In a medical emergency, time is of the essence. That is especially true in the case of a cardiac arrest. Without intervention, cardiac arrest will lead to irreversible brain damage within four to six minutes.
For that reason, health care professionals have spent decades promoting CPR training and, more recently, the use of automated external defibrillators (AEDs). Taken together, early access to quality CPR and an AED can dramatically improve survival rates in cardiac arrest cases. Research has proven that properly trained laypersons can effectively provide both interventions.
Unfortunately, there simply aren’t enough AEDs in the United States. They are carried in most ambulances and on many police and fire vehicles, but despite their widespread use by these agencies, the response times are almost never fast enough to give cardiac arrest victims their best chance of survival.
The key to improving survival rates is to have AEDs available for use by the general public. A recent study showed only about 2.4 million public-access AEDs in service, well short of the 30 million that experts say are needed to maximize public safety. That figure is based on having an AED within 300 feet of any given location in a public building.
Having AEDs in place at schools, shopping centers, sports arenas, and other large facilities dramatically lowers response times, and response time is key to the effectiveness of AEDs.
When a sudden cardiac arrest occurs, someone must call for help. There are usually plenty of cell phones close by, but the materials in some buildings can make it difficult to place a call, forcing the caller to go elsewhere or get a landline.
Next, the caller must be able to describe accurately where the emergency is taking place so that responding crews get accurate directions. If there are any errors in this process, valuable minutes can be lost. In comparison, AEDs are often just steps away when an event takes place.
“Horizontal” Response Time
Gridlock is a reality in most cities. Not only does it prove frustrating to commuters on their way to work, it is potentially deadly to patients in need of a rapid response by emergency medical personnel. “Horizontal” response time refers to the minutes it takes to reach the scene of the call.
When emergency vehicles are delayed by traffic, detours, or simply by long distances, those critical four minutes can evaporate rapidly, leaving little hope of an ideal outcome for the patient they will be treating. There are even phone apps that can notify people in a given area that a cardiac arrest is taking place, allowing them to arrive ahead of emergency crews.
“Vertical” Response Time
A quick review of emergency service logs might show that responders are on the scene of most calls in just a few minutes. However, there is a big difference between being on the scene and being with the patient. The additional time it takes to get into a building and to the patient is referred to as vertical response time.
By the time a crew unloads equipment, gets to the appropriate floor, and reaches the patient, several more minutes can elapse.
Availability of Equipment
Inside an institution like a school or a factory, the AED will almost definitely be available at any time. The same cannot be said about ambulances or fire trucks, which could be committed to calls elsewhere and unavailable to respond.
The investment of less than $2,000 for an AED is dramatically lower than the corresponding cost of putting additional emergency crews on the road, and it still provides even greater time savings than those investments.
Decades ago, the nation’s emergency medical network and the training of civilians was very poor. Victims of sudden cardiac arrests would almost always die. In time, CPR and improved emergency medical services have greatly improved survival rates.
Yet, it is still not enough. Too many large locations still do not have AEDs in place, and research is finding that many AEDs are placed in low-risk locations where an event is unlikely to occur, while target areas with a higher probability of emergencies continue to go without.
The shortage of AEDs represents a serious threat to survival rates for cardiac arrests, so improving this deficit must begin with adding more devices. Whether it’s through public initiatives, private efforts, or partnerships between the two sectors, more AEDs need to be installed in locations where such an emergency is likely to take place.
We must focus on creating the opportunity for them to make those lifesaving interventions. With strategic placement in high-risk areas, AEDs can maximize their potential in our most critical medical emergencies.