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New international AED sign

ILCOR has announced an official international sign for automatic external defibrillators (AEDs). ILCOR chairman and cardiologist R.W. Koster described the sign as indicating the presence of an AED within a room, a container or that an AED can be found in a certain direction. The symbol purposefully has no markings to allow for international usage.

Increasingly research is indicating that the best patient outcomes do not require advanced life support (ALS), pharmacological treatment or invasive procedures. As Dr. John Burton describes, if you want to survive a heart attack out of hospital then you will want; Someone nearby to quickly begin CPR; An AED to be very close; And to have your core body temperature dropped a few degrees. Bringing AEDs closer to cardiac arrest is one of the simplest measures that can be undertaken to improve patient outcome.

AED in O'Hare airport.

In 1999 the city of Chicago (2006’s fattest US city) placed 53 highly-visible AEDs in the terminals of their three main airports. The project, termed the “Chicago Heart Start Program”, included 3 min announcements played every half hour that would explain the AEDs were for everyone to use – regardless of training.

Recall any medical drama ever produced and think about the “paddle” scene. As the Px crashes the dashing doctor grabs for two paddles, yells clear and shocks the protagonist back into the plot. AEDs accomplish a similar task. With the pads of an AED placed, on the sternum and left lateral chest wall, the AED will automatically analyze the Px heart rhythm. AEDs are only effective when the heart trades its usual steady beat for either ventricular fibrillation (a useless quivering of the heart’s muscles) or ventricular tachycardia (the ventricles are contracting too quickly to pump blood). If the AED detects one of these rhythms it will anounce (in a very creepy voice) to stand clear and deliver a shock. The goal is to reset the heart’s electrical pacemaker (the Sinoatrial node) to a healthy rhythm.

Caffrey et al observed the Chicago AEDs over a two-year period and found they were used on 26 individuals. Of these 26 individuals, 22 were actually in cardiac arrest and 18 were in a condition the AED could treat (Vfib or Vtach). In a normal out of hospital arrest setting we could expect 2 to 7 of these patients to survive. With the AED 11 survived, 10 surviving over a year after the arrest incident. Even more interesting is that 6 of these 11 patients were treated by good samaritan bystanders with no previous AED training.

Caffrey et al noted that, given the 10-year shelf life of an AED, the complete project cost of installing and maintaining 53 AEDs for the Chicago program was a mere $35,000 USD a year. This equates to $7,000 per saved patient. AEDs are relatively inexpensive, require very little maintenance and are extremely easy to operate. These really are monkey proof. As one instructor once told me, “The only way you can screw up using an AED is if you forget to bring it or you put it on your chest.”

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