Katarzyna Pogorzelczyk1, 2, Marta Gallas3, Marlena Robakowska4, Przemysław Żuratyński1, Sylwia Jałtuszewska5, *Daniel Ślęzak1
The popularity of AED and its use
Popularność AED i jego stosowanie
1Department of Emergency Medicine, Faculty of Health, Medical University of Gdansk, Poland
2Cathedral of the Economic Policy, Economic Department, Medical University of Gdansk, Poland
3Department of Nursing Management, Faculty of Health, Medical University of Gdansk, Poland
4Department of Public Health and Social Medicine, Faculty of Health, Medical University of Gdansk, Poland
5Institute of Theories about the Health, Plant of the Medical Rescue, Pomeranian Academy in Slupsk, Poland
Spośród wszystkich zarejestrowanych przyczyn śmierci na świecie najczęstsze są te związane z zatrzymaniem krążenia. Korzystanie z aparatów wspomagających akcje ratownicze w przestrzeni miejskiej stanowi niezaprzeczalną wygodę i pomaga w sytuacjach nagłego zagrożenia zdrowia i życia poszkodowanego. Celem pracy było wskazanie rzeczywistych przyczyn niestosowania sprzętu AED zlokalizowanego w przestrzeni publicznej w sytuacji wystąpienia NZK w warunkach pozaszpitalnych. Materiał składał się z publikacji krajowych i zagranicznych, literatury światowej opowiadającej o programach profilaktycznych i zakupach nowych AED. Pod uwagę wzięto także opinie i wytyczne środowisk ekspertów w dziedzinie kardiologii. Do przeprowadzenia badania wykorzystano analizę tekstów naukowych, publikacji branżowych, raportów i aktów prawnych.
Out of all registered causes deaths in the world are most frequent the ones associated with the circulatory arrest. Using apparatuses assisting rescue operations in the municipal space constitutes the undeniable convenience and is helping with situations of the sudden threat to the health and the life of the aggrieved party. Showing real reasons for not-applying the AED equipment located in the public sphere in the situation of the NZK riot in extra-mural conditions was a purpose of the work. Material consisted of domestic and foreign publications, of world literature telling about preventive programs and the new AED shopping. also opinions were considered and guidelines of circles of experts in the cardiology. Do field of conducting research were used analysis of scientific texts, trade publications, reports and legal documents.
Among all registered causes of death in the world, the most common are those associated with cardiac arrest. This phenomenon is spreading with deepening negative civilization and social changes. Epidemiological data taking into account the existence of correlations dependent on lifestyle and the incidence of cardiovascular diseases. With the increase in the level of industrialization, and thus the development of the development of Western markets, expand the number of cases of cardiac arrest (sudden cardiac arrest). The occurrence of the situation is unpredictable, it occurs unexpectedly, the health effects borne by the patient are irreversible (1).
The case of SCA is defined as a sudden medical condition, when the cardiac arrest stops, which play with cessation of blood flow. As a result, breathing stops and protection, irreversible brain damage. Each case of cardiac arrest is associated with a high risk of death, the same situations are particularly dangerous when cardiac arrest occurs, e.g. on the street, at home, and thus in non-hospital settings. Out-of-hospital Sudden Cardiac Arrest (OHCA) is an event with a particularly high risk of death. According to the latest data from a study in the United States, survival in OHCA is still around 12% and requires decisive corrective action (1). SCA consists of: myocardial professions, acute coronary syndromes, arrhythmias – here, in turn, cell fibrillation, ventricular tachycardia without pulse; pulmonary embolism, intoxication or drug overdose. In a non-hospital NZK situation, where all the first aid measures are not carried out, up to 90% of mortality is recorded (2). In Europe, 275,000 out-of-hospital cases of SCA each year, in the United States more than 375,000 (3).
One of the tools to improve survival rates, both those calculated at the time of admission to the hospital and after the completion of therapy, is a wide access to Automated External Defibrillator (AED). Their quick application minimizes the consequences of hypoxia of the body and significantly increases the chances of survival – among people who undergo activities using AED, the average survival rate is close to 50% (1). However, certain conditions must be met for the AED to be effective. One of them is the use of AED shortly after the onset of SCA. It is estimated that defibrillation efficiency decreases by 7-10% with every minute (4). The highest effectiveness is obtained when defibrillation is performed up to 3 minutes from SCA (5).
