Introduction to Public Access Defibrillation Programs

Creating a successful Public Access Defibrillation Program (PAD)

AEDs Save Lives

An AED – short for automated external defibrillator – is an easy-to-use medical device that can restore a normal heart rhythm to someone who has gone into cardiac arrest. CPR and AED use recently received national attention in 2023 when Buffalo Bills football player Damar Hamlin collapsed on the field in Cincinnati following a tackle. He was saved from a sudden cardiac arrest (SCA) because trained personnel administered CPR and the defibrillating shock from an AED to restore his heart beat!

What is Public Access Defibrillation

Public access defibrillation (PAD) is an AED program that encourages and enables lay people to use publicly available automated external defibrillators (AEDs). The goal of a PAD/AED program is to reduce mortality and morbidity of sudden cardiac arrest victims. The use of CPR coupled with an automated external defibrillator provides timely, appropriate and effective first aid anywhere there is access to a device. It is virtually the only way to help improve chances of survival for a SCA victim until emergency medical services arrive. 

Because of the urgency of giving CPR and electrical shock within minutes of a cardiac arrest, automated external defibrillators have been made to work automatically in the hands of most any bystander. Technology once only available in hospitals, for use by hospital employees with AED training, is now readily available. Its effectiveness for public use is well-demonstrated. Even children have shown the ability to use AED machines to successfully deliver a needed electrical shock and help save the lives of those who suffer sudden cardiac arrest (SCA).

When a lay first responder who is faced with a cardiac arrest has had the benefit of one of the AED training programs now available to the general public, survival rates are further enhanced. All of the AED training courses are to no avail, however, if no AED is close by. Thus the need for AED programs.

Public Access Defibrillation Programs are Needed

PAD initiatives are important because they make AEDs more readily available to those who need them in a life-threatening SCA emergency. Simply put, time is of the essence. AEDs can be used by lay people “in the field” to assess the condition of someone in cardiac arrest. The AED will determine whether a shock is needed and guide the rescuer as they respond.

Other bystanders can provide vital support such as calling for emergency medical services and performing CPR while the AED is being activated.

Along with efforts to inform and train the greater public in using cardiopulmonary resuscitation and automated external defibrillation in cases of SCA, PAD programs accomplish their mission through the widespread, systematic provision of AEDs. Such programs are being developed and required by law both by the US government and many states. They are typically launched by various public entities, such as local governments, schools, and churches. Businesses both large and small, some due to state laws, have begun PAD programs for offices as well as other workplaces.

PAD in the United States

Federal and state law as well as the efforts of national organizations have made the current state of PAD programs in the U.S. strong. Many organizations and communities are investing in AEDs and cosponsoring programs to place them in public areas. The American Heart Association (AHA) provides advisory statements and guidelines on how to create a successful PAD program.

In the U.S., AEDs are becoming increasingly available in public places and can be found in the form of PAD programs with more than 30,000 activated across all 50 states. The current state of PAD programs is making it easier for bystanders to render aid that could save a life during an SCA emergency. Still, there is much to do to make an AED available for use throughout the public domain.

Keys to Establishing an Effective PAD Program

Deliberate, coordinated effort makes for a successful PAD program. There are several key elements to consider. A step-by-step approach to PAD start-up within an organization can be built on these essentials from cdc.gov:

1. Targeted automated external defibrillator (AED) site placement;
2. Training anticipated responders;
3. Emergency medical services (EMS) coordination;
4. Emergency response plans;
5. Routine maintenance and testing of AEDs;
6. Continuous quality improvement;
7. Confirmation of [federal, state, and local] limited civil liability and/or qualified immunity law.

Help for Getting Started

Certainly, leadership must acknowledge that considerable planning is needed to fully implement a PAD program. However, a logical first step to take at the beginning of the AED program process (and ahead of other implementations) is the purchase and placement of AEDs. This can be undertaken immediately to assure that the urgent need for AEDs is met as soon as possible. Even staff AED training can follow obtaining AED devices. As indicated in the CDC list above, providing AEDs in the workplace and for public access areas as soon as possible is a top priority.

Selection and Placement of AEDs

Be aware, however, that some research is needed in making the initial purchase of a group of AEDs for a PAD program. Features such as Wifi capabilities now make it possible to network the machines purchased for tracking of placement, use, and maintenance. Also, models of AEDs vary, and should be selected according to their intended use. Expert salespeople and medical professionals can provide good advice for the best AED to fit any particular facility and its user group.

Below is information provided to jumpstart the PAD plan startup. This information is not meant as an exhaustive guide, but will aid in taking the first steps in the implementation process.

