Installation Of Automated External Defibrillators Research Articles

Basic life support and automated external defibrillators in secondary schools

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Sudden cardiac arrest is the leading cause of premature death. Effective cardiopulmonary resuscitation (CPR) and early defibrillation substantially improve survival rates. This has also been replicated in schools, with excellent outcome data in schools who advocated CPR certification together with the availability of onsite automated external defibrillator (AED). Most entities now encourage AED installation in schools. Objectives As a follow up to the BEAT-IT cardiac screening program performed across all secondary schools in 2017/2018, the main aim of this study was to evaluate the availability of AEDs in schools across the Maltese archipelago. Information on staff CPR certification was also evaluated. Methodology One school administrator in all secondary schools across Malta and Gozo (n=54) were asked to complete an online questionnaire. All data was kept anonymous. Data was tabulated. Categorical variables were presented as percentages. Statistical analysis was performed with SPSS v23. Results Most schools (n=40, 74.1%) complied, the majority from the northern harbour region (n=15, 37.5%). Student gender in most schools was mixed (n=23, 57.5%). Two schools (5%) reported a cardiac arrest in one of their pupils over the previous 10 years, one happening during school hours. A minority (n=3, 7.5%) strongly disagreed that preventing sudden cardiac death (SCD) in schools is important. Only 1 (2.5%) had never heard of an AED. Some schools (n=3, 7.5%) did not have an AED on school premises. The majority had one AED (n=1, 75.0%). Most schools service their AED regularly (n=34, 94.4%). The majority had an AED only on one floor (n=35, 97.2%). Most AEDs were installed in easily accessible areas (n=35, 97.2%), yet the location was not subjected to a risk assessment prior to installation in a significant proportion (n=17, 47.2%). Defibrillators in a third of schools (n=11, 30.6%) were not close to sporting facilities, an area traditionally recognized as a high risk location. Most schools do not organise onsite CPR certification courses (n=21, 52.5%). Some staff are certified in CPR (n=35, 87.5%), a fifth having more than 5 certified individuals (n=8, 20.0%). The majority have also undergone recertification (n=28, 70.0%). Most were strongly in favour of a systematic cardiac screening program in schools (n=28, 70.0%). Conclusion A significant proportion of schools have experienced a cardiac arrest in one of its pupils (5.0%), implying this is an important health concern. Yet some still disagree that SCD prevention in schools is important (7.5%). Despite the majority having an AED on site, a substantial proportion did not have a risk assessment prior to installation (47.2%). Only a small proportion of staff members are certified in CPR. Most schools do not organise on-site CPR courses (52.5%). More education and awareness about cardiac arrest in students and CPR certification is necessary.

Assessment on CPR Knowledge and AED Availability in Saudi Malls by Security Personnel: Public Safety Perspective.

Security personnel are the first ones who attend the scene in the case of out-of-hospital cardiac arrest (OHCA) at malls. Cardiopulmonary resuscitation (CPR) is not enough for those patients; they need an automated external defibrillator (AED) to bring the heart to function normally. This study aimed to assess the current status of CPR and AED knowledge and availability in Saudi malls by security personnel. Using a descriptive design, a study was conducted at seven malls located in the Eastern Province of Saudi Arabia. Two hundred and fifty participants were surveyed using the American Heart Association (AHA) 2015 guidelines to assess CPR and AED knowledge and availability in Saudi malls. The sample mean age was 32.60 years (SD = 10.02), and 87% of participants were working as security personnel. The majority of the participants had not received training about CPR and AED (75.8% and 95.2%, respectively). Common misconceptions are fallen into all categories of CPR and AED knowledge. Correctly answered statements ranged from 7.2% in the compression rate to 24.2% in hand placement. The study results indicated a poor training knowledge of CPR and AED in public settings. Integrating high-quality CPR and AED knowledge within the school and college curricula is a vital need. However, in order to maximize the survival rate, it is important to set laws and legislation adopted by stakeholders and decision makers to advocate the people who try to help, mandate AED installation in crowded places, and mandate teaching hands-only CPR and AED together as a package.

