Use of Automated External Defibrillators by Police Officers for Treatment of Out-of-Hospital Cardiac Arrest

doi:10.1016/S0196-0644(98)70137-4

Annals of Emergency Medicine

Volume 32, Issue 2, August 1998, Pages 200-207

https://doi.org/10.1016/S0196-0644(98)70137-4 Get rights and content

Abstract

Objective: To determine the feasibility of police officers providing defibrillation with automated external defibrillators (AEDs) and to assess the effectiveness of this strategy in reducing time to defibrillation of victims of out-of-hospital sudden cardiac arrest.

Methods: This was a prospective, interventional cohort study with historical controls conducted in 7 suburban communities in which police usually arrived at the scene of medical emergencies before EMS personnel. All adult patients who suffered cardiac arrest before EMS arrival and on whom EMS personnel attempted resuscitation were enrolled. Police officers who were trained to use and equipped with AEDs during the intervention phase were dispatched simultaneously with EMS to medical emergencies. Police were instructed to use the AED immediately on determination of pulselessness. Outcome measures were the difference between control and intervention phases in interval from the time the call was received at dispatch to the time of first defibrillation and in rate of survival to hospital discharge for patients initially in ventricular fibrillation.

Results: EMS personnel attempted 183 resuscitations in the control phase and 283 during the intervention; of these, 80 (44%) and 127 (45%), respectively, involved patients with initial ventricular fibrillation rhythms. Mean time to defibrillation decreased from 11.8±4.7 minutes in the control phase to 8.7±3.7 minutes in the intervention phase (P<.0001). Survival to hospital discharge of patients in ventricular fibrillation did not differ between phases (6% control versus 14% intervention, P=.1). When police arrived before EMS personnel, shock administered by police compared with shock administered by EMS was associated with improved survival (26% [12/46] versus 3% [1/29], P=.01). Logistic regression analysis revealed AED use was an independent predictor of survival to hospital discharge.

Conclusion: In 7 suburban communities, police use of AEDs decreased time to defibrillation and was an independent predictor of survival to hospital discharge.

[Mosesso VN Jr, Davis EA, Auble TE, Paris PM, Yealy DM: Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med August 1998; 32:200-207.]

Section snippets

INTRODUCTION

Out-of-hospital sudden cardiac arrest (SCA) remains the single leading cause of death in the United States, affecting more than 350,000 people each year.1, 2, 3, 4 The most promising approach for successful treatment of SCA is an integrated system of stepwise care symbolized by the American Heart Association’s (AHA) chain of survival. This concept is based on the finding that survival is more likely the earlier each of 4 key events occur: emergency response activation, CPR, defibrillation, and

MATERIALS AND METHODS

This study used a prospective, interventional cohort with historical control design. The control period comprised January 1, 1990, through January 31, 1992; the intervention phase extended from February 1, 1992, through January 31, 1995. The primary intervention consisted of training, equipping, and authorizing police officers to use AEDs to resuscitate patients in cardiac arrest. The study was conducted in 7 suburban municipalities in Allegheny County, Pennsylvania, comprising 46 square miles

RESULTS

EMS personnel responded to 203 adult cardiac arrests in the control phase and to 317 during the intervention phase; 183 and 282 cases, respectively, met eligibility criteria. Patient characteristics are described in Table 1. Police arrived on the scene before EMS personnel in 83 (58%) of 144 cases in the control phase; whether police or EMS arrived first was unknown in 39 cases. We did not determine what interventions police performed during this phase. During the intervention phase, officers

DISCUSSION

This study demonstrated the feasibility of training and equipping police officers with AEDs in these suburban communities. During a 3-year period, police officers applied the AED to 69% of patients when they arrived before EMS personnel and defibrillated 61% of those in VF. These findings, while representing less than ideal compliance, demonstrate that police in this suburban setting frequently arrived at the scene before EMS personnel and that they were willing and able to use the AED in the

