Need for defibrillators in public places

15 December 2006

Automated external defibrillators (AEDs) should be made more readily available in public places, and non-medical personnel trained to use them, clinicians urge in this week's British Medical Journal.

Sarah Davies (Northampton General Hospital, UK) and Tarek Antonios (St George's University of London, UK) describe a case of cardiac arrest at a major ski resort, for which lack of a defibrillator hampered the resuscitation procedure.

The scenario also highlighted the importance of implementing international guidelines, as medical professionals who happened to be nearby were able to co-ordinate their response effectively while waiting for further assistance, despite language barriers.

While holidaying in the Alpine resort, Davies – a respiratory specialist – was called to assist a man who had collapsed on the slope near her. The man's wife had just commenced mouth-to-mouth resuscitation.

Two German nurses, a UK pediatric nurse, a French dentist, and a UK nursing student also then arrived at the scene. While the dentist performed some airway maneuvers and helped the man's wife with timing of mouth-to-mouth ventilation, the student nurse went to call for assistance and locate an AED, and Davies was assisted by the two nurses in conducting chest compressions.

Unfortunately, no AED was found in the first aid room, and, as the patient was at the top of a mountain, and a cable car journey from either of two local towns, the ad-hoc cardiac arrest team was forced to wait for an emergency helicopter before taking further steps.

The helicopter was equipped with an AED and with another doctor and a paramedic on board, and arrived in 8 minutes. The patient, who was in ventricular fibrillation, was shocked into sinus rhythm and, following anesthetization and further complications, eventually stabilized and was transferred to a local hospital.

Davies and Antonios point out that the experience not only highlights the importance of having access to a defibrillator, but also that of having internationally recognized guidelines. All the attending medical professionals were familiar with the European Resuscitation Council guidelines.

"We all knew what we were expected to do, because of the standard guidelines," Davies recounts.

The authors note that studies have shown that non-medical personnel, such as ski patrollers, can be successfully trained to use AEDs.

"This gives good weight to the argument that more automatic external defibrillators should be made available in the UK and in Europe, especially in isolated areas with relatively large numbers of people," they write.

"It also shows that in these areas it is beneficial to train non-medical people to operate automatic external defibrillators."

Br Med J 2006; 333: 1276