G Model JJCC-804; No. of Pages 4
ARTICLE IN PRESS Journal of Cardiology xxx (2013) xxx–xxx
Contents lists available at ScienceDirect
Journal of Cardiology journal homepage: www.elsevier.com/locate/jjcc
Original article
How, when, and where have rental automated external defibrillators been used in Japan? Shoichi Ohta (MD, PhD) a,∗ , Kiyokazu Harikae (ELST) b , Kazuhiro Sekine (ELST) c , Manabu Nemoto (MD, PhD) d a
Department of Emergency and Critical Care Medicine, Tokyo Medical University, Tokyo, Japan Department of Sports Medicine, Kokushikan University, Tokyo, Japan c Noda City Fire Department, Noda, Japan d Department of Emergency and Acute Medicine, Faculty of Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan b
a r t i c l e
i n f o
Article history: Received 31 January 2013 Received in revised form 6 November 2013 Accepted 14 November 2013 Available online xxx Keywords: Rental AED Temporary Outdoor Beach Marathon
a b s t r a c t Objective: Automated external defibrillators (AEDs) have been rented in various places in Japan. When rental AEDs are placed in locations where the probability of sudden cardiac arrest is high and permanent placement of AEDs is difficult, the possibility of improving survival rates might increase. In this preliminary study, we investigated how, when, and where rental AEDs have been used in Japan to clarify their characteristics when used in actual situations and to facilitate better usage in the future. Methods: We investigated the total number of AEDs rented, the duration of rental of each AED, the total number of AEDs rented monthly, the rental sites, the frequency and location of use, the number of defibrillations, and the time to defibrillation success for devices rented between January 2008 and December 2010 by a single company in Japan. Results: The number of AEDs rented annually was 590 at 391 sites in 2008, 767 at 465 sites in 2009, and 847 at 477 sites in 2010. More AEDs were rented during the summer. The devices were actually used on 17 individuals, of whom 2 individuals (at a beach and a marathon) underwent defibrillation, and 1 individual (at a marathon) survived. Conclusion: Rental AEDs can play an important role in emergency cases occurring during seasonal and temporary outdoor events. The provision of rental AEDs in locations where permanent AEDs would be unfeasible may offer a useful strategy for efficiently improving survival rates in the future. © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Introduction The provision of automated external defibrillators (AEDs) in various locations was advocated by the American Heart Association (AHA) in their guidelines published in 2000. These guidelines recommend placing AEDs in locations where cardiac arrest events are relatively likely (i.e. a probability of 1 AED use in 5 years, or an estimated event rate of 1 sudden cardiac arrest per 1000 person-years) [1]. In July 2004, AEDs were approved for use by laypersons in Japan. The efficacy of public-access defibrillation (PAD) on a national scale was described soon after this in Japan by Kitamura et al. [2]. AEDs are more useful at sites where there is a high density of both potential victims and resuscitators [3]. The survival rate is
∗ Corresponding author at: Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. Tel.: +81 3 3342 6111x5780; fax: +81 3 3342 5687. E-mail address: [email protected] (S. Ohta).
improved when more AEDs are available. However, the primary obstacle to acquiring an AED is financial resources [4]. AEDs have been rented in various places in Japan, however there are to date no reports based solely on the characteristics of rental AEDs in actual situations, particularly during seasonal events. We therefore investigated how, when, and where rental AEDs have been used in Japan to clarify the characteristics of rental AEDs when used in actual situations and to facilitate better usage in the future. Methods We investigated data obtained by a company that rents AEDs to users all over Japan, but does not manufacture them. Anyone can rent fully maintained AEDs through the Internet. The rental fee is approximately 9240–14,700 Japanese yen for a 3-day period. There is a special rate for long-term rental. An AED is generally sold at approximately 300,000 Japanese yen in Japan. The rented AEDs were Heart Start HS1, FR2, and FRx (Philips, Amsterdam, The Netherlands). The parameters investigated included the total number of AEDs, the rental days for
0914-5087/$ – see front matter © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jjcc.2013.11.012
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
G Model
ARTICLE IN PRESS
JJCC-804; No. of Pages 4
S. Ohta et al. / Journal of Cardiology xxx (2013) xxx–xxx
2
600
800
500
Number of rental AEDs
Rental place and number of rentals
900
700 600 500 400
400 300 200
300
100
200
0 0
100
200
100
300
400
Days
0 2008
2009
2010
Year
Fig. 2. Total rental numbers and the days in 2008–2010 (n = 4223). Median duration: 13.0, quarter duration: 56.0, max: 366, min: 1.0 (day) of rental per AED. AED, automated external defibrillator.