Principles of AED Placement

Thoughtful placement of AEDs in public areas such as schools, churches, offices and malls can significantly increase the survival rate among those suffering a sudden cardiac arrest (SCA) emergency. It is helpful to consider a number of factors when determining where best to place an AED for public use:

• any obvious location of a likely SCA emergency (e.g., school gymnasium, where strenuous physical activity occurs and large numbers of spectators gather);
• sites where an AED can be quickly seen and accessed;
• high traffic areas such as hallways, elevators, lobbies and reception areas;
• central locations near a people-gathering area such as a cafeteria or a recreation center; and
• a secure area that is, however, still easily accessible to both employees and visitors alike.

Suggestions for Specific Facilities

Schools

When placing a PAD program in a school, it is important to consider the age of the students and staff, how many people are in a typical classroom, the route from a classroom to a designated AED site, and how fast an AED can be accessed. Areas that should be considered for a PAD program include: 

• classrooms
• main hallways
• gymnasiums and stadiums
• nurse’s offices or health centers so long as they are not locked 
• a dedicated area near the school entrance

Churches

When implementing a PAD program in a church, it is important to consider the age of its congregation, how many people are present during a typical service, the route from a sanctuary to a designated AED site, and how fast an AED can be accessed. Areas that should be considered for a PAD program include: 

• worship areas 
• a dedicated area near a congregation gathering area 
• a secure and central location near a main entrance

A designated team of personnel who are trained and equipped to use an AED should also be created.

Businesses/Shopping Areas

When placing a PAD program in a business or shopping area, consider the age of the clients/customers, how many people are typically present in a given area, the route from an office or store to a designated AED site, and how quickly an AED can be reached. Areas that should be considered for a PAD program include: 

• a dedicated area near entrances
• a central location in a mall’s main corridor
• a secure and accessible location near stores

By investing in a PAD program, a business, school, church or mall can not only provide a safe environment for its customers and staff but also increase the chances of a successful outcome during a SCA emergency. With the right tools and training, lay people can be a valuable asset when it comes to providing early defibrillation.

Developing Action Plans and Policies

Once AED purchase and placement has been done, likely by the person selected to head deployment of the PAD program, they must take the lead to put in place plans and policies for the organization. Fortunately there are many resources providing help in this process:

• Various federal agencies provide program guidelines, such as in this article from OSHA.
• The American Heart Association provides guidance for implementing a PAD program.
• Information regarding PAD is available on a state-by-state basis.
• Local communities provide guidance and grants.

Further Steps for PAD Program Implementation

Training anticipated CPR/AED responders

Having a PAD program in place not only gives bystanders access to a life-saving device, but it also provides them with the necessary training and tools to use it. AED Superstore provides CPR and AED training and certification, including local and online access. It should be mentioned that there are often additional training resources, both public and private, in most communities.

Emergency Medical Services (EMS) Coordination

Most states have coordinators for emergency services (e.g.: state of Virginia). Local departments will likely have an official to work with various PAD program startups as well.

Emergency Response Plans

Part of the PAD setup must include specific requirements for personnel to respond to sudden cardiac arrests with automated external defibrillators. There are a number of sources for institutional first aid response plans. A starting place in understanding and forming a plan is to search out an applicable template, such as the American Heart Association Emergency Template for Schools.

Routine maintenance and testing of Each AED

One or more persons must have as part of their job description the maintenance of the AEDs. To maintain an AED, inspect it at least monthly. Check all the components to make sure they are in proper working order and replace any parts that are not working properly. Check the battery charge and replace with a new one if needed, as well as other consumables such as electrode pads. 

To keep an AED properly maintained it is helpful to use a maintenance checklist, and a record should be kept of each time a check occurs.

AEDs made by Heartsine and Physio-Control can be purchased with remote monitoring capacity, and are recommended for any larger organization with multiple departments, locations, or even vehicles which will be equipped with AEDs.

Continuous quality improvement

Continuous quality improvement (CQI) is essential to ensure public access defibrillation (PAD) programs are successful. Regular meetings must be held to take in feedback and create recommendations for any needed future action. Discussion regarding (new) task assignments, siting, AED performance and maintenance, etc. will help keep the PAD system functioning well. Adjustments will naturally need to be made as changes in the workplace, personnel, and AED technology take place.

Confirmation of Applicable Good Samaritan Law

Many bystanders are hesitant to step up and provide first aid when the time comes due to fear of liability if a mistake is made in providing help. Encouraging worksite staff (and the public) to be active responders providing effective early defibrillation is important to improving survival rates for cardiac arrests.

In order to encourage the public to be helpful to others in an emergency, Good Samaritan Laws protect a person giving first aid from liability as they are providing help. These laws exist in all 50 states of the US and in many other countries as well.

However, because of variances in these laws, part of implementing the public access AED program must include consideration of applicable laws.

Confirmation of federal, state, and local law which provides limited civil liability and/or qualified immunity must be made and the information taught in employee training courses. This will prepare them to act swiftly and properly in emergencies as they perform a rare but utmost important task as they work– to use an AED to save a life!