Effectiveness of a community based out-of-hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study

Background70% of Out-of-hospital cardiac arrests (OHCA) in Singapore occur in residential areas, and are associated with poorer outcomes. We hypothesized that an interventional bundle consisting of Save-A-life (SAL) initiative (cardiopulmonary resuscitation (CPR)/automated external defibrillator (AED) training and public-housing AED installation), dispatcher-assisted CPR (DA-CPR) program and myResponder (mobile application) will improve OHCA survival. MethodsThis is pilot data from initial implementation of a stepped-wedge, before-after, real-world interventional bundle in six selected regions. Under the SAL initiative, 30,000 individuals were CPR/AED trained, with 360 AEDs installed. Data was obtained from Singapore’s national OHCA Registry. We included all adult patients who experienced OHCA in Singapore from 2011 to 2016 within study regions, excluding EMS-witnessed cases and cases due to trauma/drowning/ electrocution. Cases occurring before and after intervention were allocated as control and intervention groups respectively. Survival was assessed via multivariable logistic regression. Results1241 patients were included for analysis (Intervention: 361; Control: 880). The intervention group had higher mean age (70 vs 67 years), survival (3.3% [12/361] vs. 2.2% [19/880]), pre-hospital return of spontaneous circulation (ROSC) (9.1% [33/361] vs 5.1% [45/880]), bystander CPR (63.7% [230/361] vs 44.8% [394/880]) and bystander AED application (2.8% [10/361] vs 1.1% [10/880]). After adjusting for age, gender, race and significant covariates, the intervention was associated with increased odds ratio (OR) for survival (OR 2.39 [1.02–5.62]), pre-hospital ROSC (OR 1.94 [1.15–3.25]) and bystander CPR (OR 2.29 [1.77–2.96]). ConclusionThe OHCA interventional bundle (SAL initiative, DA-CPR, myResponder) significantly improved survival and is being scaled up as a national program.

Public access of automated external defibrillators in a metropolitan city of China

BackgroundPublic access of automated external defibrillator (AED) is an important public health strategy for improving survival of cardiac arrest. Major metropolitan cities in China are increasingly investing and implementing public access defibrillator programs, but the effectiveness of these programs remains unclear. This study aims to evaluate the public accessibility of AED in Shanghai, a major metropolitan city in China. MethodsFrom July 1 to September 30, 2018, all AED locations indicated by AED Access Map Apps were visited and investigated in three most densely distributing areas of AED (Huangpu District, Xuhui District, and Central Area of the Pudong New District) in Shanghai. Two AED Access Map APPs were used to identify the location of AEDs. Characteristics of and the barriers to access, the AED sites were recorded. Awareness and skills of first aid and AED among on-site staff of the AED installation sites were evaluated. ResultsA total of 283 sites were marked on two AED Apps. One hundred and seventy (60%) locations were accessible, and 142 (50%) were actually with AEDs installed. Among those AED installed sites, 112 (79%) were completely identifiable to the information on the maps, 20 (14%) were inconsistent and 10 (7%) were inaccurate on the maps. Ninety-four (66%) AEDs had visible signs and information around the location, 7 (5%) AEDs had signs outside of the location, and 107 (75%) sites had educational instructions. In addition, 230 individuals who were around the AED site were interviewed. Among them, 79 (34%) had good knowledge of AED. After shown the picture of AED, 112 (49%) knew whether there was AED in the site, and 108 (47%) knew the AED’s location. Eighty-seven (38%) staff have received first aid training, and among them 26 (30%) reported that they had skills in operating the AED. ConclusionsPublic placement and accessibility of AEDs, related public signs and information on AED, and staff’s awareness about AED were not optimal in Shanghai. Continuing efforts should be made to improve public accessibility and public awareness, knowledge, and user skills of AED.

