2829 University Ave. S.E., Suite 310 Minneapolis, MN 55414-3222 (612) 627-6000 (800) 747-2011 FAX (612) 627-5442 TTY (800) 627-3529 www.emsrb.state.mn.us Automated External Defibrillator Availability in Greater Minnesota A REPORT TO THE MINNESOTA LEGISLATURE December 15, 2002 By Wayne Arrowood, Ph.D., Compliance & Licensing Administrator, with Assistance from Jocelyn Brekken, Student Worker "To provide leadership which optimizes the quality of emergency medical care for the people of Minnesota -- in collaboration with our communities -- through policy development, regulation, system design, education, and medical direction" C:\Documents and Settings\brekkenj.HLB\Desktop\title.doc An Equal Opportunity Employer REPORT TO THE MINNESOTA LEGISLATURE: SURVEY OF AUTOMATED EXTERNAL DEFIBRILLATOR AVAILABILITY IN GREATER MINNESOTA December 15, 2002 The 2001 Minnesota Legislature requested the Minnesota Emergency Medical Services Regulatory Board (EMSRB) to survey automated external defibrillator (AED) availability in Greater Minnesota. Minnesota Laws 2001, First Special Session, chapter 9, article 17, section 6, requires the Emergency Medical Services Board: …to study, in consultation with the commissioner of public safety, and report to the legislature by December 15, 2002, regarding the availability of automatic defibrillators outside the seven-county metropolitan area. The report shall include recommendations to make these devices accessible within a reasonable distance through the nonmetropolitan area, including recommendations for funding their acquisition and distribution. This report sets forth findings of this survey in three key areas of interest to the legislature: • Availability of AEDs in the 80 counties of Greater Minnesota, located outside the seven-county metropolitan region of Hennepin, Ramsey, Anoka, Carver, Scott, Washington, and Dakota counties; • Recommendations to make AEDs accessible within a reasonable distance in Greater Minnesota; • Recommendations on funding the acquisition and distribution of AEDs in Greater Minnesota. 1 Background Information Regarding AEDs Sudden cardiac arrest is a major cause of death in the United States, claiming about 220,000 lives each year (2001 Heart and Stroke Statistical Update, American Heart Association, Dallas, Texas). Most sudden cardiac arrest involves a lethal heart arrhythmia known as ventricular fibrillation. Effective treatment for ventricular fibrillation is an electrical shock using a defibrillator. With each minute that elapses, the probability of successful defibrillation is reduced by about 10%. Currently, only about five percent of persons experiencing sudden cardiac arrest survive (American Heart Association, Saving Lives with the Chain of Survival for Cardiac Arrest, 2001). For this reason, early access to defibrillation is an essential element in any emergency medical response system. The American Heart Association’s Chain of Survival metaphor summarizes four essential elements for an effective “early defibrillation” program: early activation of the emergency medical services (EMS) system, early CPR, early defibrillation, and early access to advanced cardiovascular life support care (American Heart Association, ibid.) The availability of compact, lightweight, fully automated AEDs makes it possible for trained first response personnel, such as fire departments, law enforcement agencies, and ski patrols, to respond to sudden cardiac arrest victims with this life-saving capability. Additionally, placed in locations where access by EMS personnel may be delayed, AEDs can mean the difference between life and death for many experiencing sudden cardiac arrest. Laypersons trained in the use of AEDs, and also bystanders in many situations, can make this difference a reality. 2 Availability of AEDs in Greater Minnesota The recipients and target population of this survey were fire departments, law enforcement agencies, and ski patrols throughout Minnesota. A mailing consisting of 1,153 survey instruments was distributed to these emergency responders in the 80 counties comprising Greater Minnesota. This survey instrument (Attachment #1) was developed in consultation with the American Heart Association – Northland Affiliate. After the initial mailing, and follow up effort, a total of 544 surveys were returned. Completed surveys were received from 265 fire departments, 165 police departments, 57 county sheriffs, 31 first responder squads not fire departments or public-safety related, 19 licensed ambulance services, mostly fire department-based services, 5 city government and 2 ski patrols. The rate of return for all surveys was 47%. This rate of return has provided a measure of validity to the survey for purposes of reviewing the results. Responses were received