The use of AED's - Essay Example

TABLE OF QUESTIONS (ANSWERED) Important s R1, R2, R3, R4 and R5 stand for Review Review 2, Review 3, Review 4, Review 5 and Review 6 respectively; (2) All questions are Yes/No/Unspecified type questions; (3) Y-Yes, N-No and U-Unspecified (4) All objective reports have been separately prepared on the same reviews analyzed here. Heading Questions R1 R2 R3 R4 R5 R6 Title Author(s) Abstract Introduction Literature Review The Hypothesis Operational Definitions Methodology Subjects Sample Selection Data Collection Ethical Considerations Results Data Analysis Discussion Conclusions Recommendations Is the title concise? Is the title informative? Does the title clearly indicate the content? Does the title clearly indicate the research Approach used? Does the author(s) have appropriate academic Qualifications? Does the author(s) have appropriate professional Qualifications and experiences? Is there an abstract included? Does the abstract identify the research problem? Does the abstract state the hypotheses (if appropriate)? Does the abstract outline the methodology? Does the abstract give details of the sample subjects? Does the abstract report major findings? Is the problem clearly identified? Is a rationale for the study stated? Are limitations of the study clearly stated? Is the literature review up to date? Does the literature review identify the underlying theoretical framework(s)? Does the literature review present a balanced evaluation of material both supporting and challenging the position being proposed? Does the literature clearly identify the need for the research proposed? Are important references omitted? Does the study use an experimental approach? Is the hypothesis capable of testing? Is the hypothesis unambiguous? Are all terms used in the research question/problem clearly defined? Does the methodology section clearly state the research approach to be used? Is the method appropriate to the research problem? Are the strengths and weaknesses of the approach chosen stated? Are the subjects clearly identified? Is the sample selection approach congruent with the method to be used? Is the approach to the sample selection clearly stated? Is the sample size clearly stated? Are any data collection procedures adequately described? Has the validity and reliability of any instrument or questionnaires been clearly stated? If the study involves human subjects, has the study ethical committee approval? Is informed consent sought? Is confidentiality assured? Is anonymity guaranteed? Are results presented clearly? Are the results internally consistent? Is sufficient detail given to enable the reader to judge how much confidence can be placed in the findings? Does graphic material enhance clarity of the results being presented? Is the approach appropriate for the type of data collected? Is any statistical analysis correctly performed? Is there sufficient analysis to determine whether ‘significant differences’ are not attributable to variations in other relevant variables? Is completed information (test value, df, and p) reported? Is the discussion balanced? Does the discussion draw upon previous research? Are the weaknesses of the study acknowledged? Are clinical implications discussions? Are conclusions supported by the results obtained? Are the implications of the study identified? Do the recommendations suggest further areas for research? Do the recommendations identify how any weaknesses in the study design could be avoided in the future research? Y Y Y N Y Y Y Y N N Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y N Y Y Y Y N N Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y N Y Y Y N Y Y Y Y N Y Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y N N Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y N Y Y Y N Y Y N N N N N N Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y N Y Y Y Y Y N Y Y Y Y Y N Y Y Y N Y Y Y Y Y Y N Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y N N Y Y Y Y Y Y Y N Y Y Y Y Y N U U Y Y U U Y Y Y N Y Y Y Y Y Y N Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y N N Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y N Y Y Y N Y Y Y Y N Y N Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y N N Y Y Y Y Y Y Y N Y Y Y Y Y N N N Y N N N LITERATURE REVIEWS OF RESEARCH ARTICLES ON: (1) USE OF AUTOMATED EXTERNAL DEFIBRILLATORS (2) RETENTION OF SKILLS AND THEIR INADEQUACY AMONG LAYPERSONS AN INTRODUCTION As deaths relating to cardiac arrest are seen multiplying tenfold today, it is important to take a serious stand on the issue. Cardiac deaths can occur anywhere, anytime and anyhow – be it the workplace, the house or even a playground. Since over 150000 cardiac-related deaths are reported in the UK alone, the occurrence of cardiac arrest is by no means rare. And since the worksite is the place where one frequents the day, the increasing number of cardiac related deaths is going up by the minute. Cardiac deaths are primarily caused by a fatal abnormal heart rhythm called ventricular fibrillation (VF). Many cardiac arrests occur because of VF, and unless detected and defibrillated in time, the victim’s death is certain. It is proven that the chances of successful defibrillation decline at the rate of 7-10% per minute of delay. And here is precisely where AEDs – automated external defibrillators – come into play. These devices correct the abnormal heart rhythm by providing shock waves as required. The importance of AED, however, is not backed up with public understanding. The public does not take