Public Access Defibrillation: Utilisation and Missed Opportunities

Introduction Automated external defibrillators (AEDs) for public use are becoming increasingly prevalent, but little is known about utilisation. The purpose of this study was to compare the locations of out-of-hospital cardiac arrests (OHCAs) to the locations of AEDs to determine whether missed opportunities exist. Methods A retrospective study was performed of all OHCAs in which resuscitation was attempted between 1 January 2005 and 31 December 2010 in Orange County, North Carolina, United States of America, a mixed suburban/rural emergency medical services (EMS) system. Emergency medical services records were used to determine public AED utilisation and OHCA location. The locations were plotted on a map using ArcGIS. Businesses, public buildings and facilities located within a 100 metre radius of each OHCA were surveyed to determine AED availability. Data were analysed using standard descriptive statistics. Results During the study period, 307 OHCAs occurred at 282 locations. Of these, 219 (71%) occurred in private homes, 26 (9%) in nursing or assisted living facilities, and 62 (20%) in public locations. An AED location was within 100 metres of an OHCA location in 22 cases. Five cases were excluded due to the arrest being witnessed by EMS, and late or unknown AED installation time. Of the remaining 17 OHCAs, seven (41%) had a nearby AED that was not used, constituting a missed opportunity for deployment. Conclusion In nearly half of OHCAs that have a nearby public AED, the AED was not utilised. This suggests that public awareness and accessibility of AED locations should be improved.

Locational effect on automated external defibrillator use and association of age with on-site return of spontaneous circulation

BackgroundEmergency medical services (EMSs) are used by approximately 383,000 patients with out-of-hospital sudden cardiac arrest (SCA) in the United States. Hence, it is crucial to implement automated external defibrillator (AED) programs to prepare responders for an SCA emergency. Taiwanese pass legislature to enforce AED installation in 8 mandatory areas since 2013. Our study investigated the efficacy of the policy regarding AED installation. Materials and methodsWe collected data of patients who had sudden cardiac arrest (SCA) in pre-hospital settings, and received resuscitative efforts, including cardiopulmonary resuscitation or defibrillation with AEDs. The data were from July 11, 2013 to July 31, 2015. In total, 209 adult patients were documented by on-site caregivers of different facilities, and a report was mailed to the central health and welfare unit. ResultsSchools, large-scale gathering places, and special institutions used AEDs the most, accounting for 33 (15.3%) cases. From non-mandatory AED areas, long-term care facilities had the maximum cases of AED use (32 cases; 14.9%). With commuting stations as a reference, long-distance transport had the lowest odds ratio (OR) of 0.481 (95% confidence interval [CI], 0.24–0.962). The OR for schools, large-scale gathering places, and special institutions was 4.474 (95% CI: 2.497–8.015). Regarding failure of return of spontaneous circulation (ROSC), the OR for the ≥80-year age group was higher than that for the 20–39-year age group. ConclusionsThe policy regarding the legislation to install AEDs in mandatory areas improved AED accessibility. Elderly patients aged ≥80 years have a higher rate of ROSC failure.

The utilization of automated external defibrillators in Taiwan.

Increasing attention to care of patient succumbed to out-of-hospital cardiac arrest (OHCA) and evidence for improved survival have resulted in many countries to encourage the use automated external defibrillators (AEDs) by legislation. In Taiwan, the amendment of the Emergency Medical Services Act mandated the installation of AEDs in designated areas in 2013. Since then, 6151 AEDs have been installed and registered in mandated and non-mandated locations. The purpose of this study was to investigate the utilization of AEDs at mandated and non-mandated locations. This paper analyzed 217 cases in whom AEDs was used between July 11, 2013 and July 31, 2015. Descriptive statistics were used to analyze the data. The highest frequency of AEDs used was in long-term care facilities, accounting for 34 (15.7%) cases. The second and third highest was in schools and commuting stations. The highest utilization rate of registered AED was in long-term care facilities (73.9%), the second was in residential areas, and the third was in hot spring areas. Employees at the designated locations or medical personnel operated the AED in 143 cases (84.6%), and bystanders, relatives, friends or others operated the AEDs in 26 cases (15.4%). On-site Return of Spontaneous Circulation (ROSC) after applying AEDs occurred in 76 cases (45.8%). Long-term care facilities had the highest utilization of AEDs and government should pay more attention to enforce the installing of AEDs in these places. The government also needs to promote the education public on how to search the AEDs locations.

