Public AEDs Sparsely Distributed, Rarely Used in UK Survey

February 19, 2014

SOUTHAMPTON, UK — Many public areas here have no automatic external defibrillator (AED), or at least no record of them, and where they exist they are seldom retrieved and used before ambulance arrival, suggests a retrospective review of emergency calls for out-of-hospital cardiac arrest over one year[1]. It included a survey that identified only 278 locations with public-access defibrillators in a county of 1.78 million inhabitants.

Most of the devices were identified at shopping centers or other commercial properties, although other locations included clinics and nursing homes.

"This study highlights the need for both improved [public-access defibrillator] availability and the need to improve bystander confidence in the use of these devices," according to the authors, led by Prof Charles D Deakin (University of Southampton, UK). The group reported the study online February 19, 2014 in the journal Heart.

During the study period, callers reported they were aware of a nearby AED in 44 out of 1035 (4.25%) calls made to dispatchers for confirmed cardiac arrest; in only 18 cases (1.74% of all arrests) were the devices used before arrival of trained responders.

Why less than half of AEDs known to be on site were actually used is "unclear," according to Deakin et al. "But [it appears] related to a lack of bystander willingness to use an AED in an emergency situation, poor 'visibility' or accessibility of the AED, mistaken concerns over legal liabilities, and poor levels of community knowledge about [public-access defibrillators], even following campaigns to improve public awareness."

An accompanying editorial[2] notes that "public-access AED programs have saved lives, but as the Deakin study highlights, the current strategy has enabled only modest progress." Initial signs are that the same might be true for "emerging strategies [that] leverage technologies to map AEDs, enlist social networks, and ultimately engineer more coordinated and quicker community AED response," although "these approaches deserve evaluation and may ultimately provide benefit, write Drs Mickey Eisenberg and Tom Rea (King County Emergency Medical Services, Seattle, WA).

More comprehensive public deployment of "a low-cost AED that would have a more limited scope of therapy [such as ability to deliver only a single shock] and less rigorous performance standards" might allow "a much broader reach of early defibrillation," they propose.

Deakin is director of Prometheus Medical. Deakin and Rea are recipients of "unrestricted donations" from Philips Medical and Physio Control and a grant from the Medtronic Foundation for the HeartRescue Project.

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