Adult AED Use by Lay and Nontraditional Responders

Highlights:

• Class I rating for AED programs in certain public locations
• Class I rating for AED programs for public safety responders
• Emphasis on organization, planning, training, linking with EMS and continuous quality improvement for PAD programs

AEDS: Lay and Nontraditional Responders

The rescuer should deliver 1 shock followed immediately by 2 minutes of CPR at a rate of 30:2. Class IIa. (p. IV-36.)

Lay rescuers will no longer perform checks for signs of circulation and will use a 30:2 compression ventilation ratio for all victims.

Increasing the amount of CPR time during rescue is thought to improve outcomes for sudden cardiac arrest victims. With the incorporation of cprMAX technology, LIFEPAK AEDs will include voice prompts that guide the rescuer through these new recommendations.

"AED programs in public locations where there is a relatively high likelihood of witnessed cardiac arrest (eg. airports, casinos, sports facilities) are recommended Class I." (p. IV-38)

"CPR and AED use by public safety first responder (traditional and non traditional) are recommended to increase survival rates for SCA. Class I." (p. IV-38)

Public safety first responders are good candidates for AED program inclusion as they often arrive at SCA scenes prior to EMS. Examples of nontraditional public safety responder are city police, county sheriffs, highway patrol/state police, correctional facility employees and federal agency employees such as state park rangers.

"Lay rescuer AED programs will have the greatest potential impact on survival from SCA if the programs are created in locations here SCA is likely to occur." (p. IV-38)

This statement, while not new to the 2005 Guidelines, continues the emphasis on creating a scenario for success with well-placed AEDs. A site assessment by a knowledgeable expert can be invaluable to entities who want to start or supplement a program but are inexperienced in the area of appropriate AED placement. Physio-Control has resources available to assist you with this critical step.

"To be effective, AED programs should be integrated into an overall EMS strategy for treating patients in cardiac arrest." (p. IV-38)

Physio-Control, the leader in the EMS industry, is ready to partner with you and your local EMS agency in implementing an effective AED program.

Reviewers found no studies that documented the effectiveness of home AED deployment, so there is no recommendation for or against personal or home deployment of AEDs. Class Indeterminate. (p. IV-38)

The following elements are recommended for community lay rescuer AED programs (p. IV-38):

• Planned and practiced response; typically requires oversight by a healthcare provider
• Training of anticipated rescuers in CPR and use of AED
• Link with local EMS
• Process of ongoing quality improvement

With the Physio-Control Heart Safe Solution, you have ready access to these recommended AED program elements. By partnering with the industry expert to implement and manage your AED program, you are assured of program success.

The goal of public access defibrillation is to shorten the time from collapse to first shock. Programs that fail to reduce time to defibrillation may not achieve high success rates such as those documented in airports (41%) and casinos (74%). (p. IV-38)

Time to defibrillation is an important determinant in assessing how many AEDs a site will need. The Physio-Control site assessment provides recommendations to support collapse-to-response times of 3 minutes or less. This is based on published research that reveals markedly higher success rates when response occurs in this timeframe.⁴

"It is reasonable for lay rescuer AED programs to implement processes of continuous quality improvement (Class IIa). These quality improvement efforts should use both routine inspections and post event data (from AED recordings and responder reports) to evaluate the following (p. IV-38):

• Performance of the emergency response plan, including accurate time intervals for key interventions (such as collapse to shock or no shock advisory to initiation of CPR), and patient outcome
• Responder performance
• AED function, including accuracy of the ECG analysis
• Battery status and function
• Electrode pad function and readiness, including expiration date

With the Physio-Control Heart Safe Solution, a factory-trained field technician extracts post-event data from the AED and forwards this information to the overseeing physician for review. In addition, online program management, as provided through the Heart Safe Solution, ensures appropriate tracking of battery status and electrode expiration. Furthermore, responders' skills are not only kept current and but also tracked through AED Challenge, an online course providing for AED/CPR skills refreshment. By partnering with the industry expert to implement and manage your AED program, you are assured of program success.

AED Pad Placement

"Rescuers should place AED electrode pads on the victim's bare chest in the conventional sternal-apical (anterolateral) position (Class IIa). The right (sternal) chest pad is placed on the victim's right superior-anterior (infraclavicular) chest and apical (left) pad is placed on the victim's inferior-lateral left chest, lateral to the left breast. Class IIa. (p. IV-38-39)

This is placement Physio-Control has always recommended, especially placing the left electrode lateral to the left breast (which is essentially on the side of the chest under the arm). A one-piece CPR-defibrillation pad offered by one manufacturer makes it harder to meet these criteria because even on small patients the correct placement can only be achieved when a "pin" is pulled and the lateral electrode then placed in the desired spot. So correct placement can be achieved but only after extra steps.