Position Statements

Use of Automated External Defibrillators in Correctional Settings

Background
Approximately 360,000 Americans experience sudden cardiac arrest annually. Ventricular fibrillation (VF) is the most common cause of sudden cardiac arrest with pulseless ventricular tachycardia (VT) as another leading cause. The standard therapeutic response to ventricular fibrillation and pulseless ventricular tachycardia is defibrillation. Sudden cardiac arrest is survivable. The sooner defibrillation is provided after onset, the greater the likelihood that the patient will survive a VF or VT event. It has been demonstrated that within the first ten minutes of a sudden cardiac arrest, a patient’s survival rate improves 10 percent for every minute that is saved by getting the defibrillator to the patient (Eisenberg, Horwood, Cummins, 1990). Technological innovations in Automated External Defibrillators (AEDs) have made early defibrillation programs possible in many public places, such as airplanes, restaurants, and sport facilities. The American Heart Association (AHA) has recommended that all communities implement a principle of early defibrillation with use of AEDs, strengthen  their access to the emergency dispatch system, promote cardiopulmonary training and response, and coordinate first response units with advanced life support units (AHA, 1990).

An AED is an electronic device, first introduced in 1979, that interprets cardiac rhythms, makes a “shock” or “no shock” decision, and, if appropriate, delivers an electrical shock to the patient. An AED can be applied by non-physician medical personnel and lay persons with minimal training.  The simplicity of an AED makes training and application easy. Studies have shown that volunteer first responders can remain effective past six months of a brief two hour training in applying an AED (Walters, Glucksman, & Evans, 1994).

AEDs have been found to be very effective. Studies on AED use have shown they can be instrumental in successful out-of-hospital cardiac resuscitation in adults (Stapczynski, J. S., Burklow, M. Calhoun, R. P. & Svenson, J. E. 1995). Children and young adolescents have also benefitted by the early application of AEDs (Atkins, Hartley, & York, 1998). Typically, AED units  cost a few thousand dollars, have few maintenance costs, and are lightweight and durable. Studies have found AEDs to be reliable, and experts have called for increased federal and state support for AED utilization (Smith & Hamburg, 1998). Safeguards in the equipment prevent accidental defibrillating shocks.

AEDs have become the standard of care for sudden cardiac arrest (Cummins, 1993). Training in the application and use of AEDs has become standardized in the AHA’s Advanced Cardiac Life Support (ACLS) curriculum. The success of AEDs in improving cardiac survival from a sudden arrest, its ease of use, and a fail safe technology has led the AHA to call for its use even by nonmedical, minimally trained personnel (e.g., security guards and  spouses of cardiac patients).  The American College of Emergency Physicians (ACEP) endorses the use of AEDs when integrated into the emergency medical system (ACEP, 1991 and 1993). The question facing correctional facilities is, should they incorporate AEDs into their medical systems, and if so, how?

Most correctional facilities are not practically able to maintain ACLS capability in the institution on a 24 hour a day (or even part time) basis. Most rely on the local EMS system to bring ACLS into the institution when it is required. AEDs used in the institution can provide the early defibrillation needed prior to ACLS arrival.

The implementation of an early defibrillation program requires careful study and analysis. Correctional administrators and medical directors considering the use of AEDs, should identify  when AEDs should be used, who should be trained in their use, and where AEDs should  be kept.

Position Statement
Institutions considering the implementation of an early defibrillation program and the use of AEDs should do so only after a thorough needs analysis with input from physicians who are experienced in implementing such programs. Correctional institutions should refer to the Commission’s Standards for Health Services in Prisons, the Standards for Health Services in Jails, and Standards for Health Services in Juvenile Detention and Confinement Facilities for further guidance. The standards on Emergency Plan, Communication on Special Needs Patients, Continuing Education for Qualified Health Care Professionals, Training for Correctional Officers, Position Descriptions, Assessment Protocols, and Emergency Services may be of assistance to correctional administrators.

Correctional institutions differ in size, type, population, and staffing. The decision as to who should be trained in the use of AEDs in a correctional facility should be made by the medical director in collaboration with the correctional authority. Correctional officers are generally the first responders to any situation in a jail, prison, or juvenile facility, and as such should be given appropriate training and permitted to use AEDs. When a facility is staffed 24 hours with  health care staff, it may not be necessary to train correctional officers in the application of AEDs. In prisons, jails, and juvenile detention and confinement facilities that do not have  health staff on a 24-hour basis, correctional officers are an essential element of an early defibrillation program and should be trained accordingly.

AEDs should be located were there will be quick and easy access by individuals who are trained in their use. The decision of where to place an AED in a correctional facility must be determined by the medical director working in conjunction with the facility administrator, taking into account the staffing and facility design. The following recommendations provide guidelines for instituting AEDs in a correctional setting:

1. The use of AEDs should be approved, planned, and implemented under the direction of the responsible physician in collaboration with the facility authority.
2. An early defibrillation program includes a training program to designated staff who would be authorized to use AEDs.  This includes both initial and periodic in-services as appropriate.
3. The location of AEDs should be approved by facility administrators and the responsible physician, taking into account the staffing and design of the facility.

Adopted by the National Commission on Correctional Health Care Board of Directors
November 1, 1998

References
American College of Emergency Physicians (1991). Statement on Early Defibrillation. Circulation, 83:2233.

American College of Emergency Physicians (1993). ACEP Policy Statement on Implementation of Early Defibrillation/Automated External Defibrillator Programs.  Annals of Emergency Medicine, 22(768).

Atkins, D. L. Hartley, L. L. & York, D. K. (1998). Accurate recognition and effective treatment of ventricular fibrillation by automated external defibrillators in adolescents. Pediatrics, 101 (3 Part 1), 393-397.

Cummins, R. O. (1993). Emergency medical services and sudden cardiac arrest: The "chain of survival” concept.  Annual Review of Public Health, 14, 313-333.

Eisenberg, M. S., Horwood, B. T., Cummins, R. O. (1990). Cardiac arrest and resuscitation: A tale of 29 cities.  Annals of Emergency Medicine, 19, 179?186.

Smith, S. C., & Hamburg, R. S. (1998). Automated external defibrillators: Time for federal and state advocacy and broader utilization. Circulation, 13, 1321-1324.

Stapczynski, J. S., Burklow, M. Calhoun, R. P. & Svenson, J. E. (1995). Automated external defibrillators used by emergency medical technicians: Report of the 1992 experience in Kentucky. Journal of Kentucky Medical Association, 93(4), 137-141.

Walters, G., Glucksman, E., & Evans, T. R. (1994). Training St. John ambulance volunteers to use an automated external defibrillator.  Resuscitation, 27(1), 39-45.