The training components of public access defibrillator (PAD) programs are something that can vary with state and local ordinances — and they should be addressed early in the development of your program. When we launched our program, we mandated that each recipient receiving a PAD would have a minimum of four people trained in CPR.

Through the use of fire department CPR trainers and those from other organizations, we were able to effectively school thousands of people in CPR and the PAD. It's also important to continue CPR training and maintain a significant number of citizens in the community with this lifesaving knowledge.

In Sioux Falls, our fire department trains more than 2,500 people each year in CPR. As a side note, the majority of PADs that have been used in the Sioux Falls system were deployed by people with no training. A review showed that all used the PADs successfully, following the manufacturer's instructions.

The placement of the PADs is another vital element in your program. This is a two issue concept.

First, consideration for the locations of PADs should include a historical review of cardiac arrests in your community as well as a literature review of PAD studies. The AHA’s estimate of survivability makes placement an important factor. This concept — that time in arrest decreases cardiac muscle survivability — must take into account more than just the response time to the address of the incident.

A 360 degree review of your response times is an important consideration regarding locations. A very important time factor is the patient contact time. This is the interval from a unit's on-scene time to when crews are actually at a patient's side. One needs to incorporate this "time to patient" when considering PAD locations as time increases when going up, down or vertically inside structures.

The secondary consideration involves the types of facilities where PADs can have the greatest potential impact. The most obvious locations are those with large numbers of people, and locations of large buildings such as high-rises, factories, stadiums and airports. Other important sites are those with high or at-risk populations. A quick benchmark in this consideration was populations of more than 100, and more than 50 years of age.

In our program, we use lobbies as a primary location for PADs. They are also placed on each third story next to elevators. These locations are usually well known and are easy to find when looking for a PAD. We have mandated that all PADs will be located in a cabinet that bear the same style, size and printing.

This increases the public's awareness of the program as well as making the PAD easy to locate in an emergency. Another side benefit from consistent cabinets was additional marketing and branding of the PAD program.

One other key consideration with putting together a PAD program is the integration with EMS. In this sense, EMS is used in a broad format including fire, law enforcement and EMS itself. There are several areas to consider during this phase:

1. Will the PADs be compatible with the defibrillators used by responding EMS units? Can the electrodes (patches) be used from the PAD with the responding units?

2. Will our first responder police and fire units have PADs in their vehicles?

3. Will EMS staff feel comfortable with the PAD technology that is selected? Tip — get their involvement and opinions)?

4. Will the PAD integrate into your system's current protocols (energy levels, escalating energy, biphasic vs. monophasic, pediatric capability)?

5. What is the cost to put the PAD back into service and who will support this? Tip — this can range from $40 to more than $200.

6. Who will follow up on usage, maintenance and become the PAD manager? Generally, someone in the EMS system is ideal for this role. This needs to be considered, even with small or startup programs.

Another integration consideration is having all the PAD locations added to your computer aided dispatch (CAD) database. By having the locations added to the database, 911 dispatchers can easily determine if a PAD is at the location of the caller and dispatchers can offer that information to them. Within our system, we have a small heart icon that appears when the caller's address is verified to have a PAD. This allows a quick visual prompt and provides the dispatcher the locations of all the PADs located at that address.

There are many things to consider when beginning a PAD program, in addition to those I've presented in this series. These programs are one of the key things the fire service can provide their community as a way to increase the survivability of patients in a cardiac arrest. Putting significant effort into the planning phase will ensure your PAD program is both successful and functional.

For more information or advice on developing your PAD program, feel free to contact me at my e-mail address at bottom of this article.