Acknowledgements

We thank the following individuals for their assistance:

Bill Plunkett, MEd, EMT Todd Plunkett, EMT-P Curt Neill, EMT-P Baldwin EMS, Baldwin Borough, PA Ray Carlin, BA, EMT-P Bill Taylor, AS, EMT-P Medical Rescue Team South Authority, Pittsburgh, PA Mary Ann Scott, RN, BSN, EMT-P Phil Vargo, BS, EMT-P Tri-Community South EMS, Bethel Park, PA Police Chief Chris Kelly Baldwin Borough, PA Police Chief Edward Felicetti Former Chief Joseph Kletch Bethel Park, PA Police Chief Harold Lane Former Chief

References (23)

R Roth et al.
Out-of-hospital cardiac arrest: Factors associated with survival
Ann Emerg Med
(1984)
RD White et al.
Early defibrillation by police: Initial experience with measurement of critical time intervals and patient outcome
Ann Emerg Med
(1994)
RD White et al.
High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics
Ann Emerg Med
(1996)
WD Weaver et al.
Cardiac arrest treated with a new automatic external defibrillator by out-of-hospital first responders
Am J Cardiol
(1986)
DW Spaite et al.
Prospective validation of a new model for evaluating emergency medical services systems by in-field observation of specific time intervals in prehospital care
Ann Emerg Med
(1993)
WH Cordell et al.
Does anybody really know what time it is? Does anybody really care?
Ann Emerg Med
(1994)
VM Mosesso
The most neglected tool in EMS: The clock
Ann Emerg Med
(1993)
HM Alonso-Serra et al.
Law enforcement agencies and out of hospital emergency care
Ann Emerg Med
(1997)
Centers for Disease Control and Prevention
Mortality patterns—United States, 1992
JAMA
(1995)
MD Weisfeldt et al.
American Heart Association Report on the Public Access Defibrillation Conference December 8-10, 1994
Circulation
(1995)

Cited by (246)

