Public Access Defibrillation (PAD)

Premises Behind Public Access Defibrillation Programs

For almost twenty years, emergency rescue personnel used AED's to provide early defibrillation outside of the hospital in communities throughout the United States and Canada. By the early 1990's, the medical community, having benefited from the development of AED's, reasoned that expanding the range of people who could act as first responders would significantly increase SCA victims' survival rates. The idea of moving care further into the community—by way of programs administered by trained para-professional and laypersons—triggered the development and implementation of public access defibrillation (PAD) programs.

The Windsor Casino in Windsor, Ontario, Canada, was the driving force behind a public access defibrillation program in that community. In the first five years of having AED's on site, they experienced twenty-three cardiac arrests; fifteen of these patients were saved and discharged from the hospital neurologically intact. This is a 65 percent survival rate. At that time in Windsor, people who suffered SCA outside the casino had about a 3 percent chance of survival waiting for EMS to arrive. These statistics sparked the initiation of a PAD program in Windsor; many other Canadian communities followed suit.

In the United States, two studies influenced establishing PAD programs. One study, done in US casinos, found that in those equipped with AED's and a staff member trained to use them, 53 percent of people suffering a sudden cardiac arrest, survived.^xvii In this study, when the AED was used in less than three minutes from the victim's collapse, the survival rate was 74 percent. A second study, concerning cardiac arrests on American Airline flights, found that 30 percent of people who experienced SCA's on planes equipped with AED's survived. Both studies show a dramatic improvement on the normal survival rate of 5 percent and indicate that community AED's could raise the survival rate to as high as 30 percent, saving more than 250 lives per day in the United States.

Technological advances have led product research and design to adapt the AED for conventional use by non-specialists. Currently AED's are more compact, easier to use, and more affordable. Commonly placed within corporate and public facilities—predominately in high risk and highly populated areas—there is an ever-growing initiative for placing AED's in remote and rural settings. Today, AED's are being used by a diverse cross section of non-medical people such as security officers, flight attendants, golf pros, lifeguards, ski patrols, health club employees, and employees in a variety of businesses.

In general, AED training and course requirements are usually integrated with CPR training. AED training usually takes four to eight hours and is offered by many different organizations in communities including local EMS and Fire Departments, the American Heart Association, the Heart and Stroke Foundation in Canada, the American and Canadian Red Cross, St. John Ambulance, the Life Saving Society, and many private training firms.

Several years ago, the AHA began advocating the widespread use of AED's by minimally trained laypersons, declaring that, "Rapid defibrillation and early cardiopulmonary resuscitation (CPR) are the two major contributors to survival of adult victims of sudden cardiac arrest…Automated external defibrillation is one of the most promising methods of treating cardiac arrest."^xvii Recently, AHA guidelines stated, "Public access defibrillation, which places AED's in the hands of trained laypersons, has the potential to be the single greatest advance in the treatment of VF (ventricular fibrillation) cardiac arrest since the development of CPR."^xix

Because of their accuracy and simple application, AED's have gained support from the medical, legal and political sectors. These professionals now acknowledge the value, importance, and capacity that AED's bring to the emergency scene of a sudden cardiac arrest. They recognize the significance of promoting the development of widespread PAD initiatives to effectively increase survival rates for victims of sudden cardiac arrest worldwide.

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