The logic is simple, but the implementation difficult and the costs potentially astronomical. Simple, because the cause is usually ventricular fibrillation (VF), which, if corrected within one minute, leads to survival in well over 90% of patients.1 Implementation is difficult because of the 10% fall in survival for every minute that passes from onset of VF until a defibrillator can be used.1 Astronomical cost is anticipated if all people at high risk of VF were to be offered an implantable defibrillator,2 or if the conventional ambulance service were geared up to provide a response time of less than five minutes in metropolitan areas.
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- St Vincent's Clinic, Sydney, NSW.
- 1. Marenco JP, Wang PJ, Link MS, et al. Improving survival from sudden cardiac arrest: the role of the automated external defibrillator. JAMA 2001; 285: 1193-1200.
- 2. Bigger JT. Expanding indications for implantable cardiac defibrillators. N Engl J Med 2002; 346: 931-933.
- 3. Smith KL, McNeil SS. Cardiac arrests treated by ambulance paramedics and fire fighters. The Emergency Medical Response program. Med J Aust 2002; 177: 305-309. <MJA full text>
- 4. Wassertheil J, Keane G, Fisher N, Leditschke JF. Cardiac arrest at the Melbourne Cricket Ground and Shrine of Remembrance using a tiered response strategy — a forerunner to public access defibrillation. Resuscitation 2000; 44: 97-104.
- 5. White RD, Asplin BR, Bigliosi TF, Hawkins DG. High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. Ann Emerg Med 1996; 28: 480-483.
- 6. Pantridge JF, Adgey AAJ, Geddes JS, Webb SW. The acute coronary attack. Bath: Pitman, 1975; 66-71.
- 7. Smith S, Hamburg RS. Automated external defibrillators: time for federal and state advocacy and broader utilisation. Circulation 1998; 97: 1321-1324.
- 8. O'Rourke MF, Donaldson E, Geddes JS. An airline cardiac arrest programme. Circulation 1997; 96: 2849-2853.
- 9. Willoughby PJ, Caffrey S. Implementation of an airport based PAD program. Am Heart Assoc Cardiopulmonary Crit Care Newsletter 2001; (Fall): 9-10.
- 10. Valenzuela T, Roe DJ, Nichol G, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000; 343: 1206-1209.
- 11. Davies S, Colquohoun M, Graham S, et al. Defibrillators in public places: the introduction of a national scheme for public access defibrillation in England. Resuscitation 2002; 52: 13-21.