Increasing the Availability of Automated External Defibrillators at Sporting Events: A Call to Action from the American College of Sports Medicine.

ABSTRACT: Given that most sudden cardiac arrests (SCAs) occur outside of a medical facility, often in association with exercise and sporting events, and given that early cardiopulmonary resuscitation (CPR) plus defibrillation is the strongest predictor of survival from SCA, this Call to Action from the American College of Sports Medicine recommends increasing the availability and effectiveness of early CPR plus defibrillation so that the time from collapse-to-first automated external defibrillator shock is less than 3 min.

CONTRIBUTION OF STAKEHOLDER ENGAGEMENT TO THE IMPACT OF A HEALTH TECHNOLOGY ASSESSMENT: AN IRISH CASE STUDY.

OBJECTIVES: The aim of this study was to illustrate the contribution of stakeholder engagement to the impact of health technology assessment (HTA) using an Irish HTA of a national public access defibrillation (PAD) program. BACKGROUND: In response to draft legislation that proposed a PAD program, the Minister for Health requested that Health Information and Quality Authority undertake an HTA to inform the design and implementation of a national PAD program and the necessary underpinning legislation. The draft legislation outlined a program requiring widespread installation and maintenance of automatic external defibrillators in specified premises. METHODS: Stakeholder engagement to optimize the impact of the HTA included one-to-one interviews with politicians, engagement with an Expert Advisory Group, public and targeted consultation, and positive media management. RESULTS: The HTA quantified the clinical benefits of the proposed PAD program as modest, identified that substantial costs would fall on small/medium businesses at a time of economic recession, and that none of the programs modeled were cost-effective. The Senator who proposed the Bill actively publicized the HTA process and its findings and encouraged participation in the public consultation. Participation of key stakeholders was important for the quality and acceptability of the HTA findings and advice. Media management promoted public engagement and understanding. The Bill did not progress. CONCLUSIONS: The HTA informed the decision not to progress with legislation for a national PAD program. Engagement was tailored to ensure that key stakeholders including politicians and the public were informed of the HTA process, the findings, and the advice, thereby maximizing acceptance. Appropriate stakeholder engagement optimizes the impact of HTA.

Automated external defibrillators in public places: position statement from the Faculty of Sport and Exercise Medicine UK.

Position statements published by the Faculty of Sport and Exercise Medicine UK are quick reference or information documents and include up to 10 short points of clinical relevance for the Sport and Exercise Medicine community as well as for general practitioners and health professionals. The Faculty of Sport and Exercise Medicine (FSEM) UK has published a statement to create greater awareness that the survival rate from Sudden Cardiac Arrest could improve with prompt access to an automated external defibrillator (AED).

The introduction of public access defibrillation to a university community: the University of Virginia public access defibrillation program.

The use of the automatic external defibrillator (AED) can significantly reduce the time to defibrillation in patients with sudden cardiac death. This early defibrillation via the AED can also improve patient outcome, including survival and neurologic status among survivors. We undertook the addition of a public access defibrillation program at a large mid-Atlantic university. In our design of the system, we found little useful information to guide us in the development and construction our system. This article is a review of the process of public access defibrillation AED system development such that other medical and academic leaders at similar institutions can more easily develop such systems.

Availability of automated external defibrillators in the city of Warsaw - status for May 2009.

BACKGROUND: The most frequent cause of sudden cardiac arrest (SCA) is ventricular fibrillation and ventricular tachycardia. Despite many efforts the prognosis in this patient group is poor. According to the European Resuscitation Council (ERC) recommendations, early defibrillation, preferably in the first 3-5 min, is a key link in the Chain of Survival after SCA. With an increasing number of available automated external defibrillators (AED) time from SCA to defibrillation may be reduced, thus resulting in the improvement of patients' prognosis. Therefore, the ERC recommends providing AED in public locations with a high incidence of cardiac arrests. AIM: Estimation of the availability of AED in the city of Warsaw. METHODS: Automated external defibrillators were identified according to the information from the City Hall, public services, foundations, companies and own research and knowledge. The AED presence was confirmed by phone at the potential locations and random locations were visited. RESULTS: By 15 May 2009, 117 AED had been reported in 83 points in the city of Warsaw. The number of AED was the highest in the Sródmiescie (29) and Wlochy (28) districts. On average, there was one AED per 14 706 citizens (0.68 per 10,000 citizens) and per 4.24 km(2) (2.26 per 10 km(2)). The highest ratio of the number of AED per 10,000 citizens was observed in the Wlochy (7.06) and Sródmiescie (2.25) districts, the lowest - in the Targówek (0.16), Wawer (0.15) and Bemowo (0.09) districts. The highest ratio of the number of AED per 10 km(2) were in the Sródmiescie (18.63), Wlochy (9.78) and Zoliborz (5.9) districts, the lowest - in the Wilanów (0.27) and Wawer (0.13) districts. CONCLUSIONS: The number of AED in the city of Warsaw should be increased, additional demonstrations of AED proper usage and AED promotion should be organised. It is necessary to provide easy access to the devices. Significant differences in the number of AED can be observed between the districts. Neither authorities nor public services are aware of the number of AED in the city of Warsaw.