from all 80 counties in Greater Minnesota. The information received provides a snapshot of AED access and availability for first responder units, the need for additional AEDs, CPR and AED training, and AED placement and need within other agencies and organizations in the counties comprising Greater Minnesota. AED Survey Results by County (Attachment 2), displays the 80 counties surveyed in Greater Minnesota, with the responses received within these counties from the targeted populations: fire departments, law enforcement agencies, first responders, and other emergency responders. It is important to note that, although responses were received from representative target populations in all 80 counties, the results do not represent all of the possible responses possible from any specific county. 3 The following points illustrate the results of Attachment 2: AED Survey Results by County: • Thirty-five percent (191 responses) of the 544 total respondents report no access to AEDs within their agency or organization. • The sixty-five percent (353 responses) of organizations with AED access report a total of 790 AED units. • All of the responding target population reports an additional need for 1,175 AED units. • Eighty-five percent (461 responses) of the responding target population is dispatched by a 911 emergency telephone system within each county; fifteen percent (83 responses) is not dispatched by 911. • Seventy-three percent (396 responses) of the responding target population reports physician oversight of the AEDs; twenty-seven percent (148 responses) does not have physician oversight. • The responding target population reports 7,327 persons trained in an American Heart Association CPR course, 4,314 persons trained in an American Heart Association AED Course, and an additional 1,797 persons in need of AED training. The survey Community AED Placement (Attachment 3) provides further insight from the respondents regarding their perception of AED placement in specific locations, including both emergency responder and community access locations. The survey listed possible locations as fire departments, law enforcement agencies, first responder units, 4 ski patrols, community facilities, local businesses, health care facilities, health clinics, schools, restaurants, and other public gathering places within the 80 counties surveyed. The following points summarize results from Attachment 3: Community AED Placement: • The community-based organizations and agencies with the preponderance of AEDs already in place are hospitals, health clinics, physician offices, nursing homes, and public/government facilities. • Other community-based organizations with some AED access include schools, community centers, local businesses, and assisted living facilities. • All emergency responders and community-based organizations and agencies report 884 AEDs in place, but suggest a “great need” for 940 additional AEDs and a “future need” of 999 AEDs, with 480 staff in need of AED training. The attachments to this survey provide detailed information gathered from each of the 80 Greater Minnesota counties on the availability, location, and need for AEDs consistent with the above findings. Making AEDs Accessible Within a Reasonable Distance in Greater Minnesota This study illustrates the need and expectation in Greater Minnesota to press forward with the priority of equipping emergency first responders with AED capabilities. The survey results further suggest the need to carry this capability forward for even greater accessibility in other important public locations. It should be noted that licensed ambulance services in Minnesota are required by state law to have ambulance response available 24-hours a day with defibrillation capability, provided by trained emergency 5 medical technicians. Realistically, this life-saving equipment provided by ambulance response in Greater Minnesota must travel greater distances than in more urbanized areas. This results in the ambulance often arriving too late to the scenes of medical emergencies involving cardiac arrest to make a difference in patient outcomes in rural areas of Greater Minnesota. Following are basic recommendations to make AEDs accessible within a “reasonable distance” in Greater Minnesota: • Train and equip “first responders” (fire departments, law enforcement agencies, ski patrol, other first responder units in public and private settings) to administer immediate care when needed, including CPR skills and AED usage, and encourage these first responder units to voluntarily register with the Minnesota Emergency Medical Services Regulatory Board (www.emsrb.state.mn.us). • Encourage county and city local boards of health, and public and private agencies and organizations in Greater Minnesota to