Saturday, June 24, 2017

Why is this necessary

Why this Specification is Necessary?

Sudden cardiac arrest is estimated to kill between 23,000 and 33,000 Australians each year, which is equivalent to approximately two busloads of people dying each day.  These statistics are alarming considering they represent more deaths than breast cancer, shootings and road crashes combined.

Effectiveness of AEDs

A paper[1] by a leading occupational health and safety researcher has shown that access to AEDs can significantly increase survival rates for massive heart attacks away from a hospital.  The paper also reveals a number of, largely preventable, factors that are currently undermining the effectiveness of AEDs deployed in public places and workplaces.  These factors include:

  • There is scant distribution of defibrillators in workplaces or public spaces even though research has shown that 75 per cent of sudden cardiac arrests happen away from hospital with a survival rate of just 6 per cent. Early defibrillation can significantly improve the chance of survival from cardiac arrest.

 

  • US research, which was conducted by Dr Jignesh Shah and Dr William Maisel[2], has shown that more than 21 per cent of nearly 386,000 defibrillators surveyed between 1996 and 2005 were made so defective by electrical, software and other problems that they could not defibrillate a victim when needed.  In Australia, the number of deployed AEDs is not even known, let alone their level of reliability.  Furthermore, there have been a number of instances where AED models recalled in the US due to manufacturing defects were not recalled in Australia.

 

  • In a trial, Public Access Defibrillation (PAD) sponsored by the Department of Health and Ageing, 147 AEDs were installed in 98 public and private organizations including airports, train stations, tourist sites, schools, shopping centres, sporting stadiums and clubs.  Seven lives were saved during the trial as a result of having access to an AED at the crucial moment.  A subsequent report on the trial, which was commissioned by the Federal Government, highlighted that:

 

-        the lives saved during the trial were largely due to trained first aid responders rather than untrained staff or members of the public who may be reluctant to use an AED,

-        there were not enough trained people available for the trial,

-        the AEDs installed for the trial were not always in highly visible or readily accessible locations. This is significant because survival rates decrease dramatically the more that time elapses between cardiac arrest and use of the AED,

-        it was not clear who should be responsible for carrying out regular inspections and maintenance of the AEDs installed for the purposes of the trial, and

-        there were no minimum compliance standards governing the quality and battery life of the installed AEDs for the trial.

 

  • AEDs in the workplace should be placed in prominent locations that are easily visible.  At some of Australia’s airports for example, the protective enclosure around AEDs for the PAD trial were placed too high for a disabled person to reach and signage did not meet Australian standards.

 

Further research

A quantified risk analysis conducted by the AEDDR[3] determined probabilities of failure for a leading brand of automated external defibrillator[4] in monitored and stand-alone deployment options.[5]  The risk analysis methodology used the Fault Tree Analysis technique and drew upon previous risk and reliability analyses which had established predictions of equipment failure rates and fault diagnostic capabilities.

The analysis predicted that the probability of a monitored defibrillator being in a failed state at the time of a deployment was approximately 1-in-800. This figure applied to the best quality defibrillators only. Defibrillators with lesser diagnostic capabilities were predicted to be as high as 1-in-40.

The analysis also predicted that when the same best quality defibrillator is deployed in a stand-alone (unmonitored) mode, the probability of being in a failed state at the time of a deployment could be as high as 1-in-5 depending upon the degree of compliance with daily checking and inspection requirements.

Other defibrillators were also predicted to have a similar result.  This figure is consistent with Shah and Maisel’s study of defibrillators in the USA in 2006.[6]

The AEDDR commissioned an independent cost-benefit analysis from a Fellow of the Institute of Actuaries.[7]  The report stated that the potential financial loss due to a death resulting from a failure of a defibrillator to resuscitate a casualty would be of the order of $500,000 to $1,000,000. Therefore, on the basis of the predicted probabilities of failure and these financial losses, the expected financial loss per demand on a defibrillator would be $600 to $1,200 for a monitored deployment and $100,000 to $200,000 for a stand-alone deployment.

The specifications in this document are designed to address many of these factors by providing minimum compliance standards and a certification programme for AEDs in Australia.

Dr Graeme Peel

Chair – AED Deployment Registry

 

Dr Graeme Peel is a physician who specialises in occupational, environmental and public health medicine.

He served in the Royal Australian Air Force from 1974-2000, primarily in aviation medicine roles within Australia and overseas, whilst having particular interests in illness and injury prevention and health promotion.

He was a senior executive with Qantas from 2000-2008, where he firstly developed and then managed the Group’s OHS and occupational medicine programs.

Since 2008 he has been involved in a diverse range of activities, including clinical practice and generating OHS programs for industry, as well as continuing to be a serving Air Force Reserve officer. In April 2011 he again accepted a full-time commission with the Australian Defence Force as Director, Military Medicine, Joint Health Command, located in Canberra.

He has been an independent member of Mines Safety Advisory Council since 2007.

 

 


[1] “Reliability, sustainability and effectiveness of automated external defibrillators deployed in workplaces and public areas,” written by Don Dingsdag PhD, published in The Journal of Occupational Health and Safety Australia and New Zealand, in October 2009.

[2] Shah, JS and Maisel, WH, “Recalls and safety alerts affecting automated external defibrillators”, JAMA 2006, 296(6); 655 to 660.

[3] The analysis was conducted in conjunction with Marcus Punch Pty Ltd

[4] Cardiac Science: see www.cardiacscience.com

[5] Quantified Risk Analysis (QRA) Report, Automatic External Defibrillators (AEDs) in Monitored and Stand-alone Modes, prepared by Marcus Punch Pty Ltd, 12 August, 2011.

[6] Shah, JS and Maisel, WH, “Recalls and safety alerts affecting automated external defibrillators”, JAMA 2006, 296(6); 655 to 660.

[7] Ebborn S, AED Operational Cost Estimates, PVE Actuarial Services Pty Limited, 7 July 2011.