The use of apparatus supporting rescue operations in urban space is an undeniable convenience and help in situations of sudden threat to the health and life of the injured person. Immediate care, in any case, is associated with a more positive prognosis for the further treatment process, compared with the lack of such activities. A quick response is possible, however, if the society is aware of the essence of the AED apparatus, its location, and also has the skills to use it (2). As indicated by numerous research results and guidelines of international scientific societies – the correct and well-thought-out location of an external defibrillator is one of the main factors guaranteeing the possibility of conducting successful assistance (3, 4).
Based on already existing programs implementing rescue equipment and reports and recommendations determining the conditions that a potential AED location must meet, automatic external defibrillators are becoming more widely available, especially in larger urban agglomerations (2). In western countries, where AED has been widely available in public space for years, the non-medical aspects of the use of AED have become clear – including the economic and preventive aspects (6). Despite the continuous increase in popularity of this apparatus, it is not often said about its actual use.
Indication of real reasons for not using AED equipment located in public space.
Material and methods
The material consisted of domestic and foreign publications, world literature talking about preventive programs and purchases of new AEDs. Opinions and guidelines of expert circles in the field of cardiology were also taken into account.
To conduct the study, analysis of scientific texts, industry publications, reports and legal acts was used.
With the development of AED technology, its popularity and universality have increased. This phenomenon is particularly visible in Western European countries, some Asian countries (for example Japan) (1), as well as North America.
In these countries, the percentage of non-hospital SCA in which AED is used is higher than in other countries. Education, social campaigns, and thus increasing the level of awareness about the benefits of using these devices in the event of suspected NZK in non-hospital conditions, is an inseparable element of actions to further increase the use of AEDs and is each time an integral element of subsequent apparatus installations in urban space (2, 3). Public awareness of AED is increased through systematic media campaigns, events and thematic happenings (4). The goal is to consolidate knowledge on this subject and increase the visibility of AED by citizens (3).
The installation of AED apparatus in public spaces is not a legal obligation regulated by the executive or judicial authority in Poland. The only provisions used for the arguments behind the implementation of this apparatus as a permanent element of urban life are the guidelines derived from the Act on Emergency Medical Services, the Act on Medical Devices and the Criminal Code (5-8). However, there is no law explicitly requiring the location of subsequent AED devices or the required number, e.g. per 1000 inhabitants or per km2 of space. There is also no official list or register of already installed apparatus in Poland. Data is collected in a fragmentary manner, mainly by the AED owners themselves, sometimes also by the local government. There is also no official aggregate data indicating the frequency of AED use or the number of people who were saved thanks to this apparatus.
Despite the lack of obligation to install the AED, in 2000 the introduction of the PAD system – Universal Access to Defibrillation in Poland began, as was the case in other European countries (6).
PAD, apart from the installations of the devices themselves, also includes a number of accompanying activities. As part of the activities of this project, there is primarily the dissemination of knowledge about the AED and the effects of its use in the event of a threat to life and health, as well as the urging of stakeholders (both public and private) to increasingly locate automated external defibrillators in public space (7, 8).
The first project implemented as part of PAD in Poland was the Orlen First Aid program introduced in a pilot version in 2003. Its first part involved conducting a pre-medical first aid course attended by 130 group employees. The implementation of the second stage led to the installation of equipment and staff training. The operation covered 9 petrol stations, which were located on the busiest roads throughout the country. The group of 34 people joined the course. An additional aspect of the Orlen campaign was the transfer of the Wieliczka Salt Mine Museum, one AED (8).
Currently, the policy promoting the use of AED is carried out primarily as part of the activities of local government units (JST). An example of promotional activities carried out under the PAD, directed to the local society, is the involvement of the cities of Krakow and Trzebinia in activities focusing on medical assistance using a defibrillator.
Trzebinia is the City of the Safe Heart, so the local authorities of the city and commune of Trzebinia called the first program in Poland operating in the local area to promote the use of AED. As part of this action, JST managed to purchase and locate 20 external defibrillator devices in its territorial area (9).
