The Right Place at the Right Time
Optimizing Automated External Defibrillator Placement in the Community
Article, see p 1104
Out-of-hospital cardiac arrest (OHCA) afflicts >350 000 persons annually in the United States.1 Although early defibrillation can improve survival, public access defibrillation (PAD) with an automated external defibrillator (AED) is not available much of the time.2 The American Heart Association has long advocated for the development of PAD programs,3 with the AED as a crucial component of the “Chain of Survival.”4 Early proof-of-concept studies in controlled environments, such as aircraft and casinos, demonstrated efficacy and confirmed the importance of early defibrillation.5,6 In the PAD trial, the survival rate doubled in higher-risk public settings when lay responders trained in cardiopulmonary resuscitation were equipped with AEDs compared with those who were not.7 Despite data confirming efficacy of early defibrillation, AED usage remains low.2 This finding relates, in part, to an issue of limited resources because there is a cost related to AED purchase, placement, and maintenance.
One of the challenges for PAD programs has been deciding where to place AEDs to optimize access. Early efforts focused on identifying sites or location categories with high OHCA incidence rates. For example, Becker and colleagues8 identified 10 location categories with a higher incidence of cardiac arrest in Seattle and King County, Washington; these locations included the airport, county jail, and a large shopping mall. They estimated that coverage for 134 cardiac arrest patients over a 5-year period could be obtained by the placement of 276 AEDs in the 172 highest incidence sites. However, to cover the remaining 347 arrests over this same time period, an AED would have to be placed in an additional 71 000 sites, illustrating the challenges of obtaining widespread coverage. The PAD trial, in addition …