Public access defibrillation

Sudden cardiac death (SCD) due to unexpected cardiac arrest in adults claims the lives of an estimated 250 000 adult Americans each year. Although most episodes occur in the home (rather than a public place), many episodes in public places are witnessed events in which lay rescuers could theoretically act as ‘first responders’ to provide early defibrillation using an automated external defibrillator (AED). Such a strategy has been termed ‘public access defibrillation’ (PAD). The American Heart Association has hosted two international conferences on the topic and has played a key role in helping to get state and federal ‘Good Samaritan’ laws altered to protect layperson PAD rescuers in the USA. There has already been considerable experience with the PAD concept in airports, on commercial airliners and in gaming casinos. However, most of the rescuers in these sites are trained individuals with a ‘duty to act’ in public (such as flight attendants or security officers). The benefit, safety and relative cost of a widespread community PAD strategy is still largely unknown, but is being studied in a North American prospective, randomized controlled clinical trial.