Install AEDS at all public places and in all PCR vans

An automated external defibrillator (AED) must be installed in all public places, such as temples, schools, community centers, transportation hubs, tourist attractions, high schools, universities, assembly sites, leisure areas that attract at least 3,000 people a day, large shopping malls, hotels and hot spring areas.

Based on US and European studies, when someone collapses suddenly, their chance of survival can climb to more than 50 percent if CPR is performed and an AED device is used in time.

The AED, a portable electronic device can analyze the heart’s rhythm and, if necessary, deliver an electrical shock to help the heart re-establish an effective rhythm. Bystanders should not hesitate to perform CPR on people who suddenly collapse, and to try to acquire an AED while calling for help.

Sudden cardiac arrest is a major public health challenge and early defibrillation can improve survival among those with a ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) arrest. Successful early defibrillation using an AED, when appropriate, has been shown to significantly improve survival and survival with intact neurologic function following out-of-hospital cardiac arrest.

Nationwide dissemination of AEDs in public places in Japan from 2005 through 2013 was associated with an increase in the proportion of shocks for witnessed VF arrest administered by laypersons with AEDs from 1.1 to 16.5 percent. As public access defibrillation increased, mean time to shock was reduced (from 3.7 to 2.2 minutes), with a significant improvement in one month survival with favorable neurologic function (38.5 percent compared with 18.2 percent) for those who did not receive public access defibrillation. A 2018 report from Japan also noted increased survival and improved neurological outcomes among school-aged patients receiving public access defibrillation.

Police AED programs may be the solution; police officers can sometimes respond to cardiac arrest victims more quickly than ambulance services.

A program of providing AEDs to police officers and training them in their use was initially introduced in the late 1980s in Rochester, Minnesota. Police often arrived at cardiac arrest victims due to ventricular fibrillation prior to medical help and defibrillated patients an average of 5.5 minutes following collapse. Ten of 14 patients survived to hospital discharge. In a later series of 193 patients, survival from witnessed ventricular fibrillation to hospital discharge was 46 percent. Most were neurologically intact. In contrast, survival from cardiac arrest not caused by ventricular fibrillation was only 5 percent.

Similarly, implementation of police AED programs in Pittsburgh, Pennsylvania, Miami-Dade County, Florida, King County, Washington, and Zurich, Switzerland, has also been associated with greater survival.

Resources:

1.     White RD, Vukov LF, Bugliosi TF. Early defibrillation by police: initial experience with measurement of critical time intervals and patient outcome. Ann Emerg Med 1994; 23:1009.

2.     White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation 2005; 65:279.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA