Critical Elements for Public Access or Home-Based Defibrillation Programs
(Based off the American Heart Association Recommendations)

Background of Public Access Defibrillation

• Public access defibrillation (PAD) programs are designed to improve survival from sudden out-of-hospital cardiac arrest. PAD programs include placement of AED's throughout the community and training of lay rescuers in CPR and use of an AED.

• If PAD programs are to improve survival from sudden cardiac arrest, they must significantly reduce 2 intervals:

  • Between collapse and start of CPR

  • Between collapse and delivery of first shock

• Successful PAD programs require physician oversight, careful planning, lay rescuer training and supervision, quality assurance monitoring, and a strong link with the local EMS system.

**Note:  River Falls EMS will take a large part in the following 3 steps!

1. Preliminary Steps: Preparation and Planning for PAD Program

• Establish immunity from civil liability (or provide indemnification) for:

  • Lay responders who volunteer to learn AED use and their instructors

  • Physicians who authorize AED use

  • Premises or facility owners who support or allow a PAD program.

• Identify a licensed physician to serve as medical director

• Identify a source of training, instructors, and training equipment

  • River Falls EMS is an American Heart Association training center, so will take care of these needs.

• Establish communication among the following need-to-know groups:

  • PAD Medical Director

  • Personnel or employees receiving training

  • River Falls Area Ambulance Service

  • Emergency Medical Dispatchers (River Falls Ambulance will do this!)

• Contact River Falls EMS to conduct a site visit at that site.

• Goals of the site visit

  • Identify most important responding group at the site (in general, personnel working closest to a 24-hour/7-day a week schedule).

  • Determine number and placement of the AED.  The AED should be placed near a telephone or be equipped with a device to provide automated EMS notification.

  • In an AED area, the AED will ideally be placed within a 1.5 minute walking distance of area covered.

  • Ensure that the AED being considered is compatible with River Falls EMS defibrillators.

2. Pre-event Training and Program Establishment

• Adopt approved treatment protocols consistent with recommendations of the American Heart Association and River Falls EMS.

• Adopt an approved national training course integrating CPR skills and AED use.

• Train all anticipated users.

• Establish methods to accomplish and document the following tasks:

  • Ensure skills maintenance. (include refresher training and mock drills)

  • Ensure device maintenance and readiness-for-use checks.

  • Notify clinical director of clinical use of an AED.

  • Review AED performance after any field use.

  • Review lay rescuer performance after any field use

  • Provide post-event psychological support to rescuers, family members, co-workers, etc.

  • Determine clinical outcomes - What happened to the person who collapsed?

3. Post-Clinical Event Quality Improvement Monitoring: Incident Review

• Review AED performance. (requires access to event documentation)

• Review lay rescuer performance during field use and provide feedback.

• Modify protocols or provide additional refreshers as needed.

• Offer and provide post-event psychological support to rescuer, rescuer co-workers, and victim's family members.

• Determine clinical outcome of person who collapsed - requires authority to access private hospital records from either physician or EMS medical director.

• Develop plan to track community-wide outcomes and performances over time.

***These critical elements for successful PAD programs can be achieved in a variety of ways. In the United States these programs can best be provided by programs closely affiliated with community EMS systems.