Mary M. Newman

Automated external defibrillator (AED) utilization rates and reasons fire and police first responders did not apply AEDS

Objectives. To determine the rate at which fire and police first responders (FRs) apply automated external defibrillators (AEDs) and to ascertain reasons for not applying them. Methods. Twenty-one emergency medical services (EMS) systems whose FRs had been supplied with AEDs by a philanthropic foundation provided data for all out-of-hospital cardiac arrest (OHCA) patients. Data including the incidence of AED application and explanations for not applying AEDs were analyzed using descriptive statistics. Results. A total of 2,456 OHCAs were reported. AED application information was available for 2,439 patients and revealed that FRs had not applied AEDs to 1,025 patients (42%). Fire FRs were more likely than police FRs to have applied AEDs (relative risk 1.87, 95% confidence interval 1.65-2.12). Reasons for not applying AEDs were listed for 664 (65%) of the OHCA patients to whom AEDs had not been applied. The predominant reason the FRs did not apply an AED was that the transporting ambulance defibrillator had already been applied (74%). However, when response times for FRs and the transporting ambulances were compared for these OHCA patients, it was found that the transporting ambulances arrived after the FRs 23% the time, simultaneously with the FRs 45% of the time, and before the FRs only 32% of the time. Conclusion. Fire and police FRs did not apply AEDs to a significant number of OHCA patients. Use of the transport ambulance defibrillator was the primary reason given for not applying the FR AED. Given low AED application rates by FRs, future studies are needed to determine the characteristics of communities in which equipping FRs with AEDs is the most beneficial deployment strategy, and how to increase AED application by FRs in communities with FR AED programs.

Law enforcement agency defibrillation: position statement and best practices recommendations from the National Center for Early Defibrillation

position statement and best practices recommendations from the National Center for Early Defibrillation , Mary M. Newman *, Vincent N. Mosesso, Jr. , Joseph P. Ornato , Paul M. Paris , National Center for Early Defibrillation Police AED Issues Forum 1 a National Center for Early Defibrillation, Department of Emergency Medicine, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA 15213, USA b Medical College of Virginia, Richmond, VA, USA

A C OMPARISON OF F IRST - RESPONDER A UTOMATED E XTERNAL D EFIBRILLATOR (AED) A PPLICATION R ATES AND C HARACTERISTICS OF AED T RAINING

Objective. To determine whether there were associations between the characteristics of first-responder automated external defibrillator (AED) training and AED application rates. Methods. This multicenter retrospective cohort study analyzed data from ten emergency medical services systems where first responders were trained and equipped with AEDs. Data were provided for all out-of-hospital cardiac arrests (OHCAs) occurring over two years, including whether the first-responder AED was applied (pads attached to patient). Systems were surveyed to determine the characteristics of their initial and continuing AED training. Data were analyzed using odds ratios (ORs) with 95% confidence intervals (95% CIs). Results. Overall, the first-responder AED was applied to 53% of 2,181 OHCAs. First responders applied AEDs to 60% of OHCAs when a national AED training curriculum was used and to 49% of OHCAs when a locally created curriculum was used (OR = 1.58; 95% CI = 1.32−1.88). First responders applied AEDs to 61% of OHCAs when they were trained to the level of Certified First Responder or higher and to 28% of OHCAs when they were trained only in cardiopulmonary resuscitation (OR = 3.97; 95% CI = 3.20−4.93). First responders applied AEDs to 66% of OHCAs when they each had an opportunity to apply the AED during continuing training and to 17% of OHCAs when they did not have this opportunity (OR = 9.04; 95% CI = 7.15−11.42). First responders applied AEDs to 59% of OHCAs when they had not received continuing training within one year of their initial training and to 42% of OHCAs when they had received continuing training in the first year (OR = 2.00; 95% CI = 1.67−2.40). Conclusion. Use of a national AED training curriculum, training to the level of Certified First Responder or higher, and the ability for each first responder to apply the AED during continuing training were associated with higher AED application rates. Continuing training within the first year did not appear to be as important as actually using the AED during the training.

Public Access Defibrillation

The value of early intervention in critically ill patients has long been recognized. As early as the 1700s, scientists recognized the value of mouth-to-mouth respiration and the medical benefits of electricity (1). In the modern era, advances in resuscitation began to proliferate. In 1947, Claude Beck successfully resuscitated a 14-year-old boy through the use of open chest massage and an alternating current (AC) defibrillator, the kind that is used in wall outlets. In 1956, Paul Zoll demonstrated the effectiveness of closed chest massage with the use of an AC defibrillator. In the late 1950s, Peter Safar, William Kouwenhoven, James Jude and others began to study sudden cardiac arrest (CA) and in 1960, they demonstrated the efficacy of mouth-to-mouth ventilation and closed chest cardiac massage (2). In 1961, Bernard Lown demonstrated the superiority of direct current (DC) defibrillators, the kind provided by batteries. In 1966, J. Frank Pantridge and John Geddes developed the world’s first mobile intensive care unit (MICU) in Belfast, Northern Ireland, as a way to bring early advanced medical care to patients with cardiac emergencies (3). In 1969, William Grace established the first MICU in the United States in New York City (4). Subsequently, there were efforts in the United States and throughout the world to emulate and build on this concept. In the late 1960s and early 1970s, paramedic programs were developed by Eugene Nagel in Miami, Leonard Cobb in Seattle, Leonard Rose in Portland, Michael Criley in Los Angeles, and James Warren and Richard Lewis in Columbus. In the 1980s, Mickey Eisenberg, Richard Cummins, and colleagues demonstrated the effectiveness of rapid defibrillation in Seattle, Washington (5), while Kenneth Stults demonstrated the same in rural Iowa (6). This growing body of research demonstrated the importance of rapid care for victims of sudden CA by showing that survival improved when basic life support (mouth-to-mouth ventilation and closed chest compressions) was provided within 4 minutes and advanced life support (defibrillation, intravenous medications and fluids, and advanced airway management) within 8 minutes. Subsequent studies found that the benefits of advanced life support were primarily the result of electrical countershock for patients in ventricular fibrillation (VF). From these findings, a model of care called the “Chain of Survival,” was first described by Mary Newman (7), and then by Cummins et al. (8), and eventually adopted by the Citizen CPR Foundation, the American Heart Association (AHA) and others. The Chain of Survival consists of four action steps that must occur in rapid succession to provide the patient the greatest likelihood for resuscitation: early access (call 911 or the local emergency number to notify the emergency medical services [EMS] system and summon on-site help); early cardiopulmonary resuscitation (CPR; begin immediately); early defibrillation; and early advanced care (transfer care to EMS professionals upon their arrival at the scene).