AEDs: Saving Lives on Transit Systems

Deployment Challenges

Transit organizations must not deploy AEDs casually, though, as they will be held responsible for sufficiently implementing and maintaining the program to assure the AEDs are kept in good working order. In addition, in this age of tight public-sector budgets, mass transit organizations should purchase affordable, easy-to-use AEDs priced below $1,500 each.

These AEDs will help to stretch dollars, allow the organization to deploy a higher number of AEDs, and increase the chances of successful life saves.

Meeting state and local requirements

A transit AED program must be planned and implemented in accordance with any state and local requirements relating to AED placement, AED/CPR training and certification, program medical supervision, and registration with local EMS, Stickel says. “A mass transit organization should have a dedicated AED program coordinator who is familiar with all requirements and that makes sure the organization meets them,” he explains. The coordinator should also oversee the day-to-day aspects of the AED program, including AED maintenance, recertification of staff, and review of any rescue episodes, he adds.

Affordability

While the average price of an AED has become more affordable, the price tag for an entire transit system can be intimidating. Transit systems should look for AEDs that are affordable and durable, as well as ones that will not become obsolete.

The state of New Jersey used the buying power of its cooperative purchasing program to allow NJ Transit and fire, police and other state and local entities to buy in bulk and significantly reduce the cost per AED. The state originally purchased 1,700 AEDs including those for NJ Transit in 2006. To date, more than 6,500 AEDs have been purchased through the cooperative agreement.

Preventive maintenance

Transit systems should take maintenance factors into account when choosing AED products and services. Many, if not most, AED failures can be traced to poor maintenance. AEDs are powered by long-life batteries that need to be checked and replaced from time to time. Also, American Heart Association (AHA) guidelines relating to the proper way to use an AED and perform CPR are evolving as new knowledge about resuscitation is discovered, and an AED’s audio and video instructional prompts must match these guidelines.

For example, previous AHA guidelines directed rescuers to provide one-and-a-half to three minutes of CPR before using an AED. “The AHA now recommends ‘shock first’ rather than CPR because ‘speed to shock’ saves lives — about 90 percent of those who receive shocks within the first few minutes after cardiac arrest survive,” Stickel states. The most recent AHA guidelines also emphasize the importance of chest compressions at a rate of 100 a minute, he adds. This “hands-only” method of providing CPR was recommended after medical studies demonstrated that fast, two-inch deep chest compressions to adult victims are associated with survival with good neurologic function.

Software updates provided by some AED manufacturers can be installed in the field to make the AED’s audio and video prompts consistent with the latest guidelines. NJ Transit’s staffers were able to upgrade their AED software on their own when new AHA guidelines were issued in 2010, Fittipoldi says. The AEDs perform automatic self-checks, with an indicator light showing the AED is in working order. Staff members regularly monitor each AED’s indicator light, as well as the condition of the battery, defibrillation pads and other supplies to make sure they are replaced on time. Once a year, an authorized service dealer inspects and certifies all AEDs, he adds.

User Confidence

Studies have found that many people still lack the confidence to use an AED during an emergency.

Most AEDs have audio capabilities to cue responders during an emergency event. A study by Defibtech and Harris Interactive found that adding text and video to an AED’s audio instructions dramatically improved a user’s confidence during an emergency.