Recent discussions
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Darlene M Hutton
While I agree with your recommendations against locked cabinets, for all the reasons stated, I feel that there continues to be a knowledge gap in the training of health care providers on the use of AED. As a BLS and ACLS instructor for over 25 years, I have witnessed health care providers apply the AED to a patient with an unstable tachycardia with a pulse numerous times. Their rationale at the time of the training scenario is something along the lines of "I'll apply the pads just in case they require the AED". Having trained and certified many health care providers, I realized that they are not routinely aware of the nuances of AEDs, specifically when it comes to an AED differentiating between how patients can present when in ventricular tachycardia. Approximately half of the healthcare providers that I certify doing BLS do not realize or are not confident in their knowledge that the AED cannot differential between a pulseless VT and an unstable VT with a pulse.
It's understandable why healthcare providers might err on the side of caution with unstable tachycardia, but the misconception about AED use in such cases highlights a need for added education.
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Dorothy (Doreen) Igharo
I think it might be possible to tack and retrieve stolen AED but vandalized AED require to be replaced. “AEDs can be recovered through tracking devices (Page 2024 110227)”. It also depends on the setting itself, inner circle query. Who are those stealing and vandalizing the AED? There could be one or more inner circle of the community groups involve otherwise, who else? I know this was not mention though in the research evidence
I think education in form of community groups public awareness/campaigns may play a vital role on the use of AEDs prevent vandalism and theft (Brugada 2014 S57). Thus, focuses on the importance of AED in resuscitation process, the chances of victims to survive rely greatly on AED accessibility. Vandalized and stolen AED impede the chances of victim survival rate. Even when AED are in locked or unlocked cabinets, as per this research evidence it “revealed that theft and vandalism was seen in both locked and unlocked cabinets”. However, if the community setting policy is to locked up AEDs in cabinets, instructions to access the keys should be make clear
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Edward Mak
Agree.. Communities with a good PAD program are typically in areas where there is sufficient funding. There is already a demographic bias because most PAD locations are typically the well funding areas. PAD programs need to focused on deploying AEDs in areas where EMS arrivals are >10mins. Strong recommendations EMS to be involved in ANY PAD program deployment.
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Edward Mak
Agree.. Communities with a good PAD program are typically in areas where there is sufficient funding. There is already a demographic bias because most PAD locations are typically the well funding areas. PAD programs need to focused on deploying AEDs in areas where EMS arrivals are >10mins. Strong recommendations EMS to be involved in ANY PAD program deployment.
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Edward Mak
It's quite clear there is insufficient evidence to support the practice of using Head up CPR. Even if the evidence was slightly stronger, there is a practical/ application component one must consider.
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Lino Masotti
Locked vs Unlocked AEDs for Public - LINO MASOTTI. (Heart and Stroke Foundation (CANADA) Experienced Instructor/Instructor Trainer - 23 years)
AEDs have proven to save lives and there have been many success stories with PROMPT public AED intervention in a CA. The PROS of having AED CABINETS “unlocked” in the General Public - ready for use especially in areas of increased pedestrian traffic areas (malls, plazas/piazza, convention areas, arenas/stadiums… ) greatly out weighs the disadvantages in when emergency medical services are immediately called.
From personal experience, a major concern is that a significant number of AEDs in my community are improperly maintained, lacking a maintenance plan. When I teach out-of hospital resuscitation programs; as part of training, I ask students to locate their in house AED and on several occasions find low batteries, expired pads…
On one occasion, while I was teaching, a student became severely ill and after assessing the student, called 911, had a staff member go and retrieve AED “just in case of cardiac event ” - after EMS had taken the patient to hospital, I checked the unit with the staff - low batteries and expired AED pads. I think this is an issue that needs to be addressed with certain workplaces as I do my best to make sure that they are informed about the proper maintenance and offer them solutions on updating their AEDs - this isn’t my job, but I care about healthcare making our community safer.
PROS UNLOCKED
- Effortless public access
- Immediate bystander CPR/AED -improving overall survivor stats.
CONS UNLOCKED
- Theft
- Lack of maintenance plan/control
- Environment conditions
- Vandalism
LOCKED AED CABINETS
Recommendation in environments controlled by a specialized emergency response team trained in a variety of emergencies with a duty to respond.
Facilities may also have oxygen, trauma kits, emergency medicine.
My input on where I would have a locked access AED cabinet:
PROS LOCKED
CONTROLLED ACCESS, BETTER MAINTENANCE, OTHER EMERGENCY EQUIPMENT
- Civil/Commercial aircraft
- Public transportation
- Medical/Dental Offices
- Event First Aid Stations
CONS LOCKED
- AEDs are inaccessible
- Alarms scare individuals
- Delays: If a key is required, retrieving the AED takes valuable time.
