Editor's note: In this, the first part of a two-part series, Jim Sideras discusses how you can implement a PAD program in your community using the example of his department, Sioux Falls Fire Rescue.

Photo Jim Sideras

The time to defibrillation is one of the most important factors during a cardiac arrest. To help decrease that period, public access defibrillator (PAD) programs are being developed across the country. The concept of PAD programs is to place easy to use defibrillators in public locations with the intent that a layperson will quickly use the device to defibrillate someone in a cardiac arrest.

If your department is not spearheading a PAD program, you are missing an excellent new opportunity to save citizens. The issue was highlighted in a recent a teleconference sponsored by the International City/County Management Association entitled, "Asking your police and fire chief the right questions — to get the right answers." It was stated that the biggest impact fire departments can have on a patient's survivability from cardiac arrest is to have a PAD program. Who should start such a program? The answer is simple — you.

Putting together a PAD program is a fun and extremely rewarding project. This article will share the steps to help develop a successful program.

Overview
The American Heart Association (AHA) estimates that sudden cardiac kills as many as 450,000 people in the United States annually. Although the majority of cardiac arrests occur in the home, approximately 20 percent take place in public locations. One of the only clinically proven interventions to reverse cardiac arrest is electrical defibrillation, with time being a critical component in a person's survival. The AHA estimates that for each minute someone is in a life-threatening rhythm such as ventricular tachycardia or ventricular fibrillation (VT/VF), the chance of survival decreases by 10 percent for each minute the person remains in that condition.

The City of Sioux Falls, SD, has one of the larger PAD programs in the country, with more than 800 PADs in the community and an additional 300 on a waiting list. The program has also extended into a regional program with other cities working within the Sioux Falls initiative. Here's some of the things we've learned and problems that can be expected when developing your own program:

Building a coalition of stakeholders
If your community does not have a PAD program, the fire service is an excellent organization to spearhead the project. The fire service cannot, and should not, pursue this program alone. Developing a PAD program is the opportunity to bring together all the stakeholders together into a PAD coalition. These stakeholders are any group that has an interest in a PAD program, such as fire, EMS, law enforcement, hospitals, physicians/cardiologists, the AHA, etc. If these stakeholders are included in the early stages of the program, they can help garner more initial support to help it develop and grow. This can be very important when you begin to seek funding as your program begins to expand.

Finding funding
Without a budget or funding, it will be difficult to build a PAD program. Funding can be found in many areas including grants, budgets and even fundraisers. A small program can be part of an organization's budget. The benefit of starting a small PAD program is that the proper foundation can be developed to support a larger program. As the program grows, it will become easier to approach agencies for funding as you will have a proven track record. Agencies may also seek out your program to possibly fund part of it.

Our initial program was developed through the fire department. It was for city buildings and included about 20 PADs. As it grew, we were able to garner funding through grants by the United Way for a larger PAD community program. We also continued to budget for PADs for city-owned buildings. The program has been so successful that groups have sent grant applications to us in an effort to keep the program growing.

Another consideration is to have each PAD recipient be financially responsible for half of the cost of the PAD. This could vary by the cost of your PAD, but will help offer some tangible financial benefits. By calling it a "matching grant," this method effectively doubles your financial resources. If you have $10,000 available to start the project, the matching portion would double this amount and allow for more PADS to be deployed. This also creates a sense of ownership by the recipients in the program. Its means they have a vested interest in the program and its success. This ownership will be important when it comes to monitoring the PAD and conducting maintenance.

This ownership concept is an important one. It will play a critical role as your program matures. A new program has a high level of enthusiasm, but when that fades, it is the concept of ownership that will help maintain interest in it. This will play a role in monthly monitoring of the PAD as well as any maintenance needs or requirements.