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1. The Public Access Defibrillation (PAD) Trial

Author

Heather Payne, Bruce Haynes, Jerris R. Hedges, Sarah D. McNutt, Brent Shaum, Christopher Burke, Deb Cordes, Ross E. Megargel, Brian MacGavin, Rachel Knudson-Ballard, Ruchir Sehra, Thomas Therndrup, Lynne D. Richardson, Daniel Harker, R. O. Cummins, Christopher Shields, Michael Ottaway, Terri A. Schmidt, Shannon W. Stephens, Mark C. Henry, Mohamud Ramzanali Daya, Lawrence H. Brown, Barbara Riegel, Eleanor Schron, Stephen Yahn, Brian K. Slater, Jerry Overton, Lisa M. Evans, Patricia Burke, Frederick Ehlert, Myron L. Weisfeldt, Missy Bollinger, Robert Swor, Michael R. Sayre, Dennis Rabel, Kimberlee Brown, Judith Paulsen, Tom P. Aufderheide, David B. Reed, Nadia Douglas, Lance B. Becker, Lisa Parmenter, N. Clay Mann, Andy R. Anton, Robert D. Welch, Anne Barry, Denise Griffiths, Roland Webb, Linda Asbury, Britta Myrin, James Christenson, Scott Johnson, Mary Ann Peberdy, Vijayaraghavan Krishnaswami, Jim Christenson, Robert E. O'Connor, Kammy Jacobsen, Richard A. Craven, Graham Nichol, Brian D. Mahoney, Mary D. Gunnels, Lynn Marie Mango, Alidene Doherty, David Hostler, Jonathan VanZile, Patricia Lawson, Allan Holmes, Jonathan Jui, Ronald G. Pirrallo, Patricia McGraw, Joseph P. Ornato, Scott Compton, Robert B. Dunne, Kristen Bilicki, Venard J. Campbell, Marcel E. Salive, Stephen Ehrlich, Laura Grabowski, Ellen Demertsidies, Thomas A. Mattioni, Elizabeth Ferry Godburn, Christopher Freyberg, Gary Newton, Mary Ann McBurnie, Sarah Pennington, Neal Richmond, Michael Osur, Max Harry Weil, William J. Groh, Robert Zalenski, Constance D. Jones, Ilene Wilets, Lois A. Bosken, Lynn Wittwer, Vince N. Mosesso, Susan J. Bondurant, Jennifer Holohan, Heather Brooks, and Edward R. Stapleton

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Job description, Poison control, Emergency Nursing, medicine.disease, law.invention, Clinical trial, Quality of life (healthcare), Randomized controlled trial, law, Emergency medicine, Emergency Medicine, Clinical endpoint, medicine, Emergency medical services, Cardiopulmonary resuscitation, Medical emergency, Cardiology and Cardiovascular Medicine, business
Abstract

The PAD Trial is a prospective, multicenter, randomized clinical study testing whether volunteer, non-medical responders can improve survival from out-of-hospital cardiac arrest (OOH-CA) by using automated external defibrillators (AEDs). These lay volunteers, who have no traditional responsibility to respond to a medical emergency as part of their primary job description, will form part of a comprehensive, integrated community approach to the treatment of OOH-CA. The study is being conducted at 24 field centers in the United States and Canada. Approximately 1000 community units (e.g. apartment or office buildings, gated communities, sports facilities, senior centers, shopping malls, etc.) were randomized to treatment by trained laypersons who will provide either cardiopulmonary resuscitation (CPR) alone or CPR plus use of an AED, while awaiting arrival of the community's emergency medical services responders. The primary endpoint is the number of OOH-CA victims who survive to hospital discharge. Secondary endpoints include neurological status, health-related quality of life (HRQL), cost, and cost-effectiveness. Data collection will last approximately 15 months and is expected to be completed in September 2003.

Published
2003
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2. Implementation of community-based public access defibrillation in the PAD trial

