In recent years, particular attention has been paid to the placement and training of AEDs in schools (Berger et al., 2004; Cave et al., 2011; Drezner et al., 2009; Hart et al., 2013). As with CPR education, schools provide a valuable opportunity for general AED training for a large portion of the population. In the United States, school attendance is approaching 98% for elementary and secondary school students and is equally high (97.1%) for students aged 14 to 17, but lower (71.1%) for students aged 18 to 19 (U.S. Department of Education, 2012). Students represent an important audience for education and training efforts related to cardiac arrest and the use of the AED. As previously described with CPR, training schoolchildren in AEDs may also lead to more adults learning more about defibrillation (Chamberlain and Hazinski, 2003). In addition to confusing the signs of cardiac arrest with other cardiopulmonary events or conditions, the actual symptoms of cardiac arrest can be confusing to passers-by. People who suffer from cardiac arrest may continue to breathe for a few minutes after stopping. However, breathing is not normal.
In a study of 100 records of emergency medical shipments for patients in cardiac arrest, the incidence of suspected agonal breathing (wheezing) was estimated to be about 30%. Surrounding descriptions of breathing have been reported as “difficult breathing”, “poor breathing”, “wheezing”, “wheezing”, “impaired” or “occasional breathing” (Bang et al., 2003). This agonal respiration is associated with survival, but decreases rapidly over time (Bobrow et al., 2008). It is important to note that agonal breathing can cause confusion in controls, leading to misunderstandings with dispatchers and delaying the onset of CPR (Berdowski et al., 2009). Another condition that can make it difficult to detect cardiac arrest is a brief seizure-like activity (tremor) that occurs due to anoxic brain injury resulting from lack of oxygen associated with cardiac arrest (Clawson et al., 2008). These anoxic seizures can be confused with seizures, which are more often associated with epilepsy and can further delay the viewer`s action and shipping. From the beginning, it is important to note that the vast majority of jurisdictions offer some sort of legal liability protection for AED users. Often, these protective measures are provided by the statutes of the Good Samaritan. As a general rule, AED users are protected from liability as long as they act reasonably and rationally. Liability protection generally does not extend to gross negligence or wilful or deliberate conduct, such as a deliberate effort to injure the patient or use an AED in an unaccepted and non-standard manner.
Although not associated with digital technologies, similar efforts have been proposed for neighborhood-level pad programs and responses. Given the success of programs such as volunteer services and neighbourhood watches, PAD programs in the neighbourhood have also been proposed as viable options for expanding the reach of AEDs (Zipes, 2001). In this context, neighbors trained in CPR and AED could respond to cardiac arrests nearby. The 911 call could be transmitted simultaneously to selected neighborhood helpers to shorten the time to the first chest compression or shock time. This approach would require voluntary, trained and available forces in neighbourhoods where cohesion and borders are well established. This approach would also require further research prior to implementation to understand the necessary elements and potential impacts (Zipes, 2001). Arrests or detentions shall be limited and temporary and shall not last longer than is necessary to achieve the purpose of the arrest or detention. Stopping the investigation for too long turns into a de facto arrest that must meet the Fourth Amendment`s arrest warrant requirements. However, there is no clear line for determining when an investigative freeze becomes a de facto arrest, as courts are reluctant to impede police flexibility and discretion by imposing artificial time constraints on the fluid and dynamic nature of their investigations.
Rather, it is a question of whether the detention is temporary and whether the police acted with appropriate deployment to quickly confirm or dispel the suspicions that initially triggered the investigative detention. Stakeholders have successfully implemented PAD programs and lobbied state and federal legislators for AEDs in schools, demonstrating the potential impact of involving survivors, families, and stakeholders in improving OHCA outcomes (Berger et al., 2004). The initiatives described in this section highlight how social media, mobile apps, crowdsourcing, and communities can connect with available viewers to improve viewer engagement and increase awareness and use of the AED. Additional studies and pilot projects are needed to understand the possibilities, limitations and benefits of digital tools and how these tools could complement the existing infrastructure for the individual and community response to cardiac arrest. Requires the Ministry of Public Health to develop training, availability and use strategies for “victims of cardiac arrest in public institutions, including but not limited to state institutions, municipal institutions and mass public assemblies”, with the report expected on 1/1/04. (signed on 23.05.03) There are large differences in the cpR rates of passers-by in the United States, depending on community, neighborhood, and socioeconomic factors. The magnitude of the effect of CPR on controls is higher in communities with lower baseline survival rates. In a meta-analysis that included 79 studies involving 142,740 patients, the cumulative odds ratio (OR) for survival in patients receiving control CPR compared to those without CPR ranged from 1.23 in studies with the highest initial survival rates to 5.01 in studies with the lowest baseline rates (Sasson et al., 2010b). Variations in cardiac arrest outcomes correlate with differences in control response rates.
For example, a review of 28,289 UNOBAsed by EMS employees found that survival to hospital discharge was significantly higher among those who received control CPR (McNally et al., 2011).