Posted By Tim
Hi,

Our company has a Heart Defibulator, are there are hard and fast rules where it should be situated ?
Should it be situated in the 1st aid room or on a floor where the majority of the staff are situated ?

Thanks in anticipation

Posted By Zyggy Turek
Tim,

Whilst agreeing with David's advice, we were "warned" by our insurers that the AED should not be kept in a place where "unauthorised" persons could gain access to it.

I do realise that there is a school of thought that anybody can use an AED, but speed is essential in such cases & an untrained person could forget some vital elements of a resuscitation process as opposed to a trained First Aider who has had additional experience in the use of an AED.

Posted By David Bannister
Zyggy, having worked for various insurers I can strongly confirm that underwriters are by nature mostly conservative pessimists and will advise the employer to "protect your posterior" in every case. This however is not always the best advice in every case.

If I were in VF I would hope that I could get attention in the very quickest time, not be waiting for a trained AED operator to be found, to run to the (locked?) first aid room and then to me before returning me to the land of the living.

Zyggy, I stand by my advice and may I suggest to you that you request further information from your insurers as to why they are providing that advice, contrary to advice of the professional agencies in the field.

Posted By Jay Joshi
An important factor in deciding locations, especially in multi-building sites etc is that the shock has to be given in the first 5 minutes--as this is the critical period!

Therefore the timeliness (i.e. means of communication to the responsder) of the "first aid" call and the delivery of the shock using the defibrillator should be less than 5 minutes.

We have carried out drills with our first aid team to decide locations on a large multi-building site so that the response is less than 5 minutes.

Posted By Jay Joshi
I presumed that the question related to the location of the defibrillator and not of the entire first aid treatment that includes CPR.

My post indicates the imporatnce of prompt access and use of the equipment.

Refer to:-
http://www.resus.org.uk/pages/AED.pdf

"Electrical defibrillation is well established as the only effective therapy for cardiac
arrest caused by VF or pulseless ventricular tachycardia (VT). The scientific
evidence to support early defibrillation is overwhelming; the delay from collapse
to delivery of the first shock is the single most important determinant of survival.
The chances of successful defibrillation decline at a rate of 7-10% with each
minute of delay; basic life support will help to maintain a shockable rhythm but is
not a definitive treatment."

Posted By Tabs
Thanks Jay, I did understand your intention about how critical time is and those were the facts I was referring to. "The chances of successful defibrillation decline at a rate of 7-10% with each minute of delay" (so possibly 10-14 minutes available) and "basic life support will help to maintain a shockable rhythm" means it *might* be even longer. (My training referred to eight minutes, but I know it differs).

It is still uncertain science due to the small number of reliably timed uses, and I would hate for someone not to get the defib out just because more than five minutes had passed - or even fifteen. Or to define areas where it can be used and can't be used just by response time.

If you only have one machine, centralise it - or possibly bias it towards a vulnerable population (as mentioned above).

The machine will detect whether a shockable rhythm exists regardless of the time it is used.

If it was me lying there, I would want anyone to have a go ... the worst that can happen is that I continue to die. I would have nothing to lose.

Please, Tim, don't get completely hung up on time - it may have to be a compromise. If you find your response times are excessve though, consider more than one machine. Just don't waste any time unlocking rooms etc.

We also used to position them in 24/7 manned security positions - the nearest was despatched to meet the first aider (they also had lift overide keys with them).

Posted By Tabs
Reading further on the UK Resus pages, I found this:
"The experience and expertise in NHS Ambulance Services is now such that they are the most appropriate organisations to undertake the tasks of clinical governance that accompany the appropriate deployment and use of AEDs in the community. Community defibrillation officers (CDO) are employed by NHS Ambulance Services throughout the UK and are well placed to advise on the subjects "

Have a look here: http://www.resus.org.uk/pages/gl5addm1.htm