1800
Number of rentals
Fig. 1. Rental location and number of rentals between 2008 and 2010. , total number of places where automated external defibrillators (AEDs) were rented between 2008 and 2010: 1333. , total number of rental AEDs between 2008 and 2010: 2204.
each AED, the total number of rental AEDs per month, the rental sites, the frequency and location of use, the number of defibrillations, and the duration period from turning on the power supply to the attachment of the AED pad to the patient. The data obtained covered 3 years from January 2008 to December 2010. The data were entered into a Microsoft Excel 2007 spreadsheet (Microsoft Corporation, Redmond, WA, USA). Images were prepared using Photoshop Elements 6.0 (Adobe, San Jose, CA, USA) and Microsoft PowerPoint 2007 (Microsoft Corporation). Statistical analysis was performed using PASW Statistics 18 software (Chicago, IL, USA).
Results One of the rental AEDs company in Japan rented 590 AEDs to 391 sites in 2008, 767 AEDs to 465 sites in 2009, and 847 AEDs to 477 sites in 2010. The total number of rental sites and that of AED rentals have been increasing every year (Fig. 1). The mean number of AEDs rented per site was 1.7 (range, 1–71), and 80% of the rentals involved only 1 AED rented to 1 event or location. The median duration of rental per AED was 13 days, and the quarter duration was 56 days (Fig. 2). The most common type of rental (30%) was a 3-day short-term rental, followed by periods of 1–3 months (28%), and 3–7 days (21%). The rental situation according to season showed that most AEDs were rented out during the summer (36.9%) (Fig. 3). A rented AED was actually used on 17 individuals, among which 14 were used at waterside locations, such as a beach or a pool. Defibrillation was applied to 2 of these 17 individuals, 1 at a beach and the other at a marathon. The individual treated at the marathon survived (Tables 1 and 2).
1600
Total number of rental AEDs
Rental location
1400 1200 1000 800 600 400 200 0
Spring
Summer
Autumn
Winter
Fig. 3. Total number of rentals by season between 2008 and 2010 (n = 4223). Spring: March, April, May. Summer: June, July, August. Autumn: September, October, November. Winter: December, January, February. AED, automated external defibrillator.
In the 17 cases of use, the mean duration period from turning on the power supply to the attachment of the AED pad to the patient was 24 s (range, 3–117 s), with a duration of 28 s for the single survival case.
Table 1 Situations in which rental AEDs were used.
Number of AEDs AEDs used Location Seaside Poolside Mountain Public facility Marathon Defibrillation applied Seaside Marathon Number of survivors Marathon
2008
2009
2010
Total
1183 6
1427 6
1613 5
4223 17
5
4 1 1
4
13 1 1 1 1 2 1 1 1 1
1 0
1 1
0
0
1 1 1 1 1
AED, automated external defibrillator.
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
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S. Ohta et al. / Journal of Cardiology xxx (2013) xxx–xxx
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Table 2 The details of 17 cases. No.
