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How Do You Know Whether You Need An On-Site CPR-AED Program?
  1. Is it unlikely that the local EMS system would be able to reliably achieve a “call-to-shock” interval of five minutes or less at this site?
  2. Has an SCA incident occurred at this site in the past five years and have the demographics of the population served at this site remained relatively constant?
  3. Does this location have an at-risk population?
  4. Is this location considered a higher-risk location?
  5. Can an active, hands-on medical director be identified for this location?
  6. Does this location have personnel willing and able to respond to cardiac emergencies to provide CPR and defibrillation?

If the answer to any of these questions is "yes," then it may be wise to consider implementing an on-site CPR-AED program.

On-Site AED Programs

Even if a community has done everything possible to strengthen its chain of survival, emergency responders can only do so much. The time to first shock for victims of sudden cardiac arrest (SCA) may be delayed in rural areas, where emergency medical services (EMS) have to travel long distances, and in urban areas, where EMS has to contend with traffic and high-rise buildings. This is why many locations—such as airports, office complexes, industrial complexes, residential communities, shopping centers, entertainment centers, sports centers, transit centers and schools—have established on-site CPR-AED programs.

Higher-risk locations

The home
When sudden cardiac arrest occurs outside the hospital, it occurs most often in the home (57-75% of cases). For this reason, families of some at-risk individuals have elected to place AEDs in their homes and to be trained in CPR and AED use.

Public locations
A number of studies have looked at the frequency in public locations (i.e., not in private residences) with variable results. Most studies seem to indicate that the majority of non-residential events occur as isolated events. As a result, it is difficult to predict where sudden cardiac arrest will occur in the future.

Nevertheless, these studies have identified locations that seem to have a higher incidence of sudden cardiac arrest. These include:

  • Airports
  • Community/ senior citizen centers
  • Dialysis centers
  • Doctors’ offices (cardiology, internal medicine, family medicine and urgent care centers)
  • Ferries/ train terminals
  • Gaming establishments
  • Golf courses
  • Health centers/ gyms
  • Homeless centers
  • Jails
  • Large industrial sites
  • Large shopping malls
  • Nursing homes
  • Sports/ events complexes
  • Streets and highways

Lessons from the Public Access Defibrillation Trial: Adding AEDs doubles survival

A large study conducted between 2000 and 2003 in 24 locations in the U.S. and Canada, the Public Access Defibrillation (PAD) Trial, found that twice as many people survive SCA in locations with lay responders trained and equipped with AEDs and CPR than if they were trained in CPR alone.

The study compared outcomes from SCA in two settings:

  • Locations with emergency response plans relying on laypersons as responders trained in CPR, and
  • Locations with emergency response plans relying on laypersons as responders trained in CPR and AED use and equipped with AEDs.
More than 19,000 volunteers were trained at 993 locations, which were randomly assigned to either arm of the study. Locations included both multi-unit residential (14%) and public (86%) venues, such as recreational facilities, shopping centers, entertainment complexes, community centers and large office buildings. Training was conducted to meet competency standards of the American Heart Association.

The study found that a victim of SCA was twice as likely to survive at an AED site as at a CPR-only site (30 survivors in 496 units with AEDs versus 15 in 497 units that did not have AEDs). This result was statistically significant, and was largely due to improved survival in public locations. No difference was found in the residential sites. Ninety percent of survivors in each group had normal functional status or only mild impairment at hospital discharge.

How to Set Up an On-site CPR-AED program: 10 Tips for Success - Click Here