An evaluation of the Public Access Defibrillation (PAD) Demonstration

1.1 Background to the PAD Demonstration

Page last updated: August 2008

Cardiovascular disease is one of the largest causes of premature death in Australia. Heart, stroke and vascular diseases are Australia's largest health problem, accounting for 46,134 deaths in 2005 (35% of all deaths) and affecting 3.7 million Australians in 2005.2 Investing in strategies to improve cardiovascular health outcomes is one of the Australian Government's National Health Priority Areas initiative due to the widespread nature of heart, stroke and vascular disease and the potential for prevention in this area.3

Death from sudden cardiac causes is believed to account for approximately half of all deaths related to cardiovascular causes.4 Sudden cardiac arrest is when the heart has ceased to function due to an electrical malfunction of the heart, disrupting that muscle’s normal rhythm.5 The chance of survival from an out-of-hospital cardiac arrest in Australia is less than 10%. Cardiopulmonary Resuscitation (CPR) and early defibrillation are key factors that can significantly improve the chance of survival from cardiac arrest, forming part of the emergency chain of survival.6

Early defibrillation is the most effective treatment to re-start the heart function of a person whose heart has stopped, and time to defibrillation has been identified as the most important determinant of survival from sudden cardiac arrest.7 The development of automated external defibrillators (AED) has allowed for the possibility of community based early defibrillation for cardiac arrests in public places.

The Australian Resuscitation Council’s guidelines identify three categories of early defibrillation:

  • Emergency medical services: defibrillation by ambulance service personnel
  • First responder: defibrillation by appropriately trained persons who have a duty to respond to medical emergencies and
  • Public access defibrillation (PAD): defibrillation undertaken by anyone trained or untrained.8
In December 2002, the Department hosted a workshop to explore a government initiated PAD project in Australia. Chaired by the Commonwealth Chief Medical Officer, the workshop was attended by senior representatives from government and leading non-government organisations such as St John, the Australian Resuscitation Council and the National Heart Foundation, as well as representatives from private industry, consumers, ambulance, other emergency medical service (EMS) personnel.9 The outcome from this workshop was an agreed statement of principles in support of developing a strategy for implementing PAD in Australia.10 Top of page

1.1.1 The PAD Demonstration project
1.1.2 The broader policy context

1.1.1 The PAD Demonstration project

The installation of AEDs through the PAD Demonstration represents a new approach to responding to sudden cardiac arrests that occur in the public places. In July 2005, St John Ambulance Australia (St John) was engaged by the Australian Government Department of Health and Ageing (the Department) to design and implement a Public Access Defibrillation Demonstration (PAD Demonstration). This PAD Demonstration built on 'Project HeartStart', a PAD program that was implemented by St John in August 2003. The overall objective of the PAD Demonstration was to:

Adequately assess the feasibility, acceptability and effectiveness of PADs for reducing mortality in Australians experience sudden cardiac arrest, compared to current emergency care arrangements.
147 AEDs have been installed at approximately 100 selected host organisations, across all Australian states and territories under the Department funded PAD Demonstration. These venues included airports, train stations, tourist sites (such as zoos), schools, shopping centres, sporting stadiums and clubs (such as local golf or bowling clubs). Top of page

1.1.2 The broader policy context

PAD Demonstration was designed to provide an effective intervention by response to individual health incidents (sudden cardiac arrest) occurring in public places. The program objectives are in line with the Australian Government's broader health prevention policy, which aims to design and implement evidence-based and targeted programs to contribute to the sustainability of the Australian health system by reducing preventable illness and mortality.11

Whilst response to a health emergency is primarily the responsibility of the State and Territory Governments, the Australian Government assists the States and Territories by enhancing their response capabilities and providing extra resources when requested. The Australian Government exercises this responsibility through Emergency Management Australia (EMA) within the Attorney-General's Department.12

EMA provides national leadership in the development of emergency measures to reduce risk to Australian communities and improve the resilience of the Australian people for emergencies.13 A key focus for the future of emergency measures is the promotion of community safety and resilience to ensure 'safer sustainable communities'. Effective engagement with the community is core to this goal, as an engaged community is more likely to be responsive and self-managing when emergencies arise.14

The PAD Demonstration is an area where the Australian Government has assisted the States and Territories to respond to a nationally significant public health problem. By preparing organisations and individuals to respond quickly and effectively to sudden cardiac arrest events, the PAD Demonstration assists with the more effective distribution of emergency service resources and encourages community engagement to work towards a safer sustainable Australian community. This has been demonstrated by St John receiving the Attorney General's Australian Safer Communities Award (in the Post-Disaster Projects of national significance category) for their involvement in the PAD Demonstration. Top of page

2 Australian Institute of Health and Welfare (AIHW) 2004. Heart, stroke and vascular diseases - Australian facts 2004. AIHW, Canberra (Cardiovascular Disease Series No. 22)
3 AIHW Australia's Health 2008
4 National Health Priority Action Council (NHPAC) 2006, National Service Improvement Framework for Heart, Stroke and Vascular Disease, Australian Government Department of Health and Ageing, Canberra
5 St John Ambulance Australia AED Implementation Guidelines
6 Australian Resuscitation Council, Guideline 10.1.3, Public Access Defibrillation, http://www.resus.org.au
7 St John Ambulance Australia AED Implementation Guidelines; Chain of Survival http://www.chainofsurvival.com/cos/COSOverview_detail.asp
8 Australian Resuscitation Council, Guideline 10.1.3, Public Access Defibrillation, http://www.resus.org.au
9 http://www.stjohn.org.au/index.php?option=com_content&task=view&id=37&Itemid=51
10 The Eclipse Statement was provided in the Department's original Request for Tender for this evaluation
11 http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-about.htm#hppb
12 http://www.ema.gov.au/
13 Australian Attorney-General's Department, Emergency Management Australia (2008), 'This is EMA' (www.ema.gov.au/agd/EMA/rwpattach.nsf/VAP/(084A3429FD57AC0744737F8EA134BACB)~5713+This+is+EMA+web.pdf/$file/5713+This+is+EMA+web.pdf)
14 www.ema.gov.au/agd/EMA/emaInternet.nsf/Page/Communities