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

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.

Energy attenuator for pediatric application of an automated external defibrillator.

Although automatic external defibrillators (AEDs) are extensively deployed to rapidly treat sudden cardiac arrest in adults, their applicability for children is presently limited. It is desirable to extend the indications for this lifesaving equipment to all ages, even though AED application to children will be rare compared with adults. It is imperative that the inherent simplicity of present adult AED operation not be compromised to extend its use to include children. We propose a method that does not affect the normal operation of an AED on adults. For adults, unmodified AEDs would be used normally with adult electrodes. However, special pediatric electrodes would be available as a disposable accessory. When used with the AED, the delivered energy would be reduced within the electrodes, and only a portion of the energy output by the AED would be delivered to the pediatric patient. These electrodes could be used in conjunction with currently deployed AEDs with electrocardiographic analysis algorithms appropriate for children. This eliminates the need for a separate AED specifically for children or the purchase of a new AED with pediatric capability to replace previously deployed models.