In conclusion locked/unlocked AEDs involves weighing accessibility against security/maintenance concerns. Balancing these approaches optimizes both public access and readiness which they were ultimately meant for.
Hope this information helps. Keep up the excellent work.
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Lino Masotti
Locked vs Unlocked AEDs for Public - LINO MASOTTI. (Heart and Stroke Foundation (CANADA) Experienced Instructor/Instructor Trainer - 23 years)
AEDs have proven to save lives and there have been many success stories with PROMPT public AED intervention in a CA. The PROS of having AED CABINETS “unlocked” in the General Public - ready for use especially in areas of increased pedestrian traffic areas (malls, plazas/piazza, convention areas, arenas/stadiums… ) greatly out weighs the disadvantages in when emergency medical services are immediately called.
From personal experience, a major concern is that a significant number of AEDs in my community are improperly maintained, lacking a maintenance plan. When I teach out-of hospital resuscitation programs; as part of training, I ask students to locate their in house AED and on several occasions find low batteries, expired pads…
On one occasion, while I was teaching, a student became severely ill and after assessing the student, called 911, had a staff member go and retrieve AED “just in case of cardiac event ” - after EMS had taken the patient to hospital, I checked the unit with the staff - low batteries and expired AED pads. I think this is an issue that needs to be addressed with certain workplaces as I do my best to make sure that they are informed about the proper maintenance and offer them solutions on updating their AEDs - this isn’t my job, but I care about healthcare making our community safer.
PROS UNLOCKED
- Effortless public access
- Immediate bystander CPR/AED -improving overall survivor stats.
CONS UNLOCKED
- Theft
- Lack of maintenance plan/control
- Environment conditions
- Vandalism
LOCKED AED CABINETS
Recommendation in environments controlled by a specialized emergency response team trained in a variety of emergencies with a duty to respond.
Facilities may also have oxygen, trauma kits, emergency medicine.
My input on where I would have a locked access AED cabinet:
PROS LOCKED
CONTROLLED ACCESS, BETTER MAINTENANCE, OTHER EMERGENCY EQUIPMENT
- Civil/Commercial aircraft
- Public transportation
- Medical/Dental Offices
- Event First Aid Stations
CONS LOCKED
- AEDs are inaccessible
- Alarms scare individuals
- Delays: If a key is required, retrieving the AED takes valuable time.
In conclusion locked/unlocked AEDs involves weighing accessibility against security/maintenance concerns. Balancing these approaches optimizes both public access and readiness which they were ultimately meant for.
Hope this helps.
Keep up the excellent work!
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Daniel Cherrier
According to my experience in emergency field and as an instructor for many years, it is obvious to me that AED should not be in a locked cabinet. When an emergency occurs, as far as cardiac arrests are concerned, stress among the emergency personnel and also with the layperson who is willing to help the cardiac arrest patient is at its most high level. So if the accessible AED is in a locked cabinet, that will bring confusion and increasing the stress level to the rescuers. In a lot of public facilities, it is difficult and a waste of precious seonds to try to get the AED and some security personnel has the bad idea of thinking that they are the only individuals to respond to a cardiac arrest episode. We all know that this is not true at all, every person who is trained to perform CPR should have access to an AED, no questions asked.
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Peter Mertins
I agree with this articles concluding statements. AED cabinets should not be locked to public,an if so, an easy,safe and effective method should be devised to gain access..
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Andrew Benson
I would strongly advise against having locked cabinets in the setting of public access defibrillators. The program I was associated with for 25 years supported in excess of 400 public access defibrillators and never had an incident of vandalism or theft. I will qualify the statement that our experience was almost exclusively with indoor AEDs. we have limited experience with AEDs place in outdoor public settings.
As has been well established, ready access to defibrillators enhance the outcome of victims of cardiac arrest. Our own experiences would indicate better than a 50% survival to discharge when a PAD device is used.
I believe several aspects need to be balanced: ownership and cost of the AED will at times heighten the concern and implications for theft and vandalism which can be offset by support of a program (and back up devices should it occur); vs the public perception of a locked device suggesting it is not for everyone's use, regardless of training and may create inherent delays in access and application of the AED as well potential for damage to the case and or the individual trying to access the AED.
We need to ensure everyone has access to these potentially life saving devices as well as educating the public about their availability and need.
Thanks for the opportunity
Andy Benson