AED use in businesses, public facilities and homes by minimally trained first responders

Abstract

Background: Automated external defibrillators (AEDs) have become increasingly available outside of the Emergency Medical Systems (EMS) community to treat sudden cardiac arrest (SCA). We sought to study the use of AEDs in the home, businesses and other 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. 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. Use was defined as an AED taken to a medical emergency thought to be a SCA, regardless of whether the AED was applied to the patient or identified a shockable rhythm. Results: Of owners that participated in the survey, 13% (209/1581) of businesses and 5% (4/73) of homes had responded with the AED to a suspected cardiac arrest. Ninety-five percent of the businesses/public facilities offered training that specifically covered AED use. The rate of use for the AEDs was highest in residential buildings, public places, malls and recreational facilities with an overall usage rate of 11.6% per year. In-depth interviews were conducted with lay responders who had used the AED in a suspected cardiac arrest. In the four cases where the AED was used solely by a lay responder, all four patients survived to hospital admission and two were known to be discharged from the hospital. There were no reports of injury or harm. Conclusions: This survey demonstrates that AEDs purchased by businesses and homes were frequently taken to suspected cardiac arrests. Lay responders were able to successfully use the AEDs in emergency situations. Further, there were no reports of harm or injury to the operators, bystanders or patients from lay responder use of the AEDs.

Sumàrio

Introdução: Os Desfibrilhadores Automáticos Externos (AEDs) têm sido disponibilizados de modo crescente fora da comunidade de Sistemas Médicos de Emergência (EMS) para tratamento da paragem cardı́aca súbita (SCA). Propusemo-nos estudar a utilização de AEDs no domicı́lio, nos locais de negócios e noutros locais públicos, por primeiros reanimadores com treino mı́nimo. Foram analisadas a frequência de utilização do AED, o tipo de treino dos primeiros reanimadores e os resultados da AED. Além disso, perguntou-se aos reanimadores se tinham encontrado algum problema de segurança associado ao AED. Métodos: Fizemos um inquérito telefónico a locais públicos e de negócios (2683) e a domicı́lios (145) em que houve pelo menos um AED durante 12 meses. A utilização foi definida como o transporte de um AED para uma emergência médica interpretada como SCA, independentemente de o AED ser utilizado no doente ou da identificação de um ritmo desfibrilhável. Resultados: Dos detentores de AED que participaram no inquérito, 13% (209/1581) de locais de negócios e 5% (4/73) de domicı́lios responderam com o AED a uma suspeita de paragem cardı́aca. Noventa e cinco por cento das instituições públicas / de negócios ofereceram treino que cobria especificamente o uso de AED. A taxa de uso de AEDs foi maior nos prédios residenciais, locais públicos, comerciais e recreativos, com uma taxa de uso global de 11,6% por ano. Foram conduzidas entrevistas aprofundadas a reanimadores leigos que utilizaram o AED numa suspeita de paragem cardı́aca. Nos 4 casos em que o AED foi utilizado apenas por um reanimador leigo, todos os doentes sobreviveram até à admissão hospitalar e dois deles tiveram alta do hospital. Não se registaram danos. Conclusões: Este inquérito demonstrou que os AEDs adquiridos para locais de negócios e domicı́lios foram frequentemente transportados para situações suspeitas de paragem cardı́aca. Os reanimadores leigos foram capazes de usar com sucesso os AEDs em situações de emergência. Além disso, não houve registo de danos ou lesões provocados pelo uso de AEDs por reanimadores leigos, nos operadores, testemunhas ou doentes.

Resumen

Antecedentes: Los desfibriladores automáticos externos (AEDs) se han hecho progresivamente disponibles fuera de la comunidad de los sistemas de emergencias médicas(EMS) para tratar paro cardiorrespiratorio súbito (SCA). Buscamos estudiar el uso de AEDs en el hogar, en oficinas de negocios y otros ambientes comunitarios por primeros respondedores con entrenamiento mı́nimo. Se investigaron la frecuencia de uso de los AED, tipo de entrenamiento ofrecido a los primeros respondedores y resultado del uso de los AED. Además se les preguntó a los primeros respondedores mı́nimamente entrenados si habı́an encontrado problemas de seguridad asociados con el AED. Métodos: Condujimos una encuesta telefónica en edificios públicos y de negocios(2683) y en hogares (145) que poseı́an al menos un AED por un perı́odo de al menos 12 meses. Se definió uso como el haber llevado el AED a una emergencia médica que se cree sea un SCA, sin importar si acaso se aplicó el AED al paciente o si se identificó un ritmo que requiriera descarga. Resultados: De los dueños que participaron en la encuesta, el 13% (209/1581) de las oficinas y 5% (4/73) de los hogares habı́an respondido con el AED ante la sospecha de un paro cardı́aco. 95% de los edificios públicos o de negocios ofrecieron un entrenamiento que cubrı́a especı́ficamente el uso de AEDs. La frecuencia de uso de los AEDs fue mas alto en los edificios residenciales, sitios públicos, centros comerciales y establecimientos de recreación con una tasa de uso global de 11.6% por año. Se realizaron entrevistas mas profundas a aquellos primeros respondedores que habı́an usado los AEDs en un caso de sospecha de paro cardı́aco. En los 4 casos en que el AED fue usado solo por el primer respondedor, los 4 pacientes sobrevivieron a la admisión hospitalaria y dos fueron dados de alta vivos del hospital. No hubo reportes de lesión o daño. Conclusiones: Esta investigación demuestra que los AEDs comprados por negocios y hogares fueron llevados con frecuencia a casos de sospecha de paro cardı́aco. Los reanimadores legos fueron capaces de usar exitosamente el AEDs en situaciones de emergencias. Mas aún, no hubo reportes de daño o lesión a los operadores, testigos o pacientes cuando se usaron los AEDs operados por legos.

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.