Use of a geographic information system to identify differences in automated external defibrillator installation in urban areas with similar incidence of public out-of-hospital cardiac arrest: a retrospective registry-based study

ObjectivesEarly defibrillation in out-of-hospital cardiac arrest (OHCA) is of importance to improve survival. In many countries the number of automated external defibrillators (AEDs) is increasing, but the use is low....

Abstract 22: Geographic Proximity of Automated External Defibrillators to Out-of-hospital Sudden Deaths in Wake County, North Carolina

Introduction: Survival rates for out-of-hospital sudden cardiac arrest are substantially improved by access to automated external defibrillators (AEDs) prior to Emergency Medical Services (EMS) arrival. However, AED use may be inhibited if their locations are unknown or far from the bystander. Objectives: We sought to classify out-of-hospital sudden death (OHSD) event locations, ascertain if bystanders utilized AEDs prior to EMS arrival, and calculate the distance to the nearest AED. Methods: From 2013 to 2015, we screened all EMS-reported out-of-hospital deaths aged 18-64 within Wake County, North Carolina to identify OHSDs. We geocoded event locations from EMS records and classified them as residential, commercial, public, or unknown using US Postal Service Residential Delivery Indicator, EMS narratives, and web searches. AED locations and installation dates, registered by law, were obtained from North Carolina Department of Health and Human Services. We used EMS narratives to determine AED use prior to EMS arrival. Walking distance between coordinates of an OHSD location and every AED installed prior to the death date was estimated using the Great-Circle distance. Results: Of 434 adjudicated OHSDs, 390 (90%) were residential, 31 (7%) were commercial, and 11 (2.5%) were public. Of commercial locations, 12 (39%) occurred in hotels. Of public locations, 6(46%) occurred in parking lots or parks. Wake County had 168 registered AEDs during the study period. The mean distance from OHSD to closest AED was 3.2 km (95% CI: 3.0-3.5 km). Only 20 (4.6%) of OHSDs were within 500 meters of an AED; the closest AED was 77 meters from an OHSD. Bystanders used AEDs prior to EMS arrival twice. Conclusions: While potentially lifesaving, AEDs are not placed optimally with respect to OHSD locations and are rarely utilized by bystanders, even in non-residential spaces. Public health strategies should be considered that incentivize optimal AED placement to witnessed cardiac arrest locations.

Locating Automated External Defibrillators in a Complicated Urban Environment Considering a Pedestrian-Accessible Network that Focuses on Out-of-Hospital Cardiac Arrests

Automated external defibrillators (AEDs) are portable devices that defibrillate and diagnose sudden-cardiac-arrest patients. Therefore, AEDs are widely installed in public places such as airports, schools, sport complexes, etc., and the installation of AEDs is required by law in these places. However, despite their usefulness, AEDs are mostly installed indoors with limited coverage outdoors. Hence, this study conducts research in the placement of AEDs in outdoor locations. This study considers a complicated urban environment using a pedestrian network dataset and network barriers. We draw on the Teitz and Bart’s (1968) heuristic method that was built in the location-allocation solver in ArcMap. The results of this study found that a total of 455 AEDs, including 227 pre-installed AEDs, could be placed in the study area, thus providing an additional 228 devices. Compared with 10 different installation methods that were set as experimental groups, our test results found that additional installations were able to cover 10% to 30% more actual out-of-hospital cardiac-arrest cases. The main contribution of this study is the proposal of a new method in locating AEDs in optimal areas while considering complicated urban environments. We predict that the cardiac-arrest-related mortality rate would be reduced through implementing the findings of this study.

