Abstract 23: Does it Pay to Place the Pads? Use of External Defibrillator Pads After a Myocardial Infarction in the Transport Environment
INTRODUCTION: Patients experiencing an acute myocardial infarction (AMI) are at risk for sudden death from ventricular arrhythmias. Resuscitation from a fatal arrhythmia often depends on rapid defibrillation. At present, there is no aeromedical community standard addressing which patients require defibrillator pad placement prior to transport A survey of Duke Life Flight nurses revealed a wide variation in clinical practice. The patient cost per defibrillator pad is more than $350.
METHODS: This is a single transport program, retrospective chart review. All adult patients diagnosed with an AMI that were transported by Duke Life Flight helicopter between June1, 2003 and May 31, 2005 were included in this study. Patients were separated into two groups; those who were defibrillated during transport and those who were not Data were analyzed using descriptive and correlation statistics.
RESULTS: 341 patients were included in this study. During the period reviewed, 102 patients (30%) had defibrillator pads placed on them, 98 of these being placed prior to transport. 27 patients were defibrillated prior to transport, two of whom required further defibrillation and one required pacing during transport. Overall, Five patients (1.5%) required defibrillation during transport, three of whom had defibrillator pads placed prior to transport, while the other two had pads placed during transport. Two additional patients had pads placed during transport, although they were not used. Usage of defibrillator pads placed on patients was 5.8% (6 patients). The total cost of all pads placed the study without established guidelines was $35,700, whereas the cost of those actually used was $2100.
CONCLUSIONS: While the number of patients who required defibrillator pads was small, they were placed on 30% of all study patients. If pads were placed only at the time when needed, an annual cost savings of more than $16,000 could be realized. This study looked at AMI patients transported by helicopter and did not include the greater number of patients that come via ground transport. The potential savings in health care dollars with more expectant use or better identification of those patients who will require pads is enormous.