An evaluation of the Public Access Defibrillation (PAD) Demonstration

5.1 Experiences under the current PAD Demonstration

Page last updated: August 2008

5.1.1 AEDs perceived as valuable
5.1.2 Appropriateness of PAD host organisations
5.1.3 Location of AEDs
5.1.4 Experience with St John
5.1.5 AED training
5.1.6 Lay persons and AEDs
5.1.7 Emergency response plans and broader awareness of AEDs

5.1.1 AEDs perceived as valuable

The potential to save a life was the most commonly cited benefit of involvement in the PAD Demonstration by management and trained staff. Despite only a small number of activations, most host organisations interviewed believed that AEDs provided the most effective method for responding to sudden cardiac arrest and improving survival rates for sudden cardiac arrest victims.

It is helping save lives. I don't know the stats, but with an AED at least you have a chance of saving them. It is good support for the first aider who has to respond. (Manager, tourist attraction)
Best practice in duty of care, reassurances, and good corporate citizenship were other benefits cited by management stemming from their organisation's involvement in the PAD Demonstration.

Benefit for us is that we have to be best practice. People expect us to respond to incidents in the most efficient way. I think people would be surprised if an international airport did not have defibrillators installed. (Manager, international airport)

It's a commitment to our public image. (Manager, sporting club)

It [the AED] provides a sense of security for staff. Knowing that if something goes we are confident and have the technical support to help the out. (Manager, secondary school)

AEDs were perceived as valuable life saving devices. Top of page

5.1.2 Appropriateness of PAD host organisations

The majority of AEDs under the PAD Demonstration had been placed at sites with either a high volume of people (airports, train stations, zoos), a high proportion of persons aged over 50 (golf and yacht clubs), locations where there had been previous sudden cardiac arrest or where an ambulance would be delayed in reaching a patient (national parks).

Most host organisations believed that their site was a suitable and appropriate location for the installation of an AED.

We thought it was a fantastic idea. We are out of range of ambulance services here. We are the only first aid people around during the ski season. (Manager, state national park)
However, some venues did not seem to fit the criteria for being a site of 'high risk'. Managers at these sites did not believe that their organisation was the most suitable site to receive a government funded AED. The main reason given was that the organisation had only small volume of people moving through the venue. One organisation was surprised to have been approached by St John to receive a 'free' AED, as they had already purchased a device privately.

I am still amazed that we got one, it's like money for jam really ... Though from a tax payer point of view there are other clubs less well off than ours that probably would have been more appropriate to get one of these defibrillators from the government. (Manager, golf course)

I was a bit surprised. I have been in policing for 20 years and haven't ever had people need one of these at a station. Would be better suited on patrols I think. (Manager, police station)

Most of the AED sites selected for the PAD Demonstration were appropriate based on the project guidelines for selecting venues according to risk of sudden cardiac arrest.19 Top of page

5.1.3 Location of AEDs

Host organisations had collaborated with St John and other emergency personnel to ensure that the devices were accessible by trained responders within two to three minutes. While AEDs were generally placed in publicly accessible areas, a number were not accessible by the general public. This placement was inline with the views of management that trained emergency personnel were the most appropriate first responders, and the units were kept with other emergency response equipment.

We have one located in the foyer, under the key safe. It is not immediately visible to the public, although they could see it if they looked around for it. The concern about making it too visible was that you ideally need to be trained in the use of a defibrillator unit. (Manager, casino)
AEDs were located where trained emergency response staff could access them quickly in the event of an emergency. Top of page

5.1.4 Experience with St John

Many managers reported that the personal element provided by St John project management was of great value, and assisted them with adjusting to being part of a PAD Demonstration, including engaging their staff, reassuring higher level management, and informing their customers.

St John provided a really really good service. Excellent. Amazing. You can tell that she [the project manager] really cares about what she is doing. She really believes in the program. (Manager, tourist attraction)
Most managers felt no need for ongoing support from St John once the AED had been installed and staff trained. Others were concerned that communication with St John eased off over time, and would have preferred arrangements for regular communication between St John and the host organisation.

When we first got it, St John was on the phone regularly. Having that program manager make contact was fantastic. But we have had it for two years now – the program really could do with ongoing check up, follow up and background support. (Manager, state national park)
St John project management provided support, reassurance and guidance through the planning and implementation process. Top of page

5.1.5 AED training

There was universal praise for the expertise and nature of the St John trainers from managers and staff at host organisations. Reassurance and confidence were seen as important components with regard to effective AED response. Staff and managers reported that the St John training primarily provided a level of reassurance and confidence, and demonstrated how simple the AEDs were to use.

The training was really well delivered. St John were excellent. (Manager, shopping centre)

The whole set up was perfect. They had it up and running in a matter of weeks. The program manager was always available, we had our queries answered right away. Had them out here to help us decide where to put the units. (Manager, metropolitan train service)

The additional emergency first aid training (including CPR) was another important and valued aspect of the training noted by both management and trained staff.

