Setting up a successful public access defibrillator (PAD) program should be on the forefront of every fire and EMS agency’s agenda. The American Heart Association notes that for every minute a person is in a cardiac arrest, their survivability decreases by 10 percent. Having easy-to-use PADs that are quickly accessible by the public increases the probability of delivering life-saving defibrillation sooner.
Here are the top five things to consider when starting a PAD program, along with some of the strategies I used to start a PAD program that has grown to more than 1000 PADs over just a few years.
Involve the stakeholders With any successful startup program, getting the key players involved at the beginning is critical. Start by inviting those organizations and individuals who are the stakeholders – those with a vested interest in the success of starting a PAD program. This group should include fire, law enforcement, EMS, 9-11 communications, hospitals, cardiologists, the local American Heart Association, and other interested parties.
Start with regularly scheduled meetings and open discussions on the importance of PADs to the survival of cardiac arrest patients. You may begin the initial meeting by walking the group through the continuum of care that each member provides, starting at 911, through prehospital responders, to hospitals, and finally outpatient care. This helps everyone understand the many vital roles needed to help increase survivability. This group may grow and develop subgroups as other key tasks or steps are identified.
Funding After the stakeholders have bought in to the program, one of the next steps is locating funding. Funding will be integral to starting and maintaining the program. A well connected stakeholder group may be able to tap into their individual networks to locate funding, and this task may also turn into a subgroup of the stakeholders. Funding may come from a variety of other sources, including community grants, endowments, fundraising events, matching funds, or other programs.
Hospitals may also have access to funding sources or use other methods to lower costs. For example, in one successful program, a hospital used its purchasing power to lower the costs for PADs. They did this by purchasing in PADs in volume at 100 units at a time, and also by helping to negotiate a lower price. This lead to a lower cost through a volume discount and lower shipping costs per unit. The hospital also offered to use their staff to help augment the program, store, and even tracking individual PADs. Their CEO was an early member of the stakeholder’s committee, and he quickly understood the importance of PADs to saving lives. He was used as part of the negotiating team to help get the lowest possible price for the PADs.
PAD selection and training The team should determine whether the program will use a single model of PAD, or whether a variety of brands will be used. An argument for a single model is that as the program grows certain things become easier (and cheaper) due to economy of scale such as training, system upgrades, recalls, purchasing batteries and patches. Having one brand may also create a direct pipeline to the company for maintenance and support. Since CPR training includes PADs, if one particular brand of PAD is selected, then models for that particular device can be incorporated into training. This ensures realistic training based on the system.
The team should also ensure the PAD model integrates with the brand of device that prehospital responders are using. This will allow for similar defibrillation technology and protocols from PAD to responders, and ultimately the receiving hospital.
During this step, the team can also begin to focus on the location and placement of the initial PADs in the community. The team should consider sites where mass gatherings are common, areas with large populations over 50 years old, schools, and sites that take EMS longer to respond.
Marketing This can be ongoing from the beginning of the process, and is important for creating “buzz” in the community. Once word is out, you may be surprised at the demand for the program from individuals and businesses.
Some marketing ideas can also be turned into fundraising opportunities. Two ways to get the word out and involve the community are mass CPR training days, and a contest to name the PAD program. The front of the PAD cabinet is also a prime marketing location and can be used to further market the program with contact information and logo placement.
The PAD program can also rely on local media for marketing. Depending on the situation, consider asking for coverage of successful cardiac arrest “saves,” or giving awards to citizen heroes for taking action.
System Integration Early on, prehospital providers may be reluctant to embrace the program. Some may view it as encroaching on their turf and won’t fully understand the value PADs bring to increasing survivability. You should clearly explain that PADs will keep patients alive and offer responders a better opportunity to provide their skills to potentially survivable patients. Here are some integration considerations:
The dispatching center should have a database that will notify the call taker if a PAD is located at the site, and also provide instructions for use. Some computer aided dispatch programs (CADs) have the capability to flag addresses with PADs located on the property.
Some groups may not embrace the change because they may be required to perform new roles or change their operation, i.e. police may have to carry PADs in their patrol vehicles. It is important to overcome these arguments, as police often beat firefighters and EMS to the scene and can start defibrillation even sooner.
First responders should understand the importance of PADs and also be able to transition from a PAD to their device for transport. There needs to be guidelines and training on switching from a PAD to a more advanced cardiac device, and also when should they continue using the PAD.
This goes back to the importance getting key players from various agencies together so they can communicate the importance of the program back to their organizations.
Conclusion These are only some of the areas to focus on prior to setting up a PAD program. These programs are easy to start and garner great success by increasing patient survivability from sudden cardiac arrest. If fire and EMS agencies do not step up and provide the necessary leadership to start a PAD program, some other organization will fill that role and take a significant new standing in your community. A successfully implemented PAD program is one of the only tools presently available for a city or EMS system to increase the rates of patient survivability from sudden cardiac arrest.
Feel free to contact me for any questions on PAD programs. I've helped start several programs, including one which received the national heart safe community award.
About the author
Jim Sideras is a division chief for Sioux Falls, S.D., Fire Rescue. He is a 23-year veteran of SFFR and a registered nurse with a masters of science degree in nursing as a clinical nurse specialist. Jim received the Harvard University Fire Executive Fellowship, and has also completed a human resources program at Cornell University. He is currently in the National Fire Academy's Executive Fire Officer program, and has spoken at several national conferences on emergency medical topics. In addition, Jim is a former intensive care burn nurse and a member of the National Association of EMS Physicians, Sigma Theta Tau International Honor Society of Nursing, the South Dakota Nurses Association and the South Dakota EMT Association. In summer 2007, he received his national Chief Fire Officer designation. To contact Jim, e-mail Jim.Sideras@FireRescue1.com.
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