate of 11.6% per
Conclusions
In this survey, AEDs purchased by businesses and homes were taken frequently to suspected cases of cardiac arrest. Lay responders were able to use the AEDs successfully in emergency situations. Survey respondents reported that during lay responder use, there were no reports of harm or injury to the AED operators, bystanders or patients from the AEDs.
Acknowledgements
We would like to thank Robin Havrda, Carol Bowen, and Ellyn Murphy for their contributions to the survey.
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Part 12: Education, implementation, and teams: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :In adults and children with out-of-hospital cardiac arrest (including residential settings), does implementation of a public access AED program, as opposed to traditional EMS response, improve successful outcomes (e.g., ROSC)? One RCT (LOE 1)197, four prospective controlled cohort studies (LOE 2)357–360, one study using historical controls (LOE 3)361, nine observational studies (LOE 4)226,227,362–368, and one mathematical modeling study (LOE 5)369 showed that AED programs are safe and feasible and significantly increase survival of out-of-hospital ventricular fibrillation (VF) cardiac arrest if the emergency response plan is effectively implemented and sustained. For EMS programs, 10 studies (LOE 1370; LOE 2358; LOE 3224,371,372; LOE 4373–377) supported AED use; 11 studies (LOE 2378,379; LOE 3380–383; LOE 4384–388) were neutral, and two meta-analyses359,389 suggested benefit.
A population-based investigation of public access defibrillation: Role of emergency medical services care
2010, ResuscitationCitation Excerpt :Evidence indicates that in some circumstances PAD programs can be lifesaving and improve survival following out-of-hospital cardiac arrest.5 Based on such evidence, many communities have equipped a variety of locations and/or nontraditional responders with AEDs.6,7 It is unclear whether the growing dissemination of PAD AED has translated to increasing PAD involvement in actual cardiac arrest over time.
AED in Europe. Report on a survey
2010, ResuscitationCitation Excerpt :Home AEDs: it is well known that the great majority (approximately 80%) of out-of-hospital cardiac arrests occur in a private setting,25 so the purchase of home defibrillators (AEDs) could seem a logical precaution. Only very few studies, however, have addressed this subject and have shown little or no benefit.26–28 It is hardly surprising, therefore, that in 19 countries very few home programmes have been initiated and in 17 countries none at all, although privately purchased AEDs undoubtedly do exist.