Before training, managers at host organisations and those selected to be first responders often had initial concerns about the responsibility of activating the AED, and the threat of litigation if something went wrong. All respondents stated that St John project management and trainers effectively eased any concerns about litigation, by citing the protection offered by Good Samaritan legislation.

Some individual staff members were concerned about litigation if they could not resuscitate a patient. The St John trainer provided reassurances and the liability issue was explained really well in the training. (Manager, shopping centre)
For organisations that already provided first aid and emergency response (e.g. airports, national parks, casinos, zoos etc) the AED training was incorporated into annual refresher courses for dedicated emergency responders. The AED had become part of these organisations' standard public liability and occupational health and safety procedures.

If you don't do it [refresher training] you're not confident. If you're not confident, you're not competent. (Manager, zoo)
Organisational awareness of the correct procedures for activating the AED tended to diminish at smaller organisations. Those that did not routinely train staff in first aid tended not to have arranged for any refresher training for staff.

The training was effective at the time, but only if you use it. When I found out you were coming to talk to me I needed a refresher, to remind me of the correct response procedures. (Manager, secondary school)
The quality of the AED training provided by St John was widely reported to be effective, efficient and appropriate. However, knowledge of correct AED procedures diminished over time in those organisations that did not provide regular refresher training sessions. Top of page

5.1.6 Lay persons and AEDs

Untrained (or lay) staff interviewed at host organisations stated that they would not feel confident in their ability to activate the AED without training. This was the case even for some staff trained in Level 2 first aid.

I don't know what I would do. I haven't really looked at it. I mean, I have Level 2 first aid, but I don't know that I would use [the AED]. I could do more harm than good you know? (Untrained staff member, national park)
Most management believed that trained first responders should be the first to activate the AED. In some organisations this translated to AEDs placed in locations only accessible to first aid staff.

It is always our trained accident first response team that would respond to a collapse. Have to be able to evaluate the scene, to respond to any type of situation at anytime. Have to know CPR, we give two minutes of compression to get some sort of pressure building in the patient before we give them a shock – you can get a more positive result that way. Would not be appropriate for someone without training to respond. (Manager, international airport)
A number of managers also noted that the signage around the AEDs acted as a deterrent to public use of the unit. This was especially the case at venues such as airports, where most signage was designed to discourage public access to airport equipment.

People are tentative about what they can do and what they can't. People are scared of doing stuff that is against the law. With the signage and the security box, only a medical professional would be likely to take it off the wall. (Manager, airport)
Managers and trained staff at host organisations did not believe it was appropriate or necessary for the general public to activate the AED. Most believed that effective emergency response procedures had been put in place through trained first responders.

Most host organisation representatives did not believe that the public should activate AEDs and that their emergency response procedures ensured that trained responders were the first to reach the AED.
Lay persons were not likely to activate the AEDs.
Top of page

5.1.7 Emergency response plans and broader awareness of AEDs

Organisations that already provided first aid and emergency response had very effective first aid plans in place. These organisations always had at least one trained first aider on site and tended to conduct regular safety drills. Smaller organisations did not regularly encounter emergency incidents, were more naive about emergency procedures and tended to have fewer trained AED staff and a less rigorous emergency response plan. Whilst most organisations reported having an emergency response plan in place that incorporated the use of the AED(s), the extent and efficiency of these plans tended to vary.

Managers and trained staff interviewed were aware of the organisation’s emergency response procedure and felt confident in their ability to activate the AED. Many managers reported that their organisation included information about the AED in their induction packages for new staff to ensure broader awareness of the AEDs. However, amongst untrained staff awareness of the AED and the correct procedures for activating the device tended to be low.

I developed a manual, copied all the information St John gave us, our organisations' emergency response plan and ensured that every station manager had one, and distributed it to all emergency staff. (Manager, metropolitan train service)
Public awareness of the use of AEDs and their benefits was also reported to be very low. Some attributed the lack of public awareness of AEDs to a lack of awareness and acceptance amongst senior management – with AEDs often a low occupational health and safety priority.

Awareness of the AED was high amongst managers and trained staff at host organisations. However, the general consensus was that untrained people are not aware of AEDs and not likely to activate one. Trained first responders were perceived as being best placed to provide optimum care in an emergency.

Overall, the PAD Demonstration has been effective in establishing that organisations can be accepting of AEDs. High quality training was provided and most organisations had effectively incorporated the AEDs into their standard emergency response procedures.

19 The broad guidelines adopted by St John consider the venue appropriate if: length of time for local ambulance to arrive greater than five minutes; previous sudden cardiac arrests have occurred; 10,000 or more persons regularly gather at the location; there is a large concentration of persons over 50 years old or there is a high probability of sudden cardiac arrest.