Policy Statement: ESC–ERC recommendations for the use of automated external defibrillators (AEDs) in Europe1☆,
Section snippets
The need for a policy conference on the use of automated external defibrillators
The use of automated external defibrillators (AEDs) has a major impact in the management of cardiac arrest and substantial implications for public health. It is therefore important for the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC) to join forces to develop European recommendations for legislation on defibrillation, for training in AED use and for the development of AED community programmes.
To fulfil these objectives a policy conference was organised
The role of AEDs in the prevention of sudden cardiac death
Sudden cardiac death remains the single most important cause of premature death in the adult population of the industrialised world despite its recent slow decline in incidence [3]. The incidence of out-of-hospital sudden cardiac death varies with age, gender, and the presence or absence of cardiovascular disease. Several studies have helped to define the profile of sudden cardiac death victims [4], [5]. The Maastricht study [6] monitored all cases of out-of-hospital cardiac arrest occurring in
Strategies for community defibrillation with AEDs
The strategies available for organising a community programme for early defibrillation should be tailored to each specific environment. One of the first objectives when planning a new project is to achieve a compromise between the widespread distribution of AEDs and the economical feasibility of the programme in terms of the available resources. A decision must be made at an early stage as to whether a programme is to be designed within the professional Emergency Medical Service (EMS) or
AED: legislation and organisation in Europe
Unfortunately AED programmes are still only partially implemented in Europe: reasons for slow implementation are lack of awareness, and discrepancies in the organisational and legislative aspects. The structure and organisation of EMS-systems and the legislation concerning defibrillation are still largely variable in Europe. In some countries, there is no law that regulates the use of defibrillators. The absence of specific legislation should, in theory, not be a formal obstacle, but it may
AED programmes in Europe: SWOT analysis
The members of the policy conference applied a systematic approach to the evaluation of the current situation on the use of AEDs in Europe by performing a “SWOT analysis”. This approach consists in the identification of the strengths, weaknesses, opportunities and threats for early defibrillation programmes in Europe.
The results of the SWOT analysis are reported in Table II and are commented in Section 3 in the on-line Appendix C (http://www.escardio.org and http://www.erc.edu). Overall, the
How should AED programmes be organised in Europe?
Several variables inherent to the local environment (topography of the area, road traffic conditions, location of a hospital with an ER, etc.) may play a critical role in determining the choices for implementing early defibrillation in the community. Therefore, a standardised set of rules cannot be established. Nonetheless, the experience gathered over the years may allow the definition of a basic set of general criteria that should be followed, independently of the local environment and of the
Conclusions
The rational to the implementation of AED programmes is based on the evidence that an improvement in survival after cardiac arrest can be obtained by reducing the time to defibrillation. The joint ESC–ERC policy conference has been an important step to set out the key elements for a European action plan that should be promoted by ESC and ERC and should seek comprehensive involvement by all of the stakeholders.
We have identified priorities and needs for the achievement of better outcome for
Acknowledgements
We acknowledge the contribution of the following companies that have provided an unrestricted educational grant to the ESC–ERC to support the organisation of the Policy Conference: Medtronic Physio-Control; Laerdal/Philips,Cardiac Science; Zoll International; Lifecor. We thank Mrs. Emmanuelle Bourg and Mrs. Keren Deront of the European Heart House for the organisational support.
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Cited by (26)
European Resuscitation Council Guidelines for Resuscitation 2015. Section 2. Adult basic life support and automated external defibrillation.
2015, ResuscitationCitation Excerpt :Dispatched lay CPR providers, local to the victim and directed to a nearby AED, may improve bystander CPR rates33 and help reduce the time to defibrillation.40 When implementing an AED programme, community and programme leaders should consider factors such as development of a team with responsibility for monitoring, maintaining the devices, training and retraining individuals who are likely to use the AED, and identification of a group of volunteer individuals who are committed to using the AED for victims of cardiac arrest.219 Funds must be allocated on a permanent basis to maintain the programme.
Defibrillation in rural areas
2014, American Journal of Emergency MedicineCitation Excerpt :However, the advantage of a 2-tier system could not be replicated in areas where the response time of an ALS team had been fast (within minutes) before the program was introduced [41–43]. As a result, both the American Heart Association and European Resuscitation Council recommend that BLS teams should be equipped with AEDs [44]. Studies reporting outcomes after early defibrillation in urban areas within an EMS are listed in Table 1.
In-hospital cardiac arrest characteristics and outcome after defibrillator implementation and education: From 1 single hospital in Sweden
2012, American Journal of Emergency MedicineCitation Excerpt :However, survival with an estimated good cerebral function was more common after the intervention. Priori et al [18] stated that time to defibrillation would be delayed if the patient had to wait for a rescue team. This is one of the reasons to advocate the deployment of AEDs at various different locations within hospitals.
Public access defibrillation: Time to access the public
2011, Annals of Emergency MedicineCitation Excerpt :Legislation varies in different countries; however, in most countries, including the United States and large parts of Europe, laypeople can use AEDs without having to fear legal consequences or liability.18,19 Only a few countries, including France and South Korea, explicitly prohibit AED use by laypeople.19,20 To diminish the legal uncertainty that prevails, legislation should be as explicit as possible and information campaigns should address legal aspects.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators
2010, ResuscitationCitation Excerpt :Dispatched first responders like police and fire fighters will, in general, have longer response times, but have the potential to reach the whole population. When implementing an AED programme, community and programme leaders should consider factors such as the strategic location of AEDs, development of a team with responsibility for monitoring and maintaining the devices, training and retraining programmes for the individuals who are likely to use the AED, and identification of a group of volunteer individuals who are committed to using the AED for victims of cardiac arrest.149 The logistic problem for first responder programmes is that the rescuer needs to arrive, not just earlier than the traditional ambulance, but within 5–6 min of the initial call, to enable attempted defibrillation in the electrical or circulatory phase of cardiac arrest.44
Responding to Sudden Death in the Community: Cardiopulmonary Resuscitation With Prompt Defibrillation
2010, Revista Espanola de Cardiologia Suplementos
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Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.resuscitation.2004.01.001
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This paper has been copublished in European Heart Journal Vol. 25, Issue 5, pps. 437–445.