Year
Rental season
Rental days
Rental numbers
Location
Defibrillation applied
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
2008
Summer Summer Summer Summer Summer Summer Summer Summer Summer Summer Summer Summer Spring Summer Summer Summer Summer
34 38 32 38 34 31 63 32 54 33 32 37 3 33 33 32 39
2 4 10 1 2 1 1 10 1 2 7 3 32 8 8 4 1
Seaside Seaside Seaside Seaside Seaside Public facility Mountain Seaside Seaside Seaside Poolside Seaside Marathon Seaside Seaside Seaside Seaside
X X X X X X X X 7 X X X 1 X X X X
2009
2010
Result
Success
X, no applied to defibrillation.
Discussion AEDs are utilized in a small percentage of all out-of-hospital cardiac arrests, but are available at most public facilities, and vast sums of money are spent installing and maintaining these devices [3]. Health and fitness facilities with more than 1500 members are encouraged to have on-site AEDs, given the high incidence of sudden cardiac arrest. Temporary AEDs should also be rented strategically at sites where people frequently gather, but permanent installation in such locations is not always feasible [5]. Most rental AEDs were used at short-term events, where the provision of a permanent AED would have been unfeasible. AEDs in this study were used at beaches. In Japan, swimming in the ocean is generally permitted only during the 2 months of July and August. The placement of a permanent AED is usually feasible at swimming pools, whereas the maintenance of a permanent AED may become difficult with the seasonal and temporary conditions associated with the beach and outdoors. Usually, 1 AED was rented at 1 location for fewer than 3 days and most AEDs were rented during the summer. This study based on preliminary data showed that at seasonal and outdoor events, rental AEDs may be useful and have some advantages in addition to those of permanently installed or purchased AEDs. Rental AEDs that can be strictly controlled and maintained may allow more lives to be saved from out-of-hospital cardiac arrests by allowing flexibility in usage. Needless to say, many people go swimming in the summer, increasing the demand for AEDs. Availability of rental AEDs appears to be particularly well-suited to this kind of use. Conventionally, a first responder such as a lifeguard, support marshal, or patrol member who has been medically trained in cardio-pulmonary resuscitation and the use of AEDs is present at the waterside or along the event course. Similar issues are involved in irregular athletic meetings held outdoors, such as marathons. Many cases of individuals surviving cardiac events with the use of AEDs at marathons have been reported. However, AEDs are not available at all marathons, and fatal cases are sometimes reported. Sudden cardiac arrest occurs in approximately 1 in 57,000 marathon runners, is more common in older males, and usually occurs in the last 4 miles of the race course. Prompt resuscitation including early use of an AED improves survival rate. Emergency planning to include trained medical staff and sufficient AEDs throughout the race course is recommended [6].
For the 17 cases in the present study in which an AED was applied, the mean duration period from turning on the power supply to attachment of the AED pad to the patient was 24 s, with a significant difference between the maximum and minimum values. Public education is crucial to maximizing the life-saving potential of PADs [7]. In this system, the rental AED is delivered along with a digital versatile disk explaining the handling of the device. The provision of educational information at the sites of temporary AED installation may help to improve the skills of bystanders. Regarding cost, there were 2204 cases needing AEDs over 3 years to obtain with 17 cases of actual use, and the rental costs were approximately 53,790,000 Japanese yen, or 24,405 Japanese yen per AED. If 2204 AEDs had been purchased, the cost would have been approximately 661,200,000 Japanese yen. On the other hand, the rental cost was only 53,790,000 Japanese yen, but since the rental fee is only 8% of purchase costs, we believe that good cost-effectiveness was achieved. The limitation of this study is that it is a preliminary report of a survey on rental AEDs provided by one company in Japan. We intend to survey other companies and countries to compare the effectiveness between the rental and standard AED deployment strategies by establishing medical control systems for rental AEDs. We were not able to analyze detailed data because there were restrictions to the contract. In this study, we used existing data as suggested by our lawyer. In the future, we will prepare a contract that allows us to obtain more medical data and continue to investigate aspects of prognosis.
Conclusion At outdoor sites, rental AEDs may be more suitable and play an important role in some circumstances such as seasonal and temporary outdoor events. The provision of rental AEDs in locations where permanent AEDs are unfeasible may offer a useful strategy for improving survival rates in an efficient manner in the future.