AED very seriously, and that is another point of concern. The six articles reviewed here are full of accurate, recent and verified data that give us a deep insight into the use of automated external defibrillators and of course, the alarming decline in first aid skills in laypersons. Literature Review 1: Public Access Defibrillation in Out-of-Hospital Cardiac Arrests The Review The article is a well researched survey that studies the concept of PAD – Public Access Defibrillation – and how it is highly significant in public life. Out-of-hospital cardiac arrests are naturally much higher than in-hospital attacks, and clearly far more dangerous. There are no paramedics, no doctors – just ordinary people and laymen all around. So, the concept of PAD is clearly a life saving one, and this has been well talked about in the article. The study design and choice of location is immaculate. The area of survey was Seattle and the surrounding King County, Washington. For the sake of study purposes, PAD was considered any non-EMS (Emergency Medical Services) AED use, and regardless of the AED operator. This important assumption means that any use of automated external defibrillators by the general public was covered under the survey, making it highly accurate. The sample size chosen for the survey befits its importance. The chosen area consisted of over 1.75 million residents, and comprised of multiple ethnic backgrounds. The article elucidates the entire study design perfectly well, and calls for taking AEDs beyond EMS – straight to the public itself. While the entire study is a community-based research survey, there is still a lack of uniformity as regards the strategy of “community-wide AED placement”. This means that while some groups have mandated AED placement, some have made it voluntary. The article says that a community conference was called in 1996 to implement the strategy of taking AED beyond EMS. Accordingly, enrollment in the PAD AED program required trained AED and CPR administration, to call local EMS and of course, 9-1-1. The article crisply quotes the collection of data in the following words: “For each participating entity in the Community Responder AED Program, information was collected during registration that included site name and address, site coordinator, medical supervisor, device location, number of persons trained, and type of training, as well as plans for maintenance and ongoing training. Information about cardiac arrest involving PAD AEDs was collected from 3 possible sources: the EMS report, a direct contact between the EMS agency and Community Responder program manager, and/or a direct contact between the PAD AED entity and the program manager.”1 The results as reported by the article are promising. 475 AEDs were registered with the community program. An overwhelming 4004 people were trained. Out of 2124 cardiac cases reported in Seattle and 3037 in the King County, a total of 4.9% of cardiac arrests were treated with PAD AEDs, before EMS arrival. Translated, a total of 50 cases were taken care of by PAD AEDs. (22% or 11 cases (out of fifty) were not treated by PAD AEDs.) Conclusion The article is a precise, verified and an authentic survey. The article also discusses these findings and numbers in depth. All the figures quoted above are merely a drop in the ocean. In this article, every single finding was supported with authentic data, making it a highly, highly reliable one. Literature Review 2: Public-Access Defibrillation and Survival after Out-of hospital Cardiac Arrest (NEW ENGLAND JOURNAL OF MEDICINE) The Review The article talks about out-of-hospital deaths arising out of cardiac arrests. The article reports at the very beginning that the rate of survival of such victims is extremely low, thus stressing on the need for public awareness about the same. The article calls for the increased use of AEDs by the public, and help avert fatalities in the absence of qualified help. The article is also a well conducted research like the previous one. This research is also a community-based project, studying 993 communities. However, in this case, two main population groups were studied: The volunteering respondents and patients with out-of-hospital cardiac arrests. The project spawned over three years. The AEDs that were used for the survey were approved by the FDA and were produced by three manufacturers. Another difference between this study design and the previous one lies in the randomization. In this study, communities were assigned to two groups: one trained in CPR only, and the other trained in CPR-plus-AED administration. The results clearly reflected a greater success rate of the second group. The survival rate of victims was only 7% in the group trained only in CPR administration. The results of the survey have been well reported. Out of the 993 communities assigned, many volunteers chose to participate in the CPR-cum-AED group, in which hospital admission was reported as higher. Majority of the facilities were located in recreational areas – shopping malls, theaters, etc. Many people crossed over from the CPR only group to the CPR plus AED group. Conclusion The article is well-researched, full of statistics and numbers, and definitely a good source to study PAD patterns. The sample size was pretty high, and every minute detail – ranging from hospital admissions to survival rates to important discussions of the results – has been perfectly taken care of. Literature Review 3: Outcomes of Rapid Defibrillations by Security Officers after Cardiac