Blunt thoracic trauma and cardiac injury in the athlete: contemporary management.

Commotio cordis and cardiac injuries are rare events usually following a chest blunt traumas during sports activities. Various etiologies have been identified to cause electrical (commotio cordis) and/or structural (contusion and further injuries) damage, but high-velocity tools such as baseballs or hockey pucks (also called projectiles) have been chiefly identified. Clinical consequences are challenging, varying from uncomplicated supraventricular arrhythmias to cardiac wall rupture. Ventricular fibrillation is the most remarkable outcome leading to cardiac arrest in some individuals. In this article, up-to-date epidemiological and pathophysiological issues are discussed, along with the most suitable assistance protocols of the injured athlete in the sports arena. Current knowledge about traumatic sports injuries and ensuing cardiovascular sequelae made significant steps forwards than in the past. The majority of athletes (especially the youngest ones) wearing chest protectors are usually preserved from serious outcomes and sudden cardiac death, but further technical effort is encouraged to attain more satisfactory barriers against projectile's impact. Educational campaigns among students, closer team surveillance, implementation of the sports arenas with adequate rescue devices and medical assistance remain mandatory items in contact sports activity.

Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?

Out-of-hospital sudden cardiac arrest (OHCA) is a leading cause of death all over the world. Although the outcome of OHCA resulting from 'nonshockable' rhythms (asystole and pulseless electrical activity) is poor regardless of resuscitation efforts, 'shockable' rhythms such as ventricular tachycardia or fibrillation may carry a good prognosis if early defibrillation is performed. At present, simplified cardiopulmonary resuscitation techniques (hands-only cardiopulmonary resuscitation) and automated external defibrillators (AEDs) offer lay people the possibility to provide lifesaving treatment to OHCA victims in the critical minutes before the arrival of the emergency medical system. Programs aimed at increasing provision of cardiopulmonary resuscitation and use of AEDs by lay people have been set up in different countries, including Italy, and have contributed to improve survival rates. However, success of these programs critically depends on appropriate planning and design, and on cultural predisposition of witnesses to undertake immediate measures of resuscitation in the case of OHCA. Placement of a large number of AEDs may carry high costs and little benefits if it is uncoordinated and not preceded by educational campaigns to spread widely the 'culture of resuscitation' in the population.

Displacement of death in public space by lay people using the automated external defibrillator.

This paper reports on a study where a technology, the Automated External Defibrillator (AED), enables a socially troubling death in public space to be moved to a more acceptable location. This was a qualitative study, using semi-structured interviews with lay (non-medical) people, in a variety of locations, who had been trained to use an AED. The AED, and its use by lay people, means that the time and place of death from heart attack can be changed from a location like a railway station or shopping centre to the ambulance or hospital. Thus the lay people involved can act as what Timmermans (1999) terms 'death brokers'.

Shocking a community into action: a social marketing approach to cardiac arrests.

Social marketing techniques have enhanced the success of programs designed to improve the health outcomes of individuals or communities when adopting new health behaviors. Current research suggests, however, that behavior change models, when added to social marketing techniques, could result in even greater success in changing health behaviors and health outcomes. This retrospective analysis of the results of a Public Access Defibrillation (PAD) Trial, designed to improve a community's response to cardiac arrest, tests this proposition. Data from one of the 24 participating PAD Trial sites were analyzed and interpreted from a social marketing and behavior change model perspective, to assess the success in changing a community's response to cardiac arrest victims in 61 residential buildings that participated in the PAD Trial in New York City (NYC). The findings suggest that to improve the success of community-based, emergency response systems to cardiac arrest victims, health programs must first assess the community's awareness of the health problem and their willingness to change behaviors before designing and implementing social marketing programs for health behavior change.