Author contributions Shoichi Ohta contributed to the conceptualized and conducted the study; Kiyokazu Harikae and Kazuhiro Sekine contributed to the analyzed the data; Manabu Nemoto contributed to the overall supervision of the conduct of the study.
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
G Model JJCC-804; No. of Pages 4
ARTICLE IN PRESS S. Ohta et al. / Journal of Cardiology xxx (2013) xxx–xxx
4
Acknowledgments We are indebted to the medical editors of the Department of International Medical Communications of Tokyo Medical University for their editorial review of the English manuscript. References
[3] [4]
[5] [6]
[1] ECC Committee, Subcommittees, and Task Forces of the American Heart Association. Part 4: the automated external defibrillator. Circulation 2000;102(Suppl. I):I60–76. [2] Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A, Implementation Working Group for the All-Japan Utstein Registry of the Fire and Disaster
[7]
Management Agency. Nationwide public-access defibrillation in Japan. N Engl J Med 2010;362:994–1004. Winkle RA. The effectiveness and cost effectiveness of public-access defibrillation. Clin Cardiol 2010;33:396–9. Drezner JA. Preparing for sudden cardiac arrest – the essential role of automated external defibrillators in athletic medicine: a critical review. Br J Sports Med 2009;43:702–7. Drezner JA, Asif IM, Harmon KG. Automated external defibrillators in health and fitness facilities. Phys Sports Med 2011;39:114–8. Webner D, Duprey KM, Drezner JA, Cronholm P, Roberts WO. Sudden cardiac arrest and death in United States marathons. Med Sci Sports Exerc 2012;44:1843–5. Patrick S, Frederieke BvD, Joost JLMB, Stephan AL, Lothar AS. Public access defibrillation: time to access the public. Ann Emerg Med 2011;58: 240–7.
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
ARTICLE IN PRESS Journal of Cardiology xxx (2013) xxx–xxx
Contents lists available at ScienceDirect
Journal of Cardiology journal homepage: www.elsevier.com/locate/jjcc
Original article
How, when, and where have rental automated external defibrillators been used in Japan? Shoichi Ohta (MD, PhD) a,∗ , Kiyokazu Harikae (ELST) b , Kazuhiro Sekine (ELST) c , Manabu Nemoto (MD, PhD) d a
Department of Emergency and Critical Care Medicine, Tokyo Medical University, Tokyo, Japan Department of Sports Medicine, Kokushikan University, Tokyo, Japan c Noda City Fire Department, Noda, Japan d Department of Emergency and Acute Medicine, Faculty of Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan b
a r t i c l e
i n f o
Article history: Received 31 January 2013 Received in revised form 6 November 2013 Accepted 14 November 2013 Available online xxx Keywords: Rental AED Temporary Outdoor Beach Marathon
a b s t r a c t Objective: Automated external defibrillators (AEDs) have been rented in various places in Japan. When rental AEDs are placed in locations where the probability of sudden cardiac arrest is high and permanent placement of AEDs is difficult, the possibility of improving survival rates might increase. In this preliminary study, we investigated how, when, and where rental AEDs have been used in Japan to clarify their characteristics when used in actual situations and to facilitate better usage in the future. Methods: We investigated the total number of AEDs rented, the duration of rental of each AED, the total number of AEDs rented monthly, the rental sites, the frequency and location of use, the number of defibrillations, and the time to defibrillation success for devices rented between January 2008 and December 2010 by a single company in Japan. Results: The number of AEDs rented annually was 590 at 391 sites in 2008, 767 at 465 sites in 2009, and 847 at 477 sites in 2010. More AEDs were rented during the summer. The devices were actually used on 17 individuals, of whom 2 individuals (at a beach and a marathon) underwent defibrillation, and 1 individual (at a marathon) survived. Conclusion: Rental AEDs can play an important role in emergency cases occurring during seasonal and temporary outdoor events. The provision of rental AEDs in locations where permanent AEDs would be unfeasible may offer a useful strategy for efficiently improving survival rates in the future. © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Introduction The provision of automated external defibrillators (AEDs) in various locations was advocated by the American Heart Association (AHA) in their guidelines published in 2000. These guidelines recommend placing AEDs in locations where cardiac arrest events are relatively likely (i.e. a probability of 1 AED use in 5 years, or an estimated event rate of 1 sudden cardiac arrest per 1000 person-years) [1]. In July 2004, AEDs were approved for use by laypersons in Japan. The efficacy of public-access defibrillation (PAD) on a national scale was described soon after this in Japan by Kitamura et al. [2]. AEDs are more useful at sites where there is a high density of both potential victims and resuscitators [3]. The survival rate is
∗ Corresponding author at: Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. Tel.: +81 3 3342 6111x5780; fax: +81 3 3342 5687. E-mail address: [email protected] (S. Ohta).
