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Public access defibrillation: a review
  1. K B Kern
  1. Department of Medicine, Section of Cardiology, University of Arizona College of Medicine, 1501 N Campbell Avenue, Tucson, Arizona 85724, USA
  1. Dr Kern.

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Sudden cardiac death remains a worldwide health problem. More than 1000 such deaths occur daily in the United States1; most are secondary to ventricular fibrillation (VF).2Unfortunately, only about 5% of victims survive.3-5Sudden cardiac death is the most common “accidental” death in the US. A combined total of all airline, automobile, and drowning deaths would not equal the number of accidental or unexpected sudden cardiac deaths.

The key issue in successfully treating sudden cardiac death is early defibrillation. “The sooner the better” is never more true than with defibrillation of VF. In various settings, if defibrillation is applied immediately or very early, such as in the cardiac catheterisation laboratory or at cardiac rehabilitation centres, a survival rate of 90% is possible and should be expected.6-8 For every minute of delay, however, the survival rate appears to decrease by approximately 10%.9

The importance of early defibrillation for successful resuscitation has prompted important statements on both sides of the Atlantic supporting first responder defibrillator use. The American Heart Association has stated, “it is essential to integrate the concept of early defibrillation into an effective emergency cardiac care system”.10 To achieve this goal, the AHA endorses the position that “all emergency personnel should be trained and permitted to operate an appropriately maintained defibrillator, if their professional activities require that they respond to persons experiencing cardiac arrest”.10 The UK Department of Health Steering Group on ambulance performance standards has likewise proposed that:

Emergency medical system response should occur within eight minutes of cardiac arrest through the use of rapid response vehicles, including motor bikes, and through first responder automated external defibrillation schemes. The first responders are anyone who has been selected and trained by an ambulance service to provide basic support and, in the event …

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