Getting more AEDs in public places

Sudden cardiac arrest (SCA) is a leading cause of premature death. In the UK alone, approximately 30 000 people sustain cardiac arrest outside hospital and are treated by emergency medical services (EMS) each year (Pell et al, 2003). However, many SCA victims can be saved by bystanders who recognise what has happened, summon the ambulance service as soon as possible, perform basic CPR and use an AED to provide a high-energy electric shock to restore the heart’s normal rhythm (Resuscitation Council (UK) and British Heart Foundation, 2013).

It has been shown that a strong predictor of SCA survival is the interval from collapse of the patient to defibrillation (Valenzuela et al, 1997). While this generally applies to defibrillation as carried out by healthcare professionals—from emergency physicians, to paramedics, to first responders—it also extends to defibrillation carried out by the layperson (Rea and Page, 2010). The introduction of public access defibrillation (PAD) programmes has produced positive results. One US study, which looked at a prospective series of cases of SCA in casinos, attended to by security officers instructed in the use of AEDs, recorded survival rates as high as 74% (Valenzuela et al, 2000).

In April, the Department for Education announced a plan to allow schools to purchase defibrillators at a lower cost. As a result, the Government is currently working to identify a supplier who will offer defibrillators at a competitive price, affirming that the deal will be sealed in time for the autumn term. Around 270 cardiac arrests occur in schools in the UK each year, highlighting the evident need to have AEDs on hand.

Ambulance services have played their part in encouraging PAD as well as the number of defibrillators in the community. On 1 May 2014, London Ambulance Service NHS Trust launched a campaign to get 1 000 defibrillators in shops, businesses and gyms across the capital, while South Central Ambulance Service NHS Foundation Trust have launched an app that uses GPS functionality to show where the nearest AED is, as well as a list of other AEDs in the area, as part of its ‘Start a Heart’ campaign.

Undoubtedly, there are considerations to take into account with regards to PAD, such as the investment to purchase AEDs and maintain layperson responder proficiency (Rea and Page, 2010). However, given that AEDs are designed to be used by laypersons, with the machine guiding the operator through the defibrillation process by verbal instructions and visual prompts (Resuscitation Council (UK) and British Heart Foundation, 2013), there is plenty of argument in favour of PAD.

References:

Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM (2003) Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology. Heart 89(8): 839–42

Rea T, Page RL (2010) Community approaches to improve resuscitation after out-of-hospital sudden cardiac arrest. Circulation 121(9): 1134–40

Resuscitation Council (UK) And British Heart Foundation (2013) A Guide to Automated External Defibrillators (AEDS). Resuscitation Council (UK), London

Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP (1997) Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation 96(10): 3308–13

Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG (2000) Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 343(17): 1206–9

Taken from Journal of Paramedic Practice, published 6 June 2014.

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