improved when more AEDs are available. However, the primary obstacle to acquiring an AED is financial resources [4]. AEDs have been rented in various places in Japan, however there are to date no reports based solely on the characteristics of rental AEDs in actual situations, particularly during seasonal events. We therefore investigated how, when, and where rental AEDs have been used in Japan to clarify the characteristics of rental AEDs when used in actual situations and to facilitate better usage in the future. Methods We investigated data obtained by a company that rents AEDs to users all over Japan, but does not manufacture them. Anyone can rent fully maintained AEDs through the Internet. The rental fee is approximately 9240–14,700 Japanese yen for a 3-day period. There is a special rate for long-term rental. An AED is generally sold at approximately 300,000 Japanese yen in Japan. The rented AEDs were Heart Start HS1, FR2, and FRx (Philips, Amsterdam, The Netherlands). The parameters investigated included the total number of AEDs, the rental days for
0914-5087/$ – see front matter © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jjcc.2013.11.012
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
G Model
ARTICLE IN PRESS
JJCC-804; No. of Pages 4
S. Ohta et al. / Journal of Cardiology xxx (2013) xxx–xxx
2
600
800
500
Number of rental AEDs
Rental place and number of rentals
900
700 600 500 400
400 300 200
300
100
200
0 0
100
200
100
300
400
Days
0 2008
2009
2010
Year
Fig. 2. Total rental numbers and the days in 2008–2010 (n = 4223). Median duration: 13.0, quarter duration: 56.0, max: 366, min: 1.0 (day) of rental per AED. AED, automated external defibrillator.
1800
Number of rentals
Fig. 1. Rental location and number of rentals between 2008 and 2010. , total number of places where automated external defibrillators (AEDs) were rented between 2008 and 2010: 1333. , total number of rental AEDs between 2008 and 2010: 2204.
each AED, the total number of rental AEDs per month, the rental sites, the frequency and location of use, the number of defibrillations, and the duration period from turning on the power supply to the attachment of the AED pad to the patient. The data obtained covered 3 years from January 2008 to December 2010. The data were entered into a Microsoft Excel 2007 spreadsheet (Microsoft Corporation, Redmond, WA, USA). Images were prepared using Photoshop Elements 6.0 (Adobe, San Jose, CA, USA) and Microsoft PowerPoint 2007 (Microsoft Corporation). Statistical analysis was performed using PASW Statistics 18 software (Chicago, IL, USA).
Results One of the rental AEDs company in Japan rented 590 AEDs to 391 sites in 2008, 767 AEDs to 465 sites in 2009, and 847 AEDs to 477 sites in 2010. The total number of rental sites and that of AED rentals have been increasing every year (Fig. 1). The mean number of AEDs rented per site was 1.7 (range, 1–71), and 80% of the rentals involved only 1 AED rented to 1 event or location. The median duration of rental per AED was 13 days, and the quarter duration was 56 days (Fig. 2). The most common type of rental (30%) was a 3-day short-term rental, followed by periods of 1–3 months (28%), and 3–7 days (21%). The rental situation according to season showed that most AEDs were rented out during the summer (36.9%) (Fig. 3). A rented AED was actually used on 17 individuals, among which 14 were used at waterside locations, such as a beach or a pool. Defibrillation was applied to 2 of these 17 individuals, 1 at a beach and the other at a marathon. The individual treated at the marathon survived (Tables 1 and 2).