Mismatch between Sites of Incidence of Out-of-Hospital Cardiac Arrest and Locations of Installed Automated External Defibrillator in the Tokyo Metropolitan Area

Background: Since 2004, the number of installed Automated External Defibrillator (AED) has been increased in Japan annually, the cumulative number of sold AED more than 600,000 units by 2016. Despite there have been about 130,000 out of hospital cardiac arrest annually, there have only 1302 cases delivered defibrillation by bystanders at the scene. Therefore, we investigate that number of AED installation and usage rate for Out of Hospital Cardiac Arrest (OHCA) patients. Methods: Retrospective metropolitan wide cohort study. Subject: Total 13,364 OHCA patients in the Tokyo Metropolitan area from Jan. 1 through Dec. 31 in 2012 were eligible for theses analyses. Also, OHCA occurrence place and AED usage rate were studied. Results: 82.8% of OHCA occurred at residences, 10% at outdoors, 6.4% at indoors, only 0.7% at schools. In the other hand, highest bystander’s CPR rates were found in sports facilities and schools (71.4%). The installation rate of AEDs in residences was 9.6%, instead of highest incidence for OHCA patients, school and sports institute made up 21.4% of AED installations, but only 1.0% of the incidences of cardiac arrest. We found that there is a mismatch between incidence sites of cardiac arrest and locations of installed AED. Discussion: It is essential to increase the number of AED installations. Furthermore, it is desirable to install AEDs in locations where cardiac arrest is liable to occur following guidelines for the proper placement of AEDs, and important to further spread BLS education among the general citizens.

Quality of basic life support education and automated external defibrillator setting in schools in Ishikawa, Japan.

Automated external defibrillators (AED) have been installed in schools in Japan since 2004, and the government strongly recommends teaching basic life support (BLS). We therefore examined the quality of BLS education and AED installation in schools. We conducted a prefecture-wide questionnaire survey of all primary and junior high schools in 2016, to assess BLS education and AED installation against the recommendations of the Japan Circulation Society. The results were analyzed using descriptive statistics and chi-squared test. In total, 195 schools out of 315 (62%) responded, of which 38% have introduced BLS education for children. BLS training was held in a smaller proportion of primary schools (18%) than junior high schools (86%). More than 90% of primary school staff had undergone BLS training in the previous 2 years. The most common locations of AED were the gymnasium (32%) followed by entrance hall (28%), staffroom (25%), and infirmary (12%). The reasons given for location were that it was obvious (34%), convenient for staff (32%), could be used out of hours (17%), and the most likely location for a heart attack (15%). Approximately 18% of schools reported that it takes >5 min to reach the AED from the furthest point. BLS training, AED location, and understanding of both are not sufficient to save children's lives efficiently. Authorities should make recommendations about the correct number of AED, and their location, and provide more information to improve the quality of BLS training in schools.

Abstract 60: Survival After Ventricular Fibrillation in Sao Paulo Metro

Background: Automated external defibrillators (AEDs) in public places can improve the rate of survival among patients who have had an out-of-hospital cardiac arrest (OHCA). Sao Paulo Metro carries about 4.5 million people per day and since 2006, the security officials of metro (lays rescuers) are trained in cardiopulmonary resuscitation (CPR) and handling of AED. This program also included the installation of AEDs in every metro station. Methods: From September 1, 2006, through November 31, 2012, we conducted a prospective, longitudinal, observational study involving patients who had cardiac arrest in Sao Paulo Metro and were attempted by security officials of metro. The outcome of each patient was followed through medical records of the hospitals to which patients were referred. Reading the AED registration of each patient was performed. The primary end-point was minimal neurologic impairment after hospital discharge. Results: A total of 102 sudden collapses were included in the study; 86 were cardiac arrest and 62 of these patients had ventricular fibrillation with initial cardiac rhythm. The percentage of patients who achieved sustained return of spontaneous circulation was 45 (73%), 34 (55%) of patients arrived alive at the hospital and 23 (37%) were discharged and were alive at 1 year with minimal neurologic impairment. Comparing the periods of the Sep/2006-Nov/2009 with Oct/2009-Nov/2012, respectively, the rate of patients without neurological impairment before discharge and at 1 year was 22% versus 45% (p=0.072). Multivariate logistic regression analysis revealed that the time interval in minutes between collapse and first shock was the only variable independently associated with the primary end point (odds ratio = 0.13, 95 % CI 0.05 to 0.38, p <0.0001). Conclusion: The study supports a significant beneficial impact of implementation of PAD program in Sao Paulo Metro. Shorter intervals between arrest and defibrillation are necessary to achieve the highest survival rates. These results support strategic expansion of PAD programs in similar places in Brazil.