Out-of-hospital cardiac arrest outcomes when law enforcement arrives before emergency medical services
2024, Resuscitation
Law enforcement (LE) professionals are often dispatched to out-of-hospital cardiac arrests (OHCA) to provide early cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) application with mixed evidence of a survival benefit. Our objective was to comprehensively evaluate LE care in OHCA.
This is a secondary analysis of adults with non-traumatic OHCA not witnessed by EMS and without bystander AED use from 2018-2021. Our primary outcome was survival with Cerebral Perfusion Category score ≤ 2 (functional survival). Our exposures included: LE On-scene Only (without providing care); LE CPR Only (without applying an AED); LE Ideal Care (ensuring CPR and AED application). Our control group had no LE arrival before EMS. We performed multivariable logistic regression analyses adjusting for confounders and stratified our analyses by patients with and without bystander CPR.
There were 2569 adult, non-traumatic OHCAs from 2018-2021 meeting inclusion criteria. There were no differences in the odds of functional survival for LE On-scene Only (adjusted odds ratio [95% CI]: 1.28 [0.47–3.45]), LE CPR Only (1.26 [0.80–1.99]), or LE Ideal Care (1.36 [0.79–2.33]). In patients without bystander CPR, LE Ideal Care had significantly higher odds of functional survival (2.01 [1.06–3.81]) compared to no LE on-scene, with no significant associations for LE On-scene Only or LE CPR Only. There were no significant differences by LE care in patients already receiving bystander CPR.
LE arrival before EMS and ensuring both CPR and AED application is associated with significantly improved functional survival in OHCA patients not already receiving bystander CPR.
The association of fire or police first responder initiated interventions with out of hospital cardiac arrest survival
2022, Resuscitation
Fire and police first responders are often the first to arrive in medical emergencies and provide basic life support services until specialized personnel arrive. This study aims to evaluate rates of fire or police first responder-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, as well as their associated impact on out-of-hospital cardiac arrest (OHCA) outcomes.
We completed a secondary data analysis of the MI-CARES registry from 2014 to 2019. We reported rates of CPR initiation and AED use by fire or police first responders. Multilevel modeling was utilized to evaluate the relationship between fire/police first responder-initiated interventions and outcomes of interest: ROSC upon emergency department arrival, survival to hospital discharge, and good neurologic outcome.
Our cohort included 25,067 OHCA incidents. We found fire or police first responders initiated CPR in 31.8% of OHCA events and AED use in 6.1% of OHCA events. Likelihood of sustained ROSC on ED arrival after CPR initiated by a fire/police first responder was not statistically different as compared to EMS initiated CPR (aOR 1.01, CI 0.93–1.11). However, fire/police first responder interventions were associated with significantly higher odds of survival to hospital discharge and survival with good neurologic outcome (aOR 1.25, 95% CI 1.08–1.45 and aOR 1.40, 95% CI 1.18–1.65, respectively). Similar associations were see when examining fire or police initiated AED use.
Fire or police first responders may be an underutilized, potentially powerful mechanism for improving OHCA survival. Future studies should investigate barriers and opportunities for increasing first responder interventions by these groups in OHCA.
A glimpse of what could be
2021, Resuscitation
AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest
2020, Resuscitation
For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated.
We included OHCA cases with the TM-system activated in residential areas between 2010–2017. For each case, densities/km² of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated.
In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km² did not result in further decrease of time to first shock but >10 TM-responders/km² resulted in more defibrillations <6 min.
With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km² and >10 TM-responders/km².
Public access defibrillation and outcomes after pediatric out-of-hospital cardiac arrest
2017, Resuscitation
Use of automated external defibrillators (AEDs) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA). However, there are no conclusive studies that elucidated the effectiveness of public-access defibrillation (PAD) in children.
This was a nationwide, population-based, propensity score-matched study of pediatric OHCA in Japan from 2011 to 2012, based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients (aged 1–17 years) who received bystander cardiopulmonary resuscitation. The primary outcome was a favorable neurological state 1 month after OHCA (defined as a CPC score of 1–2).
A total of 1193 patients were included in the final cohort; 57 received PAD and 1136 did not. Among 1193 patients, 188 (15.8%) survived with a favorable neurological status 1 month after OHCA. The odds of neurologically favorable survival were significantly higher for patients receiving PAD after adjusting for potential confounders: propensity score matching, OR 3.17 (95% CI 1.40–7.17), and multivariable logistic regression modeling, OR_adjusted 5.10 (95% CI 2.01–13.70). Similar findings were observed for the secondary outcomes (i.e., neurologically favorable survival with a CPC score of 1, one-month survival, and prehospital return of spontaneous circulation). In subgroup analyses, there were no significant differences in neurologically favorable survival between the PAD group and non-PAD group in the unwitnessed cohort (OR_adjusted 7.76 [0.75–81.90]) or the non-cardiac etiology cohort (OR_adjusted 6.65 [0.64–66.24]).
PAD was associated with an increased chance of neurologically favorable survival in pediatric OHCA (aged 1–17 years) who received bystander CPR, except for in cases of unwitnessed or non-cardiac etiology.
Automated external defibrillator prevalence among the municipal police agencies of New Jersey: How regional differences affect national data
2015, Public Health

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^☆: From the Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA,^* and the Department of Emergency Medicine, Strong Memorial Hospital, Rochester, NY.^‡

^☆☆: Supported in part by Physio-Control Corporation, Redmond, WA.

^★: Reprint no. 47/1/91586 Reprints not available from the authors.

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Use of Automated External Defibrillators by Police Officers for Treatment of Out-of-Hospital Cardiac Arrest☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

Acknowledgements

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Am J Cardiol

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Mortality patterns—United States, 1992

JAMA

American Heart Association Report on the Public Access Defibrillation Conference December 8-10, 1994

Circulation