Ambulance: Public Access Defibrillation

Critical Elements for Public Access or Home-Based Defibrillation Programs

(Based off the American Heart Association Recommendations)

Background of Public Access Defibrillation

Public access defibrillation (PAD) programs are designed to improve survival from sudden out-of-hospital cardiac arrest. PAD programs include placement of AED's throughout the community and training of lay rescuers in CPR and use of an AED.

• If PAD programs are to improve survival from sudden cardiac arrest, they must significantly reduce 2 intervals:
  • Between collapse and start of CPR
  • Between collapse and delivery of first shock
• Successful PAD programs require physician oversight, careful planning, lay rescuer training and supervision, quality assurance monitoring, and a strong link with the local EMS system.

**Note: River Falls EMS will take a large part in these following 3 steps!

1. Preliminary Steps: Preparation and Planning for PAD Program
   • Establish immunity from civil liability (or provide indemnification) for:
     • Lay responders who volunteer to learn AED use and their instructors
     • Physicians who authorize AED use
     • Premises or facility owners who support or allow a PAD program.
   • Identify a licensed physician to serve as medical director
   • Identify a source of training, instructors, and training equipment
     • River Falls EMS is an American Heart Association training center, so will take care of these needs.
   • Establish communication among the following need-to-know groups:
     • PAD Medical Director
     • Personnel or employees receiving training
     • River Falls Area Ambulance Service
     • Emergency Medical Dispatchers (River Falls Ambulance will do this!)
   • Contact River Falls EMS to conduct a site visit at that site.
     • Goals of the site visit:
       • Identify most important responding group at the site (in general, personnel working closest to a 24-hour/7-day a week schedule).
       • Determine number and placement of the AED. The AED should be placed near a telephone or be equipped with a device to provide automated EMS notification.
       • In an AED area, the AED will ideally be placed within a 1.5 minute walking distance of area covered.
       • Ensure that the AED being considered is compatible with River Falls EMS defibrillators.
2. Pre-event Training and Program Establishment
   • Adopt approved treatment protocols consistent with recommendations of the American Heart Association and River Falls EMS.
   • Adopt an approved national training course integrating CPR skills and AED use.
   • Train all anticipated users.
   • Establish methods to accomplish and document the following tasks:
     • Ensure skills maintenance. (include refresher training and mock drills)
     • Ensure device maintenance and readiness-for-use checks.
     • Notify clinical director of clinical use of an AED.
     • Review AED performance after any field use.
     • Review lay rescuer performance after any field use
     • Provide post-event psychological support to rescuers, family members, co-workers, etc.
     • Determine clinical outcomes - What happened to the person who collapsed?
3. Post-Clinical Event Quality Improvement Monitoring: Incident Review
   • Review AED performance. (requires access to event documentation)
   • Review lay rescuer performance during field use and provide feedback.
   • Modify protocols or provide additional refreshers as needed.
   • Offer and provide post-event psychological support to rescuer, rescuer co-workers, and victim's family members.
   • Determine clinical outcome of person who collapsed - requires authority to access private hospital records from either physician or EMS medical director.
   • Develop plan to track community-wide outcomes and performances over time.

***These critical elements for successful PAD programs can be achieved in a variety of ways. In the United States these programs can best be provided by programs closely affiliated with community EMS systems.