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- Article #4 -

School AED Program - The Public Access Combination Unit - A Better Way

NOTE:
Numbers in article are LINKS to footnotes

Because of the deaths of students in schools 1 across the Nation, many state legislatures have provided automated external defibrillators to schools. For example, the Pennsylvania legislature has provided two free defibrillators to each school district. New York has mandated each school having over 1000 students install AED's. Policies have been set addressing the use of AED's in an emergency.

In our opinion, there are three glaring errors in the AED programs and in their methods of administration:

• First and foremost is that youth in general do not suffer from cardiac arrest due to ventricular fibrillation, and, therefore, do not respond to defibrillation.2 Typically, there is an underlying medical problem that has caused cardiac arrest, e.g., respiratory failure, e.g., asthmatic attack.3
  
• Second, the AED programs do not recognize the necessity of oxygen in an emergency involving youth and the necessity for oxygen to be present in a possible AED emergency. 4
  
• Third, schools have not fully adopted the "public access" significance of the deployment of AED's. The use of AED's has been restricted to authorized personnel, placed in offices, etc.5
  

In an emergency, the time in which medical assistance can be given is key. Often the events leading to the medical emergency occur in or near the gymnasium. Not only are student athletes susceptible to medical emergencies, but coaches, guests at athletic events, etc. are susceptible too. Many of these events occur after normal school hours and at a time when trained personnel and medical equipment is not readily available, e.g., kept in the nurse's office or in the administration office.

The combination unit which has been designed for public access and comprised of an AED and TXO2® AUTOMATED First Aid Oxygen offers a better solution to medical emergencies than an AED alone. Consider these two reported facts, (1) approximately 50% of the cardiac arrest emergencies respond to defibrillation,6 and (2) on average, shocks are delivered only 20 to 25% of the time. 7 If "No Shock" is indicated in the other times, that may mean the victim is breathing and that there may still be a heartbeat and, of course, oxygen administration, is mandated. It also means in those two instances that the defibrillator is of no value. The combination unit offers the responder the defibrillator for those less frequent cases and oxygen in all cases.

Footnotes:

1 From reports, Greg Moyer ( www.momsteam.com ) initially was not in cardiac arrest. He arrested before EMS arrived. Oxygen was locked in the nurse's office. Although the import of the web site is to encourage installation of AED's in schools, etc. there is no mention of the need for oxygen. It is a well known fact that early administration of oxygen may prevent cardiac arrest and it is also well known that oxygen administration post defibrillation is recommended. Back to Article

2 93 % of pediatric cardiac arrests did not respond to defibrillation. Back to Article

3 3 students died (late 2002) while in school (2 from Delaware and 1 from New Jersey) from an asthma attack. It was reported that CPR was given. One point with regard to these emergencies, a defibrillator is of no value in an asthma attack which leads to cardiac arrest. Back to Article

4 Because of the higher metabolism of youth to that of adults, hypoxia can develop more quickly. A student successfully responding to an initial defibrillation may revert back to ventricular fibrillation because of inadequate oxygen. (See Case Commentary) Back to Article

5 Tthe term, Public Access" has been interpreted to mean that AED's should be accessible to the public and does not mean that any member of the public who witnesses an event should be able to use one (See Guidelines For Public Access Defibrillation Programs in Federal Facilities. In our view this is DUMB, DUMB, DUMB, policy. No one would disagree that if trained personnel are available it is they that should be the ones to use the device. However, in many cases there is no one present that is trained and, if the untrained do nothing the victim has been given a death sentence. Second, the AED units are so simple to use and have been successfully used by untrained personnel. There are so many reports that they aren't presented here. Back to Article

6 Emergency Medicine an Approach to Clinical Problem-Solving by W.B. Saunders Company, A Division of Harcourt Brace & Company p. 45 (1991) noted that, "[o]f the estimated 1000 cardiac arrests that occur per day in the United States, approximately half (48%) are cardiac in origin. Underlying ischemic disease accounts for two thirds of these arrests. Back to Article

7 ECC Study reported by Medtronic in their brochure entitled LIFEPAK CR Plus Defibrillator-Ready When You Need It. Back to Article