Elsevier

Annals of Emergency Medicine

Volume 58, Issue 3, September 2011, Pages 240-247
Annals of Emergency Medicine

Cardiology/original research
Public Access Defibrillation: Time to Access the Public

Presented at the European Society of Anesthesiology annual meeting, June 2009, Milan, Italy.
https://doi.org/10.1016/j.annemergmed.2010.12.016Get rights and content

Study objective

Public accessible automated external defibrillators (AEDs) are increasingly made available in highly frequented places, allowing coincidental bystanders to defibrillate with minimal delay if necessary. Although the public, as the largest and most readily available group of potential rescuers, is assigned a key role in this concept of “public” access defibrillation, it is unknown whether bystanders are actually sufficiently prepared. We therefore investigate knowledge and attitudes toward AEDs among the public.

Methods

Standardized interviews were conducted at the Central Railway Station of Amsterdam, the Netherlands, a highly frequented and AED-equipped public place with a high number of travelers and visitors from all over the world.

Results

Surveys from 1,018 participants from a total of 38 nations were analyzed, revealing a considerable lack of knowledge among the public. Less than half of participants (47%) would be willing to use an AED, and more than half (53%) were unable to recognize an AED. Overall, only a minority of individuals have sufficient knowledge and would be willing to use an AED. Differences between subgroups were identified, which may aid to tailor public information campaigns to specific target audiences.

Conclusion

Only a minority of individuals demonstrate sufficient knowledge and willingness to operate an AED, suggesting that the public is not yet sufficiently prepared for the role it is destined for. Wide-scale public information campaigns are an important next step to exploit the lifesaving potential of public access defibrillation.

Introduction

Sudden cardiac death is a leading cause of mortality in North America and Europe.1, 2 The initial underlying rhythms are most often ventricular tachyarrhythmias,3, 4, 5 requiring electrical defibrillation to restore coordinated activity of the heart. Even short delays in defibrillation significantly deteriorate outcome because the odds of survival decrease by 7% to 10% per minute.6, 7, 8 To enable early out-of-hospital defibrillation, automated external defibrillators (AEDs) are increasingly made available for public use in highly frequented places.9 AEDs not only allow undelayed defibrillation but also often provide audible instructions for cardiopulmonary resuscitation by voice prompts and may therefore also provide benefit in patients with a nondefibrillatable heart rhythm.

Undelayed defibrillation ideally requires coincidental bystanders, ie, the public, to make immediate use of an AED when required without having to await arrival of trained personnel. Although the public is the key player in this concept of “public” access defibrillation, little is known about whether the public is sufficiently prepared to fulfill its role.

We aimed to investigate knowledge and attitudes toward AEDs among the largest and most readily available group of potential rescuers in public access defibrillation, ie, the public itself.

Section snippets

Study Design

The study was designed as a cross-sectional survey held at the Central Railway Station of Amsterdam, the Netherlands. Public knowledge about AEDs was addressed multifactorially, including the individual's ability to recognize an AED and his or her awareness of public access defibrillation programs and knowledge about defibrillation in general. Because answering questions about defibrillation could bias subsequent identification of an AED and vice versa, 2 separate questionnaires were drafted

Characteristics of Study Subjects

Of 1,019 interviews performed at Amsterdam Central Station, one was excluded because of violation of inclusion criteria, leaving 1,018 interviews eligible for data analysis. Demographic characteristics are summarized in Figure 2. Mean participant age was 40 years (SD 18 years).

Main Results

When asked what should be done as quickly as possible if someone has a suspected cardiac arrest, the most frequently given answer was “call for help” (67%; 95% CI 63% to 71%), followed by “chest compressions” (20%; 95% CI

Limitations

Because no generally accepted questionnaire was available to test public knowledge and attitudes toward AEDs, the questionnaires were designed from scratch. The questionnaires were repeatedly evaluated for clarity, conciseness, and unambiguousness and were evaluated in pilot interviews; however, they are not a validated study instrument.

In addition, our survey is subject to the inherent limitation that we cannot determine whether subjects' answers actually reflect their personal opinion, and we

Discussion

We investigated knowledge and attitudes toward AEDs among the public, which forms the largest and most readily available group of potential rescuers in case of a medical emergency in public places.

Early defibrillation is a key link in the chain of survival, and minimizing time-to-shock intervals is a pivotal step to improve probability of survival. In this context, undelayed defibrillation by coincidental bystanders using public accessible defibrillators seems a promising concept. In a landmark

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    • Barriers to bystanders defibrillation: A national survey on public awareness and willingness of bystanders defibrillation<sup>☆</sup>

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      According to previous studies, AEDs were used by bystanders in 2.3% of cases in England,10 with similar poor rates in other countries.11–13 Some barriers to the use of AEDs among bystanders were explored and included distance between the AED and the victim, location of the arrest and bystander-related barriers.14–17 The Taiwan government has undertaken several strategies to promote bystander resuscitation.

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    Supervising editor: Judd E. Hollander, MD

    Author contributions: LAS proposed the research idea. PS, JJLMB, SAL, and LAS performed the literature search and developed the study protocol. PS, FBD, JJLMB, and LAS drafted and tested the questionnaires and implemented the survey at Amsterdam Central Station. Data collection was performed by FBD and was supervised by JJLMB. Data analysis was conducted by PS and FBD. PS, SAL, and LAS were responsible for data interpretation. PS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the statistical data analysis. SAL monitored the study progress, provided logistic support, and coordinated work within the study group. PS drafted the first version of the article, and all authors critically revised it for important intellectual content. All authors read and approved the final version. PS takes responsibility for the paper as a whole.

    Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The study was supported by departmental funding (Department of Anesthesiology, VU University Medical Center, Amsterdam, the Netherlands).

    Publication date: Available online February 3, 2011.

    Please see page 241 for the Editor's Capsule Summary of this article.

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