Utilization of automated external defibrillators installed in commonly used areas of Japanese hospitals

Objective. Since July 2004, it has become legal in Japan for laypersons to use automated external defibrillators (AEDs). We investigated the effect of AED installation in commonly used areas of Japanese Association for Acute Medicine accredited training (JAAM) hospitals.Methods. In 2008, we sent questionnaires to 419 JAAM hospitals enquiring about the systems, operations, outcome and characteristics of AED usage. Results. Valid responses were received from 271 hospitals (64.7%). A total of 251 (92.8%) hospitals installed AEDs, mostly in the outpatient departments. These AEDs could also be used by laypersons. Operational responsibility was mostly assumed by the medical emergency center staff. The Engineering Department was in charge of AED maintenance. Of the surveyed hospitals, 65.5% reported having guidelines for usage. The percentages of hospitals which kept records of AED use and outcomes were low. A total of 66.2% reported having a rapid response team and 98.1% provided a non-standardi-zed resuscitation education program. In 68.3% of hospitals, an AED had been used. AEDs were used not only by medical doctors but also by other health professionals. Among the patients who received AED defibrillation, 42.5% survived without neurological deficit.Conclusion. The utilization of AEDs, installed in commonly used areas of JAAM hospitals, has shown beneficial and effec-tive outcomes for improving the resuscitation and survival of patients who experience in-hospital cardiac arrest. AEDs can be used not only by doctors but also by laypersons, making them more accessible and useful. The strategic installation of AEDs can make hospitals safer.

Optimizing locations for the installation of automated external defibrillators (AEDs) in urban public streets through the use of spatial and temporal weighting schemes

ObjectiveOut-of-hospital cardiac arrest (OHCA) occurs when the heart is deprived of oxygen without immediate medical treatment. The use of publicly accessible automated external defibrillators (AEDs) is generally considered to be an effective pre-hospital measure. Although studies have been undertaken to determine the locations of AED installations, the spatial and temporal characteristics of OHCA occurrence have not been considered comprehensively. This study attempts to assess the feasibility of using the 7-Eleven chain of convenience stores as possible locations for the installation of AEDs to capture the spatial and temporal characteristics of OHCA patients. MethodsThe methodological framework was divided into two stages. The first stage involved the development of two weighting schemes, a temporally weighted model (TWM) and a spatially weighted model (SWM), to capture the temporal and spatial variations in selecting AED locations. In the second stage, we proposed a stirring genetic algorithm (SGA) to select the limited subset of 7-Elevens covering the most weighted OHCA occurrences from the first stage. ResultsWe considered two modes of conveyance, human running and vehicle transportation, by setting the service range of the 7-Elevens at 100 and 300 m. Among a total of 323 OHCA cases within 100 m of a 7-Eleven, our results showed that there were 177 cases (54.8%) to be covered in the TWM and 150 cases (46.44%) in the SWM. When the service range was increased to 300 m, the total number of OHCA cases increased to 1271, which included 659 cases (51.85%) to be covered in the TWM and 522 cases (41.07%) in the SWM. We also found that, in public streets in urban settings, the TWM selected more 7-Elevens in commercial areas, while the SWM selected more stores in residential areas. ConclusionsWe conclude that each 7-Eleven has a different role for allocating AEDs in an urban setting. The AEDs at 7-Elevens in commercial areas help to compensate for the temporal gap of emergency medical service (EMS) in nighttime occurrences and for a high incidence of OHCA patients. For convenience stores in residential areas, AEDs help to compensate for the spatial gap in areas that are far from fire stations.