Author

Michael Proschan, Allan Holmes, Patricia McGraw, Joseph P. Ornato, David C. Goff, Ellen Demertsidis, Venard J. Campbell, Constance D. Jones, Gary Newton, Sandra S. Schmidt, Bruce Haynes, Laura Nolting, Mary Ann McBurnie, Heather Payne, Yves Rosenberg, Christopher W. Sparks, Jonathan Van Zile, Stephen Yahn, Chris von Briesen, Denise Griffiths, Margit Scholz, Brent Shaum, Brian D. Mahoney, Mark C. Henry, Michael Osur, Robert Swor, Max Harry Weil, Lynne D. Richardson, Anne Barry, Ella Huszti, Lisa O'Neill, Michael J. Domanski, Stephen Ehrlich, Ross E. Megargel, Brian MacGavin, Scott Johnson, Judith Paulsen, Graham Nichol, Louis Gonzales, H. Leon Greene, Robert B. Dunne, Jerris R. Hedges, Jerry Overton, Henry A. Feldman, Ray Lucas, William J. Groh, Art Kerr, Dennis Rabel, Myron L. Weisfeldt, Richard Moore, Kristen Bilicki, Brian K. Slater, Marge M. Lestarge, Patricia Lawson, Michael R. Sayre, Barbara Riegel, Frederick Ehlert, Lois A. Bosken, Richard A. Craven, Ronald G. Pirrallo, Deb Cordes, Andy R. Anton, Sarah Pennington, Patricia Burke, Neal Richmond, Thomas A. Mattioni, Nadia Douglas, Christine Grimmelsman, Christopher Shields, Lois Van Ottingham, Lisa Parmenter, Scott Compton, Alfred P. Hallstrom, Robert J. Zalenski, Laura Grabowski, Denise Simons-Morton, Krishnaswami Vijayaraghavan, Britta Myrin, Henry Thode, Richard W. Janisch, Robert D. Welch, George Arthur Wells, Tom P. Aufderheide, David B. Reed, Christopher Freyberg, Laurence McCullough, P. Jacob Varghese, David Feeny, Eleanor Schron, Robert E. O'Connor, N. Clay Mann, Margaret Amaya, Kathryn Irwin, Marcel E. Salive, Kimberly A. Deja, Christopher Burke, Rachel Knudson-Ballard, Sue Wood, Andrew H. Travers, Jim Christenson, Mohamud Daya, Sarah Nafziger, M. Bollinger, George Vasquez, Linda Asbury, Terri A. Schmidt, Shannon W. Stephens, Kimberlee Brown, Alice Birnbaum, Mary Ann Peberdy, Costas T. Lambrew, Mary D. Gunnels, Lynn Marie Mango, Alidene Doherty, Jerome Fleg, Debbie Morris, Jennifer Rokosh, Janyce Sanford, Craig J. Conrad, Robert Ledingham, Lisa M. Evans, Brenda Heisz, Kelly Schaffer, Lance B. Becker, Roland Webb, Thomas E. Terndrup, Ilene Wilets, Adrian Panylyk, Judy Powell, Lawrence H. Brown, Susan Alexandra Thompson, Kammy Jacobsen, R. O. Cummins, Mary Morris, David Hostler, Susan J. Bondurant, David J. Kitscha, Claudia Williams, Jennifer Holohan, Heather Brooks, Ruchir Sehra, Jonathan Jui, Edward R. Stapleton, Karen M. Kuntz, Allan Braslow, Lynn Wittwer, and Vince N. Mosesso

Subjects
Male, Volunteers, Canada, Emergency Medical Services, medicine.medical_treatment, MEDLINE, law.invention, Age Distribution, Randomized controlled trial, law, medicine, Humans, Attrition, Cardiopulmonary resuscitation, Community Health Services, Sex Distribution, Automated external defibrillator, Public Sector, business.industry, Retraining, Health Plan Implementation, General Medicine, Focus Groups, Middle Aged, medicine.disease, Focus group, United States, Socioeconomic Factors, Emergency Medicine, Female, Medical emergency, business, Qualitative research, Defibrillators
Abstract

Background The Public Access Defibrillation (PAD) Trial was a randomized, controlled trial designed to measure survival to hospital discharge following out-of-hospital cardiac arrest (OOH-CA) in community facilities trained and equipped to provide PAD, compared with community facilities trained to provide cardiopulmonary resuscitation (CPR) without any capacity for defibrillation. Objectives To report the implementation of community-based lay responder emergency response programs in 1,260 participating facilities recruited for the PAD Trial in the United States and Canada. Methods This was a descriptive study of the characteristics of participating facilities, volunteers, and automated external defibrillator (AED) placements compiled by the PAD Trial, and a qualitative study of factors that facilitated or impeded implementation of emergency lay responder programs using focus groups of PAD Trial site coordinators. Results The PAD Trial enrolled 1,260 community facilities (14.8% residential), with 20,400 lay volunteers (mean +/- standard deviation = 13.4 +/- 10.7 per facility) trained to respond to OOH-CA. The 598 locations randomized to receive AEDs required 2.7 +/- 1.8 AEDs per facility. Volunteer attrition was high, 36% after two years. Barriers to recruitment and implementation included identification of appropriate "at-risk" facilities, lack of interest or fear of litigation by a facility key decision maker, lack of motivated potential volunteer responders, training and retraining resource requirements, and lack of an existing communication/response infrastructure. Conclusions These data indicate that implementation of community-based lay responder programs is feasible in many types of facilities, although these programs require substantial resources and commitment, and many barriers to implementation of effective PAD programs exist.

Published
2005

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