On the initiative of the city of Krakow, the Krakow AED IMPULS LIFE project was created – the largest so far. The introduction of such a comprehensive and widely implemented program in the field of emergency medicine distinguishes the Krakow metropolis against other voivodship cities. As part of the project, 26 defibrillators were purchased at one time, which were installed on the main or busiest streets of the city, as well as trained the principles of using AED for over 6400 people – later potential NZK witnesses, i.e. people helping victims. The program was accompanied by a widely implemented advertising campaign in local media as well as social networks. Private investors that guarantee the purchase of further defibrillators have also joined the project (10).
Another example of PAD activities is the creation of the RatujzSercem.pl portal in 2009 (11). The creators of the portal strive to create a map with confirmed locations of AED installed in Poland. Currently, this database consists of 1501 addresses. Joining the list takes place after self-reporting to the site administrator asking for a new AED to be placed on the map. The system takes into account the division of the apparatus into 24-hour service, only during working hours, one that can only be used by employees considering its location and mobile apparatus as well as devices that are no longer in use.
In addition, for several years, the authorities of the largest companies operating in the rail transport sector and those operating in the regional area are also involved in the process of installing defibrillators in the latest trainsets and the most popular routes, thus ensuring the safety of their passengers. PKP Intercity, since 2016, has installed the AED plus defibrillator in all Express Intercity Premium warehouses – semi-automatic equipment. The cost of purchasing 20 pieces of defibrillators with equipment and training of the entire conductor staff was PLN 117,000 (12). Similar actions were applied by regional railways – Koleje Małopolskie purchased new rail depots with defibrillator devices already installed. Similarly, the Pomeranian Regional Railways in cooperation with the provincial authorities decided on a similar investment. The campaign implemented by the Pomeranian regional government also includes the purchase of 51 AED, emission of advertisements in local media and on monitors installed in trainsets owned by the Pomeranian Voivodeship. JST also sponsors the emission of advertising and instructional spots regarding basic rescue procedures as well as the use of a defibrillator (13).
At present, every year there are notifications of subsequent social initiatives in the field of installation of AED apparatus and first aid training under civic budgets.
Since the introduction of PAD to Poland, an increasing level of investment regarding AED installations in public space has become noticeable. All activities related to the installation, courses, training or other activities promoting its use in the event of NZK occurrence are undoubtedly a valuable undertaking that can bring many benefits. This is indicated by the experience of other countries where AEDs have been present for a long time.
AED situation in the world on the example of selected countries
The consequences of installing AED equipment in public spaces are widely known and appreciated in the world. Their multitude noticeable on the streets is also a kind of advertisement – it creates a sense of security and preparation for the possible need for assistance (14).
Japan since 2004, i.e. the moment when legal regulations were introduced providing for the possibility of using AED located in public space by Japanese society and people from abroad, has undeniably become number one among countries, taking into account both the number of new AEDs and their number per capita and area. It should be mentioned that earlier legal footnotes banned the Japanese from using the AED if they did not have the appropriate competence or medical education (4).
The Japanese authorities decided to invest public funds in both emergency medical services, but also in AED and training in its use, hoping for an improvement in survival rates at SCA, using technology and human resources. Again, it should be emphasized that the success of programs such as PAD is not only based on the number of devices installed. This is evident in the example of Japan, where in 2013 there were 428 821 devices newly installed, but also first aid training and skillful use of AED in the event of sudden cardiac arrest were systematically conducted. In 2013, almost 460,000 people enrolled for this type of course (4).
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9. Miasto Trzebinia o projekcie PAD; https://remiza.com.pl/kazdy-moze-uratowac-zycie-budujemy-Skuteczny-program-publiczne-dostepu-do-defibrylatorow-aed (data dostępu: 23.11.2019).
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12. PKP Intercity announcement regarding the purchase of AED; https://www.intercity.pl/pl/site/o-nas/dzial-prasowy/aktualnosci/defibrylator-aed-plus-w-kazdym-pociagu-express-intercity-premium.html (data dostępu: 30.11.2019).
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