By Dan White
Automatic external defibrillators have become central to many communities' successes in reducing mortality from sudden cardiac arrest. Cardiovascular disease is the single greatest cause of death in the United States, and every year more than 480,000 adult Americans die of a heart attack or its' complication. About half of these deaths (250,000) result from sudden cardiac arrest, a complication of heart attack.
Numerous scientific studies conducted during the past 30 years have proven that rapid defibrillation is the single most important factor affecting survival from sudden cardiac arrest in adults.
OSHA estimates that 15 percent of workplace fatalities — more than 400 per year — are caused by sudden cardiac arrest. Of these victims, it is estimated that 160 could have been saved by defibrillation within 5 minutes.
Introduced in 1979, the AED has been proven a safe, simple and critically important life-saving device. It specifically treats two of the major causes of sudden cardiac arrest: ventricular fibrillation and ventricular tachycardia.
The American Heart Association strongly advocates that all EMS first-response vehicles and ambulances be equipped with an AED or another defibrillation device (semiautomatic or manual defibrillator). The AHA also supports placing AEDs in targeted public areas such as sports arenas, gated communities, office complexes, doctors' offices and shopping malls, etc.
Here are the top things to consider when making an AED purchase:
1. Who are the intended users?
Is it for public access or professional use? AEDs accessible to the lay public should be simple, safe and easy to use. Some newer models have been FDA-approved for use by the lay public. They do not require an authorization or prescription from a physician to buy or use them. Other models may be more appropriate when the intended end users have medical direction from a qualified physician or medical director.
2. What brand of defibrillators does the responding ALS provider use?
Most AED manufacturers offer various defibrillation pad connectors to enable a smooth hand-off to the transporting provider. The compatibility issue arises when the transporting EMS agency responds and wants to be able to use the defibrillation pads already on the patient. This saves time and money. You should plan ahead for how to ensure a smooth transition to a higher level of care.
3. How long has the manufacturer been in business?
AEDs are a complexly engineered critical care medical device. Regulatory authorities carefully scrutinize the AED manufacturers, and even the most reputable have had some product issues. Several manufacturers have come and gone out of business, leaving end users holding devices they can't get parts or service on.
4. What kind of warranty and service programs does the manufacturer offer?
Much of the ongoing cost of maintaining an AED program is the cost of service. These are devices that must be periodically maintained and validated by a qualified biomedical professional. If it has to be shipped back to the manufacturer for service, how long will that take and what, if any, provision can be made for a temporary replacement?
5. What are the costs and availability of the disposable supplies associated with use?
Assuming a normal replacement schedule as suggested by the device manufacturer, what would it cost to replace the batteries as recommended? How much does it cost to replace the defibrillation pads? Find out if there is a wide selection of generic defibrillation pads. If they are widely available and competitively priced, you could enjoy a lower operating cost. The big electrode companies will only produce a compatible pad for devices that have a large installed base. This provides some additional confidence when selecting a vendor.
6. What kind of training support can you expect from the vendor?
Again depending on the intended use, you may want to consider purchasing an AED supported by clinical specialists. Often a local distributor representative with clinical experience can help a lot when it comes time to train everyone. Rolling out large scale Public Access Defibrillation (PAD) programs can require a lot of intensive community education and support.
7. What kind of quality assurance features and reporting will be required?
In a typical ambulance, fire or rescue application, there will likely be a demand for accountability data. These needs will only be amplified in a high incident application, like a major metropolitan fire department. This is accomplished with a combination of AED data recording and data export capability reviewed with special computer software. Your medical director should be intimately involved with this phase of evaluation. They will want to compare the different manufacturers' data management and software systems.
8. Run the numbers
When it comes to purchasing an AED you should care more about the cost than the price. What I mean is that only when you have added up all the costs, both to own and operate your AEDs, can you make any reasonable comparison. If the batteries and service cost twice as much with Brand A over Brand B, a lower initial price on the device can be quickly lost. Take the time to look at your estimated number of cardiac arrests the AED will serve annually, and add up all the costs before you jump at the lowest AED price.
Dan White, EMT-P, is the director of Corporate Planning & Product Development for AllMed®. He has been continuously certified as an emergency paramedic since 1977, and a certified EMT, paramedic, and ACLS instructor since 1981. Dan has designed many emergency medical products since his first one, the White Pulmonary Resuscitator in 1978. His most recent EMS product inventions are the AllMed® AVC Helmet, RapTag Triage System, and the top-selling Ultra-X Coat.