First Aid Education for High School Students - Focusing on CPR, AED installation and application -

ABSTRACT This research, by analyzing the current first aid education status in K district, Seoul and comparing first aid education systems in other developed countries, introduces the need of first aid/Cardio Pulmonary Resuscitation(CPR) education with Automated External Defibrillator(AED) usage to high school students, who are on the verge of becoming adults. The thorough research shows that schoolsshould be appointed as mandatory facilities for AEDs by laws and execute first aid education to their students. Only through organized and consistent first aid education would the students develop into true volunteers who not only have altruistic minds, but the ability to fluently adapt to medical emergency and properly use AED. In addition, the research also outlines various laws that could be legislated such as having to master the basic degrees of first aid education before getting driver’s license and graduating high school so that more people become aware of first aid. Keywords : first aid education, emergency medical service, cardiopulmonary resuscitation(CPR), automated external defibrillator(AED), volunteering

Automatische externe Defibrillatoren – Funktionsweise und Einsatz

Every year about 100,000 persons die from sudden cardiac death (SCD) in Germany. Although many efforts have been undertaken, mortality remains high. Only 2 - 10% of patients with out-off hospital SCD can finally be discharged from hospital after resuscitation. Observational studies show that ventricular fibrillation and ventricular tachycardia are the primary arrhythmias underlying SCD. For both arrhythmias the main determinant for survival is the time between onset and termination by defibrillation. The chance of survival declines by 10% for every minute of delay. These findings prompted the concept of early defibrillation by first responders. Many studies have shown that non-medical professionals, like police men, firemen or security officers, often arrive at the patient more early than emergency medical service. Thus, "smart" automated external defibrillators (AEDs), designed to identify VT/VF and prompt the user when to deliver a shock were introduced. These devices allow lay rescuers to terminate ventricular arrhythmias before the arrival of medical professionals. By this approach the time to defibrillation could be reduced and a significant reduction in mortality could be documented in selected situation. These encouraging results initialled the installation of AED at public places like aircrafts, airports, underground stations and shopping males. Due to the success of this approach doctors are more and more confronted with questions about technical details, reliability and cost effectiveness of these devices. The present review should give an overview about the current studies and guidelines.

Do Residents Want Automated External Defibrillators in Their Retirement Home?

The administration of a continuing care retirement community (CCRC), while weighing practical and ethical questions surrounding installation of automated external defibrillators (AEDs), wanted to consider resident opinions. No databased studies on this subject were found. After an information session about AEDs, CCRC residents were surveyed concerning their opinions on AED installation, their beliefs and concerns regarding AEDs, their advance directive status, and their demographic characteristics. Correlations were sought between choices about AED installation and beliefs, advance directives, and demographics. Seventy-eight percent of 107 eligible residents participated. Twenty-seven percent wanted AEDs installed, 37% were not sure, 23% were opposed, and 11% did not answer this question. Univariate analysis showed that women, the widowed or single, and those with a college degree were more likely to oppose AEDs. In the best logistic regression (LR) model the hope that "AED use could be life saving" and the fears that "AED use might lead to a very poor quality of life" and that "AEDs might be misused" were more important than any demographic variables and only education remained in the model. Those opposing AEDs supplied powerful written comments to support their choice. There is no consensus and great indecision about AED installation among the residents of this CCRC. The subjects were somewhat older and more affluent than the typical retirement home population, pointing to the need for replicating the investigation with a larger and more diverse study population. However, these findings suggest that AED installation in a retirement home would be premature without engaging the entire community in discussions and education in a process considerate of the wishes of all residents, which are likely to be quite diverse.