Elsevier

Resuscitation

Volume 62, Issue 1, July 2004, Pages 43-47
Resuscitation

An assessment of public attitudes toward automated external defibrillators

https://doi.org/10.1016/j.resuscitation.2004.02.006Get rights and content

Abstract

Objective: We assessed the familiarity of the general public with automated external defibrillators (AEDs) and their willingness to use them. Methods: Shoppers were asked to complete a survey in an AED-equipped suburban shopping mall. Results: 359 surveys were analyzed. Of the participants, 11% were healthcare professionals, 51% had training in CPR or first aid, and 44% had no medical training. Sixty percent were able to define defibrillator adequately. Seventy-one percent stated they would be likely to use an AED to resuscitate a stranger. The most common concerns were fear of using the machine incorrectly (57%) and fear of legal liability (38%). After being told of liability protection from the federal Cardiac Arrest Survival Act, 84% stated they would be likely to use the AED. This increased further to 91% if the participants were given an opportunity to receive training. Conclusion: Although a substantial number of people in this setting were willing to use an AED, education regarding legal liability and proper use of the machines increased the reported likelihood of use. Further public education may be necessary to provide optimally effective public access defibrillation programs.

Sumàrio

Objectivos: Avaliámos a familiaridade do público em geral com os Desfibrilhadores Automáticos Externos (AEDs) e a vontade de os utilizarem. Métodos: Foi pedido aos transeuntes que andavam às compras, numa alameda suburbana equipada com AED, que completassem um questionário. Resultados: Foram analisados 359 questionários. 11% dos participantes eram profissionais de saúde, 51% tinham treino em reanimação como primeira ajuda, e 44% não tinha qualquer treino médico. Sessenta por cento deles foram capazes de definir desfibrilhador de forma adequada. Setenta e um por cento disseram que seriam capazes de utilizar um AED para reanimar um estranho. As preocupações mais comuns foram o medo de utilizar as máquinas de forma incorrecta (57%) e o medo da responsabilidade legal (38%). Após esclarecidos sobre a protecção de responsabilidade da representação federal da sobrevivência à paragem cardı́aca, 84% disseram que utilizariam o AED. Esta percentagem aumentava para 91% se fosse dada a oportunidade aos participantes de receber treino. Conclusões: Embora um número importante de pessoas neste grupo pretendesse utilizar um AED, o ensino relativamente à responsabilidade legal e ao uso adequado dos aparelhos aumentou o número de casos em que a sua utilização seria provável. Pode ser necessária maior educação do público para obter programas públicos de acesso à desfibrilhação com eficácia óptima.

Resumen

Objetivo: Evaluamos la familiaridad del público general con los desfibriladores automáticos externos (AEDs) y su deseo de utilizarlos. Métodos: Se realizó una encuesta a personas que compraban en un centro comercial equipado con un AED. Resultados: Se analizaron 359 encuestas. De los participantes, 11% eran personal que trabaja en salud, 51% tenı́an entrenamiento en RCP o en primeros auxilios, y 44% no tenı́an entrenamiento médico alguno. El 60% fue capaz de definir desfibrilador. 71% dijo que usarı́a el AED para resucitar a un extraño. Las preocupaciones mas frecuentes fueron el temor a usar incorrectamente la máquina (57%) y el temor a la penalidad legal (38%). Después de explicársele acerca de la protección de la penalidad por medio del acta de sobrevida del paro cardiaco, el 84% planteó que usarı́a el AED. Esta cifra aumentó a 91% si los participantes tenı́an oportunidad de recibir entrenamiento. Conclusiones: Aun cuando una cantidad sustancial de gente en este ambiente estaba dispuestos a usar un AED, la educación respecto a la imputabilidad legal y al uso adecuado de las máquinas aumento la probabilidad de uso de los equipos. Puede ser necesaria mayor educación para proporcionar acceso público óptimamente efectivo a los programas de desfibrilación.

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.

Section snippets

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.

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