There have been 20 reported activations at host organisations since the commencement of the PAD Demonstration. In seven cases, lives were saved directly as a result of the AED. Staff at these organisations have become even more committed to the PAD program as a result of these positive outcomes.
In a number of instances, the patient could not be revived. Despite the trauma of experiencing a life being lost, staff who had responded with the AED felt reassured that they had at least been able to do everything within their power to assist.
Based on the consultations, activations have all been carried out by trained staff, trained emergency personnel or medical professional bystanders. In the few instances where activations had occurred, participants reported that the AED was used in accordance with instructions until the patient could be handed over to ambulance paramedics.
Some participants identified the need for crowd control in the event of an emergency event where the AED had to be activated. Family and friends could get distressed and concerned about the application of the AED, especially in environments such as casinos where alcohol was consumed (this is where the role of security personnel as first responder is particularly appropriate).
Two case studies of successful AED activations under the PAD Demonstration are provided below.
Case study of PAD activation at Domestic AirportIn March 2008, a passenger in the airport terminal had a sudden cardiac arrest. The person was about 80 years of age. The first response team at the airport were contracted service emergency providers located within the airport. They were called immediately following the patient's collapse. They ran to the location of the passenger. Passing the security screening area on the way, they collected the defibrillator device as they rushed to the patient. They reached the individual within approximately two minutes. The defibrillator was activated and an ambulance was called. Security staff managed the scene, keeping other airport visitors away while assistance was provided. The person who suffered the cardiac arrest was revived and went on to survive the sudden cardiac arrest.
Case study of PAD activation at a CasinoIn March 2008, a patron in the casino suffered a sudden cardiac arrest. The patron was a man of about 55 years if age. This incident occurred in the daytime. Security officers immediately assisted, while other security officers kept family/friends and other patrons at a distance and prevented interruption to emergency assistance efforts. Another security guard had meanwhile pick up the defibrillator device from its nearby location and rushed to the patient. The security guard then activated the device to restart the man's heart approximately two minutes after the sudden cardiac arrest occurred. Ambulance officers arrived soon after and took over from the security officer. The man went on to survive the event and has since returned as a regular patron. Top of page
5.3.1 Specific issues identified by host organisations
5.3.2 Lessons that may be relevant to future PAD in Australia
5.3.1 Specific issues identified by host organisationsRespondents identified a number of issues with the installation of AEDs and training provided through the PAD Demonstration. These issues included:
- Organisational awareness of the correct procedures for activating the AED tended to diminish for those organisations that had not arranged for annual refresher courses. Both managers and staff at these organisations were less clear about the correct AED procedures to be followed in the event of an emergency.
- One organisation reported a contrast in methods between the training they had received from St John under the PAD Demonstration and the regular first aid training they received from a different first aid company (for the early model AEDs that the company purchased privately, prior to the PAD Demonstration AEDs):
- Staff at this organisation had been trained by the other company to apply compression for two minutes before activating the early model defibrillation unit (which had a manual activation)
- Once the button is pushed to activate the AEDs received under the PAD Demonstration the timing of the shock administered is automatic, occurring immediately upon pushing the button
- As a result of the advice received at their regular first aid training, these trained first responders would turn off the newer AEDs in order to deliver the compression, and then have to turn it back on two minutes later to shock
- The difference in training techniques caused a level of confusion amongst the trained first responders, who reverted to the training received under the organisation they had an established and trusted relationship with.
- A number of larger organisations relied on contracted security staff (employed by an external consultancy) as the first responders for emergency first aid incidents.
All Australian security personnel are required to have a certain level of first aid training, and managers at AED sites tended to assume that their contracted security staff would also have specific defibrillation training. However, a number of managers had not specifically confirmed the AED training with their security contractor. (It should be noted that some organisations had actively incorporated the requirement of AED training into their contracts with security providers).
Some managers also identified specific issues that had initially acted as a barrier to their organisations involvement in the PAD Demonstration. Fear of litigation in was identified as a strong barrier for management in some host organisations.
When we originally received the AED we were a [shopping chain]. We have since been taken over by [larger shopping chain]. The new company have a policy of NOT installing AEDs. We have had to fight to keep it. They have advice from their legal people that they are too great of a liability. But we think the device is a huge benefit. (Manager, shopping centre)
Other issues that emerged throughout the consultations included senior management being unaware of the benefits of AEDs and reluctant to fund the costs without prior incidents. Some Occupational Health and Safety managers reported difficulty in getting senior management on board with AEDs prior to their involvement in the PAD Demonstration. Again, this reluctance was often related to litigation fears of litigation risk arising from improper use of the unit or negative outcomes. The combination of litigation fear and low levels of awareness results in inertia and resistance to the take up of AEDs.
A fear of litigation from the use of AEDs and general lack of awareness of the effectiveness in the devices in saving lives were the main issues identified as affecting the installation of AEDs in an organisation.
However, generally respondents at host organisations identified very few problems with the PAD Demonstration. Most valued the program very highly. Top of page
5.3.2 Lessons that may be relevant to future PAD in AustraliaThe installation of AEDs provides benefit for host organisations. There is value in promoting the positive outcomes of the PAD Demonstration to encourage a wider take up of the installation of the devices. Considerable work needs to be done with public liability insurance providers, larger organisations managing facilities used by large numbers of people and occupational health and safety authorities for AEDs to become a common standard of care.
It is noted that occupational health and safety is largely the responsibility of state jurisdictions. The PAD Demonstration has funded installation of AEDs in state government employers, indicating that there remains considerable work to be done to increase awareness of PAD at the state government level.
Managers and staff reported that fear of litigation can be readily overcome with clear authoritative and legally grounded advice. This barrier must be overcome prior to training but can be reinforced through the training program.