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Lawrence Frame, M.D.
Chief of Cardiology, Philadelphia VA Hospital; Associate Professor of Medicine, University of Pennsylvania
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YES
The leading cause of death among adults is heart disease, about half dying from sudden cardiac death. The chain of survival is early access to care via 911, early application of CPR, early defibrillation, and early advanced cardiac life support. Communities that don’t have AEDs widely available are missing a link in the chain.
Although CPR can help maintain circulation, it doesn’t restore normal circulation until sinus rhythm resumes. The key to surviving sudden cardiac death is defibrillation within the first five to seven minutes. For every minute after that, there’s about a 10% decrease in survival from ventricular fibrillation and cardiac arrest.
The American Heart Association estimates that about 100,000 lives could be saved each year by more access to early defibrillation.
That could come from a much wider range of people equipped with AEDs and trained in their use. Police, fire-fighters, lifeguards, and others outside the traditional medical response team can be easily trained. The devices talk to you and tell you what to do. AED training is easier and faster than CPR training.
Studies show the retention level of AED training is high, even in people who haven’t used the devices for a year. Survival rates of sudden cardiac death have increased from 2% to 25% to 30% in communities that have widely disseminated AEDs. Unfortunately, only 18% of first responders nationally have access to AEDs.
One concern is that a shock might be given to people in normal rhythm and harm them. But studies show these sophisticated devices make the right decision 95% of the time. Failure to deliver the shocks early is a much bigger problem than delivering the shocks to a person who doesn’t need them.
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Lothar Pinkers, M.D.
Chairman, EMS Standards Committee, Washington State Medical Association
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NO
Because the AHA is calling for more widespread use of portable defibrillators, both patients and AED makers are going to put pressure on physicians to prescribe them for the home.
These devices are easy to use, but if patients buy them, put them on a shelf, don’t look at them for two years, and then suddenly need them, they aren’t going to be used properly. When these devices are needed is not the time to read the directions. Moreover, people may improperly maintain the devices so that when they are finally used, they don’t operate as advertised.
There may also be delays in calling EMS. When defibrillators are used alone, survival rates are not as high as when combined with an EMS response. We want to make sure people don’t delay calling 911 while trying to use a defibrillator. We also want to make sure that patients go to the hospital after a successful defibrillation.
In communities such as Seattle, with a quick EMS response time, the risk of AEDs being used improperly outside the EMS setting is probably greater than the risk of less rapid defibrillation. Any widespread use of AEDs should be tailored to local needs.
Liability concerns also need to be addressed. There may be increased liability for physicians if they write a prescription for an AED without taking an active role in supervising its use. It’s not clear whether the Good Samaritan law covers the use of AEDs in public facilities. And who is going to pay for the maintenance and training of people who use AEDs in such public facilities?
Until we resolve all these issues, making the devices more widely available benefits the manufacturers but not necessarily patients.
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