April 6, 2019
Early defibrillation has been touted in the medical community as the most critical factor in the survival from sudden cardiac arrest (SCA). SCA kills more people than any other disease in the United States, with fewer than 10% of the over 350,000 people who suffer out-of-hospital cases making it to discharge. When defibrillation occurs within 3 minutes of onset, survival chances rise to 74% Placing automatic external defibrillators (AEDs) in as many locations as possible has rightly been one of the ways that cardiac health authorities have been pursuing as a way to reduce time-to-defibrillation and increase overall survival rates.
As one mother of a teenage SCA victim understands too well, having an AED within reach and ready to use can make the difference between life and death. As reported by Knox News, Rhonda Harrill’s son, Tanner Lee Jameson, collapsed during a basketball game but rescuers could not access the school’s only AED.
“I volunteered at the school and I never saw that AED because it was behind the teacher’s mailbox in the office,” she said. “I trusted the school system. I trusted that they would know what to do.”
Now, Rhonda is an avid advocate for AED placement in every school.
Tanner’s case is not an isolated case. A similar scenario unfolded when an OSU Institute of Technology student collapsed of cardiac arrest and rescuers willing and able to respond were unable to locate an AED until it was too late.
There are hundreds of thousands of cases like these two, which underlines the challenges of the public access defibrillation. AED shortage is not only a numbers problem but also a distribution one. One of the most critical challenges involves deciding where to place AEDs. In a study using data covering 19,000 volunteer responders from North America, researchers estimated that over a 5-year period 134 cardiac arrest victims could have been saved by placing 276 AEDs in 172 high incidence areas. However, to cover the other 347 arrests would require an additional 71,000 sites (more here: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.027305).
In another expansive study by the Occupational Health and Safety (OHS) projecting optimal spatial-temporal AED placement for the whole of the United States based on the coverage area possible for each AED found that at least 30 million AEDs were needed to cover more than 70 percent of the population, who are based in urbanized areas. The remaining 30 percent of the population, mostly living in suburban and rural areas, needed over 10 million AEDs. With an estimated 4.5 million serviceable AEDs in the US, only about 10 percent of the optimal coverage is catered to. (https://ohsonline.com/Articles/2019/01/01/A-New-Model-for-Increasing-Survival.aspx?Page=4).
A review of data from Toronto Regional RescuNET Epistry found that poor placement and readiness of AEDs contributed to high SCA-related death rates, with one in five OHCAs occurring near an inaccessible AED. The result of this inefficient distribution is that only 2% of SCA cases are treated with AEDs by bystanders.
While many state and local jurisdictions have enacted laws to promote AED procurement-such as the Good Samaritan laws which provide legal protection to AED users- AED machines are not legally required in most locations, and procurement is generally as a result of voluntary deployment by organizations.
Legislative mandates and increased emphasis on public/commercial collaboration between cardiac health advocacy groups and communities are important steps in increasing AED coverage. General AED awareness efforts and lower-priced, more portable AEDs, as promised by next-generation AED developers, should also be key drivers of AED unit adoption, particularly in cost-sensitive markets like the home and in public settings.
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