Clinical paperA national scheme for public access defibrillation in England and Wales: Early results☆
Introduction
The use of automated external defibrillators (AEDs) by lay persons who are not professional health care providers, (‘public access defibrillation’, PAD) has proved an effective strategy in the management of sudden cardiac arrest occurring outside hospital.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 Delays in performing defibrillation can be appreciably reduced if those nearby can use an AED before the arrival of the emergency medical services.
Most reports of PAD have described the use of AEDs made available in public places where the possibility of cardiac arrests can be foreseen and where lay persons working in the vicinity can be trained to use them.1, 2, 3, 4, 5, 7, 10 This is sometimes termed the ‘static AED’ or ‘on-site’ strategy.10, 11 The alternative ‘mobile’ strategy for PAD employs lay volunteers as ‘community first responders’ (CFRs) dispatched by ambulance control centres because they can reach a victim sooner than a conventional ambulance. In some areas of the United Kingdom (UK) members of the fire and police services also act in this role. Such community first responders are not limited to specific sites. They may provide the best option for treating patients at home, the commonest place for cardiac arrest to occur.12, 13, 14
In England and Wales, PAD developed during the 1990s principally through the provision of AEDs driven by the British Heart Foundation (BHF), the UK's leading heart charity. This was to equip not only locations where the ‘on-site’ strategy was planned but also community first responders (FRs) for the mobile strategy planned in association with ambulance services. Later, the Government, through the Department of Health (DH), made PAD a core part of the National Health Service (NHS) in England by placing 700 AEDs at high risk locations.15 These complemented AEDs already installed at other public sites or used by community first responder schemes.
Subsequently, the BHF was awarded a national lottery grant and joined forces with the Department of Health to coordinate the expansion of both PAD strategies throughout England through a National Defibrillator Programme (NDP). The Welsh Assembly Government and the BHF later established similar arrangements in Wales.
This paper describes the largest series of resuscitation attempts reported to date within an evolving PAD programme and is based on nationwide statistics. We report the effectiveness of defibrillation by lay persons and the relative effectiveness of different PAD strategies used in the UK.
Section snippets
Methods
The establishment of the National Defibrillator Programme, methods of data collection and standard report form used are described in detail elsewhere.16, 17 The cost of AEDs, related equipment, training and administration was provided by the NHS, the BHF, and a national lottery fund.
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‘On-site’ defibrillators
The DH placed AEDs in busy public places identified from routine ambulance data as sites where cardiac arrest was liable to occur such as airports and major railway stations. AEDs are kept in
Results
This report is based on 1530 resuscitation attempts initiated by lay persons equipped with an AED from 11th March 1999 to 31st December 2005.
Shocks were administered to 735 (48%) victims, with return of spontaneous circulation (ROSC) in 245 of them (33%). One hundred and thirty-two (18%) of those who received shocks were discharged alive from hospital. Outcome was poor among 795 unshocked patients, with 35 (4.4%) attaining ROSC and 13 (1.6%) surviving.
Important differences in patient
Discussion
This is the first report of a national scheme that has incorporated PAD into mainstream health care provision. The project was an ambitious move by the authorities because at the time it was announced very little published evidence existed for its potential effectiveness. A National Health Service that includes a statutory ambulance service and the other bodies with national coverage including the Resuscitation Council (UK), the BHF, the British Red Cross and St John Ambulance provided an
Limitations of study
This study is dependent on the voluntary reporting of resuscitation attempts by those concerned. For ‘on-site’ use the Department of Health data were collected systematically by their employees and are thought to be complete. The BHF requires all those who receive an AED from them to report every use of the device, but compliance is uncertain. The voluntary societies (which operated many AEDs in this study) require their use to be systematically reported by their members. For CFRs, reports are
Conflict of interest statement
The database is funded by the Resuscitation Council (UK). Professor Chamberlain is supported (expenses only) by a grant from the Laerdal foundation. The remaining authors have no conflicts of interest to declare.
Acknowledgements
We thank Jane Turner, Anna Oakley, Kim Read and Helen Williams for administrative and secretarial support.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.03.226.