An assessment of public attitudes toward automated external defibrillators☆
Introduction
The concept of public access defibrillation has become increasingly popular, given positive results in first responder trials and evidence that early defibrillation seems to improve outcome in out-of-hospital cardiac arrest [1]. There are several studies that have considered where the most appropriate public locations for AEDs would be and other studies that have considered the cost-effectiveness of public access defibrillation programs [2], [3]. However, few studies have looked at whether untrained lay people would be willing to approach strangers, partially undress them, and then apply and operate a medical device. So, while these studies on placement and cost-effectiveness suggest it may be beneficial to have AEDs widely available, it is unclear if they would actually be used.
Our study evaluated whether people in a typical suburban shopping mall, a site deemed a reasonable location for AED placement, were familiar with defibrillation and whether they would be willing to use an AED if they witnessed a cardiac arrest. We hypothesized that few people in a mall environment would be familiar enough with AEDs to be willing to operate one.
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Methods
Research assistants asked shoppers at a suburban shopping mall to complete a survey on several separate days in July and August 2001. The mall serves approximately 125,000 customers per week and is equipped with an AED. By calculating the standard error of a percentage and correcting for a finite population, we calculated that a sample size of 383 surveys would provide survey results with confidence intervals of ±5% at a 95% confidence level. The Institutional Review Board at our institution
Results
All 385 questionnaires were completed, although only 359 (93.2%) were included in the analysis of the results. The 26 surveys not included in the analysis had been inadvertently distributed to minors, mostly 16 and 17 year olds; this data was discarded in order to stay within study protocols and IRB approval guidelines. The ages of the participants ranged from 18 to 91 (mean=41.0) and 61% were female. A breakdown of participants by education and degree of medical training is shown in Table 1.
Discussion
In April 1997, at the second Public Access Defibrillation conference, four levels of emergency first responders were identified [4]. Level one responders are comprised of trained emergency medical personnel. Level two and three responders include the most likely non-medical personnel to have a role in responding to victims of cardiac arrest, such as fire fighters, law enforcement officers, flight attendants and lifeguards, as well as lay people who have chosen to be trained in the use of AEDs.
Limitations
Obtaining research data via surveys is a methodology with inherent limitations. Firstly, surveys can only measure what people say they will do, not what they actually do. There may also be a selection bias present in this particular survey; people with a medical background or interest in medicine would seem more likely to complete a survey involving a medical topic. Additionally, those who chose to participate may well have been more informed, more motivated, or more interested in AEDs or
Conclusion
A substantial number of people in this AED-equipped suburban mall stated that they would be willing to use an AED to help resuscitate a stranger. Education regarding legal liability and proper use of the machines increased the reported willingness to use them, suggesting a possible lack in current public education regarding the devices. Further public education may be needed to provide optimal public access defibrillation programs.
Acknowledgements
The authors wish to thank Janet Grimes, MS for her assistance with survey administration, data entry, and statistical analysis. We would also like to thank Patricia Algaze, Robert Markelewicz, Peter Lee, and John Lee for their help with survey administration.
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Presented as an abstract at the annual meeting of the National Association of EMS Physicians in Tucson, Arizona, January 2002.