1600
Total number of rental AEDs
Rental location
1400 1200 1000 800 600 400 200 0
Spring
Summer
Autumn
Winter
Fig. 3. Total number of rentals by season between 2008 and 2010 (n = 4223). Spring: March, April, May. Summer: June, July, August. Autumn: September, October, November. Winter: December, January, February. AED, automated external defibrillator.
In the 17 cases of use, the mean duration period from turning on the power supply to the attachment of the AED pad to the patient was 24 s (range, 3–117 s), with a duration of 28 s for the single survival case.
Table 1 Situations in which rental AEDs were used.
Number of AEDs AEDs used Location Seaside Poolside Mountain Public facility Marathon Defibrillation applied Seaside Marathon Number of survivors Marathon
2008
2009
2010
Total
1183 6
1427 6
1613 5
4223 17
5
4 1 1
4
13 1 1 1 1 2 1 1 1 1
1 0
1 1
0
0
1 1 1 1 1
AED, automated external defibrillator.
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
G Model
ARTICLE IN PRESS
JJCC-804; No. of Pages 4
S. Ohta et al. / Journal of Cardiology xxx (2013) xxx–xxx
3
Table 2 The details of 17 cases. No.
Year
Rental season
Rental days
Rental numbers
Location
Defibrillation applied
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
2008
Summer Summer Summer Summer Summer Summer Summer Summer Summer Summer Summer Summer Spring Summer Summer Summer Summer
34 38 32 38 34 31 63 32 54 33 32 37 3 33 33 32 39
2 4 10 1 2 1 1 10 1 2 7 3 32 8 8 4 1
Seaside Seaside Seaside Seaside Seaside Public facility Mountain Seaside Seaside Seaside Poolside Seaside Marathon Seaside Seaside Seaside Seaside
X X X X X X X X 7 X X X 1 X X X X
2009
2010
Result
Success
X, no applied to defibrillation.
Discussion AEDs are utilized in a small percentage of all out-of-hospital cardiac arrests, but are available at most public facilities, and vast sums of money are spent installing and maintaining these devices [3]. Health and fitness facilities with more than 1500 members are encouraged to have on-site AEDs, given the high incidence of sudden cardiac arrest. Temporary AEDs should also be rented strategically at sites where people frequently gather, but permanent installation in such locations is not always feasible [5]. Most rental AEDs were used at short-term events, where the provision of a permanent AED would have been unfeasible. AEDs in this study were used at beaches. In Japan, swimming in the ocean is generally permitted only during the 2 months of July and August. The placement of a permanent AED is usually feasible at swimming pools, whereas the maintenance of a permanent AED may become difficult with the seasonal and temporary conditions associated with the beach and outdoors. Usually, 1 AED was rented at 1 location for fewer than 3 days and most AEDs were rented during the summer. This study based on preliminary data showed that at seasonal and outdoor events, rental AEDs may be useful and have some advantages in addition to those of permanently installed or purchased AEDs. Rental AEDs that can be strictly controlled and maintained may allow more lives to be saved from out-of-hospital cardiac arrests by allowing flexibility in usage. Needless to say, many people go swimming in the summer, increasing the demand for AEDs. Availability of rental AEDs appears to be particularly well-suited to this kind of use. Conventionally, a first responder such as a lifeguard, support marshal, or patrol member who has been medically trained in cardio-pulmonary resuscitation and the use of AEDs is present at the waterside or along the event course. Similar issues are involved in irregular athletic meetings held outdoors, such as marathons. Many cases of individuals surviving cardiac events with the use of AEDs at marathons have been reported. However, AEDs are not available at all marathons, and fatal cases are sometimes reported. Sudden cardiac arrest occurs in approximately 1 in 57,000 marathon runners, is more common in older males, and usually occurs in the last 4 miles of the race course. Prompt resuscitation including early use of an AED improves survival rate. Emergency planning to include trained medical staff and sufficient AEDs throughout the race course is recommended [6].
