Short communicationThe Los Angeles public access defibrillator (PAD) program: Ten years after☆
Section snippets
Background
Sudden cardiac death is a leading cause of mortality in North America and Europe.1, 2, 3 Patients whose presenting rhythm is ventricular fibrillation have the highest chances of survival, which has led to efforts to expedite the rapid availability of defibrillators.3, 4, 5 Given the fact that each one minute delay in defibrillation decreases the patient's chances of survival by almost 10%,6, 7 automated external defibrillators (AEDs) have been strategically placed in public areas with very high
Methods
This was a prospective, longitudinal, observational study from 2002–2012 conducted in Los Angeles, California, a city with a population of 3.8 million. Automated external defibrillators (AEDs) were placed in city-owned buildings and other public places, including all 3 area airports, golf-courses, and public pools.
Initial funding was approved by the Los Angeles City Council in the 1999–2000 budget. This initial funding provided for purchase of 62 AEDs, which were placed in various City-owned
Results
There were 59 incidents of cardiac arrest with a public access AED applied, of which 42 (71%) occurred at an airport. 51 (86%) of the patients were male, with a median age of 64 years (interquartile range, 56.5 to 70 years).
A shockable rhythm was detected and shocks were applied in 39 (66%) patients, with 30 (77%) of these patients achieving a return of spontaneous circulation (ROSC). Of those patients who received shock(s) by public access AED, 27 (69%) survived to hospital discharge. All
Discussion
Early defibrillation is a vital link in the chain of survival. Since the interval from time of collapse to first shock is directly related to survival, and success of defibrillation decreases 8–10% with each minute that defibrillation is delayed,6, 7 public access defibrillator programs have become widespread.8, 9, 10, 11, 12
Several published reports detail the success of public access AED programs. Caffrey, et al. described the success of a PAD program at 3 airports in Chicago, which found a
Conclusion
AEDs deployed as part of a large PAD program resulted in a very high survival rate for patients with cardiac arrest, with the majority of cases occurring at area airports. This resulted in an average of three additional lives saved per year.
Conflict of interest statement
No conflicts of interest to declare.
Acknowledgement
I would like to acknowledge the efforts of Valerie Munoz and June Andrade, the Los Angeles AED Program Managers, whose dedicated efforts made this program possible.
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Cited by (20)
Myth of the stolen AED
2019, ResuscitationCharacteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk
2016, ResuscitationCitation Excerpt :Of the uncovered significant locations, most were parking lots (14 sites), commercial stores or offices with apartments (8 sites), or hotel/motels (7 sites). Some programs for public access defibrillation (PAD) have been evaluated, such as one in city-owned buildings, airports, golf courses and pools in Los Angeles, California, which found that airports were the most common site of cardiac arrest where an AED was used (71% of all AED usage), but arrests also occurred in other public spaces.25 PAD programs involve identifying places where cardiac arrests are likely to happen, where bystanders are likely to use an AED, and where there is a suitable accessible location where to place an AED.26
The Doctor of Nursing Practice Essentials in Action: Using the Essentials to Build a University-wide Automatic External Defibrillator Program
2016, Journal for Nurse PractitionersCitation Excerpt :In performing the DNP project to increase access to AEDs on campus, the lead author followed all 5 of these steps and generated evidence to guide practice. In addition to the thorough review of the literature, basic evidence from AED programs implemented in municipalities, airports, and casinos was examined to determine the key essentials that make an AED program successful.13-15 Research was also completed on the current state of the AED policy and program in place at the university to determine if the current program contained the key essentials of successful AED programs.
Public access defibrillation-results from the victorian ambulance cardiac arrest registry
2014, ResuscitationCitation Excerpt :Table 3 shows the rate of survival to hospital discharge for various patient subgroups who were first shocked by a bystander with a public AED in Victoria, Australia, alongside comparable data from other published PAD studies. Survival to hospital discharge rates seen in our study are quite favourable compared to previous PAD studies.13–18 Table 4 shows that first defibrillation by a bystander using a public AED was independently associated with an increased odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared with patients first defibrillated by EMS.
Increasing bystander participation in resuscitation
2014, ResuscitationProtecting the heart of the American Athlete: Proceedings of the American college of cardiology sports and exercise cardiology think tank October 18, 2012, Washington, DC
2014, Journal of the American College of Cardiology
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.03.029.