”Heart Safe” communities – Why public AEDs are a good idea

By Steven Poon, MD, and Jonathan Drezner, MD, Center for Sports Cardiology, University of Washington

Recently, the Faculty of Sport and Exercise Medicine (FSEM), an organization that promotes the specialist field of Sports and Exercise Medicine in the U.K., released a position statement in favor of Public Access Defibrillation programs (read it HERE).¹ We applaud the FSEM’s efforts and strongly support public access to Automatic External Defibrillators (AEDs). Medical research clearly demonstrates that early use of AEDs in the treatment of sudden cardiac arrest (SCA) improves survival rates. A longitudinal, multi-center surveillance study (Cardiac Arrest Registry to Enhance Survival – CARES) in the U.S. has shown an overall survival rate of 7-10% after SCA without bystander intervention. However, studies evaluating Public Access Defibrillation in the U.S. and worldwide have shown a marked increase in survival rates, from 50-70%.^2-3 In school athletic venues, survival rates to hospital discharge for young athletes with SCA reached 89% when on-site AEDs were available and used.⁴

We commend the statement for its concise, accurate and easily understood description of AED function, simplicity of use, portability and the vital role this device plays in increasing survival. Equipment manufacturers have emphasized the ability of bystanders to follow clearly marked application instructions and voice prompts to promote appropriate use. Furthermore, AED use has become a vital part of basic life-saving courses, such as that offered by the American Heart Association, with strong encouragement for lay person use of AEDs in emergency situations.

In addition to the excellent information presented in the FSEM position statement, other important elements for a successful Public Access Defibrillation program include AED location and placement, equipment maintenance, and an emphasis on recognizing SCA.  The success of Public Access Defibrillation programs is directly linked to ensuring that AEDs are readily available and accessible in public gathering locations. A study in Los Angeles showed increased survival rates by placing AEDs in areas with high pedestrian density such as airports and public swimming pools.⁵

What more can be done?

We would emphasize that proper planning to identify the optimal AED locations is crucial. Sports and fitness facilities are strategic venues to place AEDs because of their high population density and increased risk of SCA associated with exercise; survival rates are high when AEDs are available and used within exercise facilities.⁴ However, despite strong evidence that these are prime locations for AEDs, many exercise facilities still do not have AEDs in place.⁷ As a point of emphasis, AEDs should be accessible at all times to be most effective, with appropriate signage and public access – some studies have shown an unacceptable percentage of devices inaccessible or locked away at the time of need such as at night or on weekends.⁶

Equipment maintenance is another consideration for long-term success of a Public Access Defibrillation program. AED batteries and leads should be checked based on manufacturer guidelines (usually monthly). Within the sports medicine community, additional preparation and anticipation, including simple ‘readiness’ checks prior to sporting events, are important for emergency planning. The responsibility to properly maintain publicly located AEDs can be ill-defined, and this can lead to devices not being regularly serviced and checked. . Many AEDs now perform self-checks every 24 hours and will trigger an alarm if the battery is low or the leads need replacing. However, ensuring proper upkeep and designating the individuals responsible is essential to the program’s success.

Critical to survival and the prompt initiation of CPR and AED use is the rapid recognition of SCA. Proper management of SCA will only ensue if the emergency is recognized. The medical community can help educate the general public to understand that witnessed collapses are frequently SCA. In 2007, an inter-association task force released Guidelines for SCA recognition and management within the athletic setting.⁸ This document underscores that brief seizure-like activity can be a confusing hallmark of SCA in athletes, and SCA should be assumed in any (non-traumatic) collapsed and unresponsive athlete to eliminate delays in starting CPR or retrieving and applying an AED.⁸

The FSEM have taken a bold step to foster and improve heart safety within the U.K.  As sports medicine professionals, we should strongly support Public Access Defibrillation programs and ensure proper emergency planning and access to AEDs within our communities.

References:

• Faculty of Sport and Exercise Medicine, “Position Statement: Automatic External Defibrillators in Public Places.” July 2015.
• Culley LL, Rea TD, Murray JA, et al. Public access defibrillation in out-of-hospital cardiac arrest – a community based study. Circulation 2004;109:1859-1863.
• Ringh M, Jonsson M, Nordberg P, et al. Survival after public access defibrillation in Stockholm, Sweden – a striking success. Resuscitation 2015;91:1-7.
• Drezner JA, Toresdahl BG, Rao AL, et al. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports. Br J Sports Med 2013;47:1179-1183.
• Eckstein M. The Los Angeles public access defibrillator (PAD) program: Ten years after. Resuscitation 2012;83:1411-1412.
• Hansen CM, Wissenberg M, Weeke P, et al. Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends. Circulation 2013;128:2224-2231.
• Drezner JA, Asif IM, Harmon KG. Automated external defibrillators in health and fitness facilities. Phys Sportsmed 2011;39:114-118.
• Drezner JA, Courson RW, Roberts WO, Mosesso VN, Link MS, Maron BJ. Inter-Association Task Force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. Heart Rhythm. 2007;4:549-65