AEDs not always ready when needed: Report

More than 550 incidents of defibrillators failing in last 5 years, resulting in 9 deaths

Defibrillators can save lives, but not if they aren’t working.

There were 562 reports to Health Canada of automated external defibrillators (AEDs) failing to work on a patient in five years. Nine patients died as a result, according to a Health Canada report obtained by CBC News.

Units wouldn’t turn on, or powered off without warning, 102 times, the report stated.

The report wasn’t just on public access defibrillators, said Andrew Lotto, manager of resuscitation in Ontario for the Heart and Stroke Foundation.

“We’re aware that the Health Canada report and the CBC story suggested that there are a number of defibrillators out in the real world that are not exactly working up to spec,” he said.

The concern from the organization’s perspective is the Health Canada report listed all types of defibrillators, including hospital defibrillators, units used by emergency services personnel and even implanted devices such as pacemakers, said Lotto.

“There was a bit of a misconception that these were public access defibrillators, or the ones you would sort of see when you’re out and about in your daily travels in the public,” he said.

“Even though there’s been some stories in the press that have sensationalized defibrillators that didn’t work,” people are much more likely to be victims of sudden cardiac arrest if there wasn’t a defibrillator at all, said Cam Pollock, vice-president of global marketing at Physio-Control, a Redmond, Wash.-based company that sells AEDs in Canada.

There’s only one cure for sudden cardiac arrest and that’s a defibrillator, he said.

“Even if they failed half the time, you’d be better off having one than not having one, because you’ve got about a 10-minute window to survive,” said Pollock.

Some reports of defibrillation failure indicate the unit turned on but a shock was not delivered or not advised, said Lotto.

“Not in every instance is a shock advisable and not in every instance will a shock be delivered,” he said. “The unit looks for and detects a shockable rhythm and, if its not found, it will not shock. That’s a safety practice because it's in an effort to avoid a situation where someone could apply a unit to a perfectly well individual and shock them.”

AEDs run self-tests and all units give an audio and visual indication when there is something wrong with the unit, said Greg Slusser, vice-president of sales and marketing at Defibtech, a company based in Guilford, Conn., that is approved to sell defibrillators in Canada.

“All AEDs that are on the market run a series of self-tests,” he said.

The test are done at different intervals and they test different aspects of the unit, but the device will perform self-diagnostics at regular intervals to ensure the rescue-readiness, said Slusser.

If the unit fails any of these self-tests, it will inform the user that it's not rescue-ready, he said.

All units have a visual indicator, such as a red flashing light, to tell people when the unit needs maintenance.

Because some people put units in places they might not always be visible, such as the trunk of a car if the unit is used on the road, there is also an audio signal if there is a malfunction.

Some maintenance for the devices is the responsibility of the user. Defibrillator pads and batteries expire at different times, depending on the manufacturer.

“It’s kind of like with your car,” said Slusser.

A car goes through self-diagnostic tests to check the engine and brakes, but it can’t be responsible for ensuring every part of the vehicle is working properly.

“But at the end of the day you still need to look at your tires,” said Slusser. “If they’re bald or flat the car’s not going to tell you. So that’s the same thing with AEDs. You can test everything and make sure it’s in working order but (when) the pads and the batteries expire they need to be replaced.”

If safety professionals are putting a defibrillator in the workplace, there need to people in the organization who know how to use it. And everyone in the organization should be able to recognize the signs of cardiac arrest, said Pollock.

Despite the audio signal units make when there is necessary maintenance, Pollock advises safety professionals to place devices somewhere they are easy to see.

“People need to know where those AEDs are,” he said. “They should be in a visible location and easily accessible.”
Safety professionals have to make sure defibrillators are checked regularly. Physio-Control recommends checking them at least once a week.

“It’s a matter of having somebody look at it,” said Pollock, adding at Physio-Control they have an employee check the devices daily. “If people follow those steps it should be ready to use when it's needed.”

The failure rates of AEDs are actually really low, said Pollock.

“It’s just like any electronic device... it’s got moving parts so there’s the possibility that one may fail,” he said.

Heart and Stroke’s position is defibrillators are an essential tool in lifesaving. Defibrillators placed in public access areas by the organization have saved 39 lives over the past six years, Lotto said.

The organization doesn’t set guidelines on maintenance, but recommends that users follow the manufacturer's specifications. Typically speaking, a defibrillator should be checked at least weekly to ensure all status symbols on the unit are indicating the device is in good working order, he said.

Lotto recommends partnering with a third-party service or local emergency services unit to do inspection of a unit.

“It’s a real good insurance policy,” he said.

A unit may not deliver a shock if the pads are not plugged in or a battery is dislodged. Or if the person administering the shock doesn’t notice that someone else is touching the victim and the unit detects two heart rhythms.

“But that’s all part of the training.”

The organization also recommends annual renewal of CPR skills. All courses include AED training.

“They’re all integrated courses now,” he said.

Maintenance and training when dealing with defibrillators is essential.

“Defibrillators are inanimate pieces of plastic that are hung on a wall,” he said. “The human element is the most important component.”

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