An evaluation of the Public Access Defibrillation (PAD) Demonstration

3.3 Implementation: recruitment, training and implementation issues

Page last updated: August 2008

3.3.1 Findings from the 2004 review
3.3.2 Update: evidence published since 2004

3.3.1 Findings from the 2004 review

The 2004 review considered the effective and appropriate use of AEDs in the hands of trained and untrained lay-people, as opposed to professional members of EMS who may also administer AEDs or other forms of resuscitation. Based on examination of a number of local and overseas studies, the review stated:
  • Advancements in the technology used in AEDs reduce the training requirements for lay-people
  • Lay-people and even very young children are able to effectively and safely use an AED, however the time taken to administer the required shock is longer for this group compared with trained professionals and
  • While untrained people can safely and effectively use AEDs, the vast majority of AED activations are still performed by trained people.
The review also stated that the quantity of training required to optimally use an AED remains unproven.

The review concluded:

AEDs available within a PAD mode have been successfully used to treat patients in cardiac arrest. Training may shorten the time to defibrillation. AEDs can adequately and safely be used by the lay public with minimal or no training (Jacobs 2004, p.20).

3.3.2 Update: evidence published since 2004

The importance of AED training of both staff and volunteers is widely acknowledged as a vital component of any PAD program. However, Reigal et. al. (2006) note that skills imparted as part of training programs are not maintained indefinitely. Reigal conducted an observational follow-up study of 19,320 staff and volunteers who had taken part in AED and CPR training programs in America. Reigal estimated that 91% of the study participants had maintained the required skills and knowledge to operate AEDs five months after initial training. This proportion fell to 84% seventeen months after initial training. Retention of required skill and knowledge were noted to be higher for AED operation compared with other interventions such as CPR. Successful retraining of those who had not retained the required skills was reported to take only ten minutes.

Richardson et. al. (2005) published a descriptive study of a trial of a PAD program in America and Canada. The program in question was community-based, and used training of staff in public places as well as volunteers in the use of AEDs and CPR techniques. The paper describes a number of issues similar to the Australian experience, and notes a range of barriers to the successful implementation including difficulties in the identification of suitable sites for implementation; difficulty in recruiting businesses and individuals to take part in the program and fear of litigation as a result of participation. The key driving factor behind successful implementation was reported to be the involvement of a key decision maker at the ground level. Despite these challenges, the paper concluded that:

These data indicate that implementation of community-based lay responder programs is feasible in many types of facilities, although these programs require substantial resources and commitment, and many barriers to implementation of effective PAD programs exist (p. 668).