Recently I’ve been reading too many articles where community leaders, resuscitation experts (?) and advocates for cardiac response programs are trumpeting the fact an untrained responder, even an “idiot” (their word, not mine), can deploy an AED, not make the situation worse and maybe even make it better. While this simplistic idea may seem true on its face, there is a logical argument, supported by strong evidence, that untrained responders do in fact make things much worse. In his research Peter Ko showed that survival in a group of patients that received a shock from an AED but poor CPR was 8%, while survival in the group that received a shock plus quality CPR was 53%.
The goal of having dead people remain dead is being achieved
with overwhelming efficiency, in the 85% to 95% range, in most communities. If
the primary goal of a resuscitation program is not to make dead people worse off the
untrained responder model is perfect. If the goal is to improve survival
rates for cardiac arrest then every time untrained responders are the only
people on scene it reduces the chance of saving a life and the patient is made worse off by virtue of the fact that she is being given a smaller chance at survival. The entire community
is also worse off, family and friends remain dead while tax dollars are squandered on an ineffective program.
This is far more than an issue of semantics. When advocates
for resuscitation programs present their case to funders - municipal councils, provincial
or state governments, corporate executives, school boards - and the funders push back on cost, as they are
programmed to do, the first cost cutting measure put forward is to cut back on training.
“The machine is idiot proof, even
if an untrained responder applies the machine improperly or fails to deploy the
machine at all the patient can’t be made worse off.” explains the advocate proudly
displaying his advanced knowledge of defibrillation science
“Well by that logic” says the
funder “why pay for any training at all. If the machine is so simple an idiot can
use it we should just buy a dozen machines, hang them in our buildings and call
it a done deal.”
The advocate, anxious to walk out of the meeting with
something, accepts the offer of 12 AED and no budget for training and another
ineffective PAD program is born. What funders need to know is that to build an
effective program that maximizes the number of lives saved investment must be made in
every link in the chain of survival. The evidence is clear and unequivocal,
most patients that survive cardiac arrest benefit from the proper use of
multiple links in the chain. Funders can
take comfort in the fact that if the trained responder model breaks down and an
untrained person attempts the resuscitation they can’t make things worse, but
it is far from ideal when that happens.
If your are an “expert” trumpeting the “idiot proof”
operation of AED’s please reconsider your words or at the very least downplay this
aspect of the machine. If you are an advocate for effective resuscitation programs
in your organization or community please push for more training opportunities
for all stakeholders and potential responders.
In Memory of Brock
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