PRB Articles


Automated External Defibrillators

While the unit can be found on every commercial airline flight in the United States and at most major sporting events, and its ability to save lives is without challenge, an automated external defibrillator (AED) still cannot be found at all parks and recreation centers.

Although a well-trained staff and thoroughly stocked first-aid kit improve your department’s ability to save lives, AED technology completes a high-quality first-aid program. Before adding an AED, several key aspects must be considered.

What Is An AED?

An AED is a portable, computerized device that is used to restore a normal heart rhythm to people in cardiac arrest. This device evaluates the heart rhythm of an individual, and then indicates to the rescuer whether or not a shock is required. An AED employs a variety of methods--ranging from voice prompts, text, lights and sounds--to instruct the rescuer how to operate the device and, if required, to administer a shock to the victim. It is this shock--defibrillation--that may help the victim’s heart reestablish a constant rhythm.

Many analysts of the defibrillator industry suggest there are currently only 1.25 to 1.5 million AEDs available to the public for use, and that the market will bear 30 million; it is obvious we are at the mere conception of AEDs in the public sector. Legislation is now being passed in many states to mandate that certain public spaces have these life-saving devices on hand. For example, New York state buildings and institutions are required to have at least one AED on site. Illinois has a similar law requiring school gymnasiums and indoor park-district facilities to have an AED on the premises.

The main reason AEDs are put into use is not from an institution or governing body, but from the general public. According to Hank Constantine, Marketing Director of Public Access for ZOLL Medical Corporation, “Legal mandates are really more of a catalyst than an agent of change. When someone is saved with an AED and the word gets around, it becomes a real wake-up call for people; likewise, on the other side of the coin, when someone collapses and dies, people start to think ‘Wow, if we had an AED, we might have been able to save this person.’” Various sources indicate that survival rates for rescue attempts using both CPR and an AED device range from 36 percent to above 50 percent. Without the AED, the survival rate drops into single digits.

Where Do You Need An AED?

The short answer is any place where there is a high probability for Sudden Cardiac Arrest (SCA). These include places commonly operated by parks and recreation departments, such as golf courses, gyms, sporting events and complexes, as well as community/senior centers. Having a large number of persons over 50 years old at your facility and an EMS response time of more than five minutes also increase the probability of having an SCA victim.

Placement at your facility or park will depend on several factors:

1. It is a good idea to review any state legislation regarding AED use. While all 50 states have enacted some type of Good Samaritan immunity, legislation to protect rescuers using this technology and state requirements for having an early-defibrillation program vary.

2. Weather, temperature, accessibility and room for signage/alarms all affect placement. Check with the manufacturer for suggestions.

3. Check with your risk-and-safety department. Many organizations have policies in place as to who has access to this equipment.

4. Walk through your facility with staff and find areas that will enhance your ability to gather the equipment and reach the victim in the least amount of time. According to Joan Mellor, Program Manager for the Medtronic’s Foundation, a good “rule of thumb is--using a brisk walk or jog--a rescuer can reach the victim within two to three minutes.” When the heart stops, irreversible brain damage begins to set in after four to six minutes, with permanent brain death taking place at the eight- to 10-minute mark.

I recently witnessed how the placement of an AED saved a man's life. At a swimming event for seniors, an athlete went into cardiac arrest after finishing the race. As the athlete left the water, he asked for a seat and collapsed. The lifeguards on duty immediately began CPR while a member of the staff procured the AED. Spectators watched in awe as these professionals put their training to use. The quick response by the lifeguards in giving this man CPR, with the use of an AED, is why this man is still swimming today.

Training And Maintenance

There are two major factors in having an AED at your facility: training and maintenance.

Keeping staff current with CPR and AED American Red Cross certifications plays a major part in being prepared. One of the first things that all staff should learn is the location of the AED. Although it sounds simple, Constantine notes it is “amazing how often people who have an AED don’t think about it for the first 10 minutes.” He adds, “Everybody should know where the AED is, and if someone collapses, staff members should do two things right away: call 9-1-1 and then bring the AED to the victim.”

The other factor is maintenance. Electrode pads and batteries have a shelf life and need to be replaced at regular intervals. These items--depending on manufacturer and external conditions--will last (unused) anywhere from one to five years. Mellor suggests designating a specific person to manage the maintenance of the AED, including checking the batteries and electrode pads at least once a month. Routine maintenance may be as simple as opening the box the AED is in to ensure it has adequate power. You will want to check with the AED manufacturer for its recommendations on scheduled maintenance and a replacement timeline for accessories.

Rounding Out The List

While a major part of AED ownership is training and maintenance, an Early-Defibrillation Program should be instituted. While not everyone may agree which manufacturer produces the best AED, the need to develop an early-defibrillation program is universal. Some of the key points to an effective program are:

· A designated program manager

· Coordination or inclusion of trained medical personnel

· Routine maintenance

· Training--initial, refreshers, updates and new staff

· Coordination with local EMS

· Policies and procedures in place from the start.

Organizations such as The Center for Early Defibrillation and The Sudden Cardiac Arrest Association have information on developing a quality program.

What’s Out There?

From AED jackets to AEDs that give real-time feedback on how well you are administering CPR between shocks, options abound as to which AED is right for your organization and site. More professional models will give better-defined information, but may make the attempted rescue more difficult. So the most expensive model might not be the most beneficial for your program. Some of the features that separate AEDs in the marketplace are:

· Weight

· Durability

· Wireless technology

· Ease and simplicity of use

· EKG readout

· CPR assistance

If the purchasing decision appears daunting, start by developing an early-defibrillation program and conducting a thorough needs assessment.

While the benefit and necessity of the AED in parks and recreation centers are evident, the unit is not a replacement for CPR. High-quality CPR is paramount in saving cardiac-arrest victims. Above all else, do not over-estimate this technology; AEDs alone do not save lives.

Steve Yeskulsky is a CPRP, currently working in the parks and recreation industry in Sarasota, Fla. He can be reached via e-mail at syeskulsky@verizon.net

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