For the 17 cases in the present study in which an AED was applied, the mean duration period from turning on the power supply to attachment of the AED pad to the patient was 24 s, with a significant difference between the maximum and minimum values. Public education is crucial to maximizing the life-saving potential of PADs [7]. In this system, the rental AED is delivered along with a digital versatile disk explaining the handling of the device. The provision of educational information at the sites of temporary AED installation may help to improve the skills of bystanders. Regarding cost, there were 2204 cases needing AEDs over 3 years to obtain with 17 cases of actual use, and the rental costs were approximately 53,790,000 Japanese yen, or 24,405 Japanese yen per AED. If 2204 AEDs had been purchased, the cost would have been approximately 661,200,000 Japanese yen. On the other hand, the rental cost was only 53,790,000 Japanese yen, but since the rental fee is only 8% of purchase costs, we believe that good cost-effectiveness was achieved. The limitation of this study is that it is a preliminary report of a survey on rental AEDs provided by one company in Japan. We intend to survey other companies and countries to compare the effectiveness between the rental and standard AED deployment strategies by establishing medical control systems for rental AEDs. We were not able to analyze detailed data because there were restrictions to the contract. In this study, we used existing data as suggested by our lawyer. In the future, we will prepare a contract that allows us to obtain more medical data and continue to investigate aspects of prognosis.
Conclusion At outdoor sites, rental AEDs may be more suitable and play an important role in some circumstances such as seasonal and temporary outdoor events. The provision of rental AEDs in locations where permanent AEDs are unfeasible may offer a useful strategy for improving survival rates in an efficient manner in the future.
Author contributions Shoichi Ohta contributed to the conceptualized and conducted the study; Kiyokazu Harikae and Kazuhiro Sekine contributed to the analyzed the data; Manabu Nemoto contributed to the overall supervision of the conduct of the study.
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
G Model JJCC-804; No. of Pages 4
ARTICLE IN PRESS S. Ohta et al. / Journal of Cardiology xxx (2013) xxx–xxx
4
Acknowledgments We are indebted to the medical editors of the Department of International Medical Communications of Tokyo Medical University for their editorial review of the English manuscript. References
[3] [4]
[5] [6]
[1] ECC Committee, Subcommittees, and Task Forces of the American Heart Association. Part 4: the automated external defibrillator. Circulation 2000;102(Suppl. I):I60–76. [2] Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A, Implementation Working Group for the All-Japan Utstein Registry of the Fire and Disaster
[7]
Management Agency. Nationwide public-access defibrillation in Japan. N Engl J Med 2010;362:994–1004. Winkle RA. The effectiveness and cost effectiveness of public-access defibrillation. Clin Cardiol 2010;33:396–9. Drezner JA. Preparing for sudden cardiac arrest – the essential role of automated external defibrillators in athletic medicine: a critical review. Br J Sports Med 2009;43:702–7. Drezner JA, Asif IM, Harmon KG. Automated external defibrillators in health and fitness facilities. Phys Sports Med 2011;39:114–8. Webner D, Duprey KM, Drezner JA, Cronholm P, Roberts WO. Sudden cardiac arrest and death in United States marathons. Med Sci Sports Exerc 2012;44:1843–5. Patrick S, Frederieke BvD, Joost JLMB, Stephan AL, Lothar AS. Public access defibrillation: time to access the public. Ann Emerg Med 2011;58: 240–7.
Please cite this article in press as: Ohta S, et al. How, when, and where have rental automated external defibrillators been used in Japan? J Cardiol (2013), http://dx.doi.org/10.1016/j.jjcc.2013.11.012
