Public Access Defibrillation: A Better Way to Deploy AEDs

Every day, approximately 1,000 people die from sudden cardiac arrest (SCA). With the introduction of automated external defibrillators (AEDs) designed for use by lay providers, there has been a significant increase in the number of Public Access Defibrillation (PAD) programs in many communities. One of the biggest problems with many PAD programs, however, is that once an AED is obtained, it is often not properly deployed.

The History of AEDs

AEDs have come a long way since they were first developed more than 15 years ago. The initial devices were automatic external defibrillators, with some units that would analyze, charge and shock the patient without any user intervention. This, of course, put providers at risk of being shocked if they were not clear of the patient when the unit discharged. Since many of these AEDs were deployed in fire/EMS agencies and few in PAD applications, however, the users were well-trained and the risk of harm to a provider was small, although not zero. Given the potential risks, these were not ideal units to deploy to PAD programs where the provider was an infrequent user and not always well-trained.

Over time, AED manufacturers modified the units, partly due to FDA requirements, so they would be better suited to PAD applications. The biggest change was requiring users to push a button to shock the patient. No longer were the devices automatic, but were more likely to be automated. There are still automatic defibrillators available, but they should not be used in PAD applications. Many of the medical directors who oversee PAD programs might not provide a prescription for an automatic unit to be deployed in a lay environment.

Today's AEDs

As the technology continues to improve, AEDs are easier to use and simpler to maintain. Some states are mandating AEDs be placed not only in government buildings, but also in schools and certain market segments like health clubs and some industries. Organizations like the American Heart Association and other not-for-profits, as well as many for-profit companies and AED manufacturers, are citing recent studies that show the benefits of prompt defibrillation in increasing survival rates. All of this has resulted in an increase in demand for PAD programs in public areas like malls, golf courses, office buildings, etc.

Most people will agree that the more AEDs that are out there, and the more people who are trained in CPR and AED use, the better the odds of survival for a patient experiencing SCA in one of these locations. However, my personal research has shown that many facilities that buy AEDs because they are mandated, or because they think it is the right thing to do, are not properly deploying the units.

Educating the Public

Public Access Defibrillation programs are just that--programs where an AED should be accessible to the public so in the event of someone suffering SCA, a shock can be promptly delivered and the patient hopefully saved. This does not mean that the AED should be locked in a greenskeeper's office at a golf course, or in a security office at a mall or office building. Rather, AEDs need to be deployed as they are in several large airports-- in alarmed cabinets that are within easy reach of anyone and spaced just a few hundred yards apart.

An AED is no different to use than a fire extinguisher and should be deployed in a similar manner. We don't lock up fire extinguishers; they are accessible to everyone. The next time you are in a building with a fire extinguisher, take a quick survey to see who has been properly trained to use it. I bet the answer will be close to zero. Many PAD programs require that at least some percentage of a building's permanent occupants be trained in CPR and AED use. What we're also seeing is that many high-school students, sports coaches and other adults are learning CPR and AED. But although there are more people trained in CPR and AED use than in using a fire extinguisher, we leave fire extinguishers accessible to all and lock up the AEDs. This is a major problem with AED deployment.

In addition, most facilities do not properly notify building occupants that there is an AED on site. No building deploys fire extinguishers without proper signage. Why would you deploy an AED without letting the people who are trained to use it know where it is?

Guaranteeing Successful PAD Programs

There has been a dramatic improvement in AED technology, making them far easier to use and better suited for use by lay providers than ever before. As a result, more PAD programs are springing up throughout the country. EMS agencies should embrace this movement and help organizations properly deploy AEDs. This means that AEDs should be placed in areas that are accessible to a majority, if not all, of a building's occupants, and signage should be adequate to let people within the building know an AED is on site and where it is located. The more AEDs that are deployed, the safer our communities will be when it comes to addressing the ever-increasing occurrences of SCA.