arrests in Casinos The Review The article reports a study of instances where AEDs were used in Casinos. Accordingly, security officers were trained to administer defibrillation and were trained to use AEDs. This was to be followed by manual CPR, if required. The primary objective was the successful discharge from hospital The research involved the study of 105 patients whose cardiac arrest was caused by ventricular fibrillation. Amazingly, a total of 53% of all patients survived their cardiac arrest. The other surprising numbers, as reported by the article are: a 74% survival rate among people who received defibrillation within one minute of their collapsing, and 49% for those receiving AED aid after three minutes. Conclusion The article discusses the study design concisely. The systematic approach to the entire research and the accuracy of the study reveals a lot. Apart from backing up the research with the relevant numbers, the article reveals important facts as well; for instance, the fact that AED must be administered within three minutes or the chances of survival drop. Literature Review 4: Skill Acquisition and retention in AED and CPR by lay responders The Review The article is a thoroughly researched survey that reports the pattern of AED and CPR use and training among the 112 trainees who were chosen. The article deals with the problem of skill retention among the volunteers in the England National Defibrillator program. It has been reported that before the training was given, only about 44% of the trainees delivered a shock. But after training this figure improved and the delay of AED administration also dropped by 57 seconds. However, even after training, safety checks were not properly administered; neither were the trainees placing the electrodes in the “ideal” position. Conclusion This short article is an eye-opener in proving the fact that despite training sessions being conducted, the volunteers still do not know how to do things the right way. The retention of skills is a challenge, and the volunteers are not facing it properly. Literature Review 5: How Well are CPR and AED skills retained over time? The Review The article is one of the most interesting and informative surveys ever, detailing the skill retention and the frequency of retraining employees. Volunteer laypersons were trained and their efficiency at the end of the training was evaluated. Over 2000 volunteers participated in the CPR training, while over 3000 participated in the CPR-cum-AED program. Their training involved all normal procedures one is supposed to undertake in times of emergency. Their efficiency and retention of skills were put to test three to seventeen months after the training. A majority of the volunteers retained their skills even seventeen months after their training was over. However, this figure is not the only one to go by. There were some declines reported in the time lag, seen especially in the survey conducted 17 months later to the training. Conclusion The above survey is rare. Many surveys criticize the lack of skills among laypersons, but the survey proves it otherwise. The retention shown by the employees is superb, despite the declines reported. More than 79% of all the trainees were having an “adequate” performance rating. Literature Review 6: CPR skill retention by basic Lay rescuers The Review This article clearly shows the lack of skills among laypersons in times of emergency. The study conducted by The Manitoba Heart Foundation, revealed some startling figures. Like every other survey, training was imparted to all volunteers. Soon enough, without warning, they were tested. It was subsequently found that only 40% of all the trainees retained their skills as imparted to them during the training period. Clearly, the training fizzled out after sometime. The article rightly quotes that, “This study supports the following recommendations: 1) lay basic rescuers should be retrained within the first year; 2) further studies of the factors influencing retention are advisable; 3) the younger age groups should be the first priority for citizen CPR training; and 4) because first aid training appears to improve CPR retention, training in both should be encouraged.”2 Conclusion The survey reported in this article reports the obvious. Calling for immediate action, the article is not theoretical like others. While many surveys report findings alone, this one calls for action and gives some practical suggestions for the same. References (Listed in order of review): (1) Culley LL; Rea TD; Murray JA; Welles B; Fahrenbruch CE; Olsufka M; Eisenberg MS; Copass MK 2004 - Public access defibrillation in out-of-hospital cardiac arrest: a community-based study. Circulation, 2004 Apr 20; 109(15): 1859-63; (2) Cuthbertson, S., 2005 Volunteers trained in CPR and use of automated external defibrillators increased survival after out of hospital cardiac arrest. Evidence-Based Nursing (EVID BASED NURS), 2005 Apr; 8(2): 50 (3) Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. New England Journal of Medicine, 2000 343 (17): 1206-9 (4) Woollard M, Whitfeild R, Smith A, Colquhoun M, Newcombe RG, Vetteer N, Chamberlain D. 2004 Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study. Resuscitation 2004 Jan; 60(1):17-28. (5) How well are CPR and AED skills retained over time? – Results from the public access d (PAD) trial. 2006 Mar 13 (3): 254 –63 (6) Wilson e, Brooks, B Tweed, WA 1983 CPR skills retention of lay basic rescuers. Annals of Emergency Medicine. 1983 Aug 12 (8): 482 –4 Read More