Automatic External Defibrillation
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Kouwenhouven showed that electrical shocks applied to dogs within 30 seconds of an induced ventricular fibrillation (VF) could produce a 98% rate of resuscitation; however, those shocked after 2 minutes of ventricular fibrillation had only a 27% resuscitation rate. [1] This gave rise to the goal of early defibrillation for ventricular fibrillation and pulseless ventricular tachycardia (VT). The use of automatic external defibrillators (AEDs) can aid in reaching this objective.
Survival rates for individuals with ventricular fibrillation treated by AEDs have been reported between 0% and 31%. Comparatively, the survival rates for performing basic cardiopulmonary resuscitation (CPR) alone are reported between 0% and 6%. Theoretically, even more lives could be saved if targeted members of the general public could obtain early access to and have training in the use of AEDs and CPR. Unfortunately, only about 10-15% of cardiac arrests occur in a public place and even fewer are witnessed. [2]
For patient education information, see Automated External Defibrillators (AED) and Cardiopulmonary Resuscitation (CPR), as well as the Public Health Center and Heart Center.
In 1775, Abildgaard described a series of experiments in which he made hens lifeless with electrical impulses applied through the body. He could not restore a pulse, however, unless shocks were delivered across the chest. In 1849, Ludwig and Hoffa first described what Abildgaard had induced. They originated and defined the term fibrillation of the ventricles. In 1900, Prevost and Batelli conducted research on ventricular fibrillation (VF) in dogs. They found that weak alternating current (AC) or direct current (DC) shocks produced ventricular fibrillation, while much stronger current was needed to defibrillate.
Wiggers and Wegria expanded on the work of Prevost and Battelli, describing a vulnerable period of the cardiac cycle utilized to induce ventricular fibrillation. They also reported that the current delivered was the key to successfully performing what they termed “countershocking” of ventricular fibrillation.
Development of practical defibrillators began in the 1920s with funding from Consolidated Edison of New York in response to an increasing number of electric shock accidents and deaths. In 1947, Beck et al performed the first successful human defibrillation using specially designed internal cardiac paddles. [3] He used 2 110-volt, 1.5-amp AC current shocks to resuscitate a 14-year-old boy who had become pulseless during elective chest surgery. In 1956, Zoll et al performed the first successful human external defibrillation using a 15-amp AC current that produced 710 volts applied across the chest for 0.15 seconds. [4] In 1961, Alexander, Kleiger, and Lown first described the use of AC current for terminating ventricular tachycardia (VT). [5] Work by Lown et al in the early 1960s demonstrated the superiority and safety of DC over AC for defibrillation.
Ambulance-transported Belfast physicians first performed successful prehospital defibrillation in 1966. Defibrillation by emergency medical technicians (EMTs) without the presence of physicians was first performed in Portland, Oregon, in 1969 and was reported in 1972.
In the early 1970s, Dr Arch Diack, Dr W. Stanley Welborn, and Robert Rullman [6] developed several prototype AEDs that were tested in the Portland area. They later formed the Cardiac Resuscitator Corporation to market their device.
Prehospital trials began in Brighton, England, in 1980 using the Heart Aid. The device weighed 28 pounds and used an oral/epigastric and a precordial electrode to record ECG tracings and deliver electrical shocks. It was also capable of transcutaneously pacing the heart. In 1982, the US Food and Drug Administration (FDA) gave approval for EMT-defibrillation (EMT-D) clinical trials. Early US investigations of manual EMT-D were carried out in Washington, Iowa, Minnesota, and Tennessee.
In the early 1990s, successful training and use of AEDs by police officers and other first responders was reported.
In the 1990s, AED use by lay personnel was approved by the FDA, and Good Samaritan legislation soon followed. AED training was included in the American Red Cross basic CPR course beginning in March of 1999. In November 2002, the Phillips HeartStart AED was approved for home use with a prescription. New York State became the first state to mandate AEDs in schools in May 2003. The Federal Aviation Administration (FAA) mandated in April 2004 that all large passenger-carrying US airlines carry and have personnel trained in the use of AEDs.
In September 2004, the FDA began to allow home AED sales without a prescription. However, routine AED use in high-risk homes is controversial. On the other hand, its use in high-risk populated areas has resulted in numerous lives saved in casinos, schools, stadiums, and airports.
Early models of AEDs required inserting an oral/epigastric electrode and placing a second electrode on the chest. Current AEDs require the placement of pads at the right sternal border and at the cardiac apex. These electrodes serve to both monitor and defibrillate. AEDs also can inform the user when lead contact is poor, when the machine is preparing to defibrillate, when to check for a pulse, when a nonshockable rhythm is present, or when motion is detected.
Early AEDs were designed to respond primarily to a heart rate greater than 150 electrical complexes per minute and an electrocardiographic wave (QRS) amplitude greater than 0.15 mm. Presently, the ECG rhythm is analyzed via a combination of several methods. In addition to rate and amplitude criteria, the QRS is analyzed as to its slope, morphology, power spectrum density, and time away from the isoelectric baseline for preset levels defined as abnormal. Checks are made in 2- to 4-second intervals. In general, if abnormal complexes are detected for more than double the frequency of any other QRS for 3 consecutive checks, the AED will be primed to deliver a shock.
Fine ventricular fibrillation (VF) presents the greatest detection challenge. A trade-off exists between setting the amplitude criterion low enough to detect fine fibrillation, yet high enough to avoid shocking asystole or artifact. The sensitivity of detecting VF by AEDs has been reported as 76-96%. Specificity (correctly identifying non-VF rhythms) is reported to be nearly 100%.
Monophasic defibrillation delivers a charge in only one direction. Biphasic defibrillation delivers a charge in one direction for half of the shock and in the electrically opposite direction for the second half.
Dog studies have shown less conduction block and fewer ST segment changes after biphasic shock delivery than after monophasic delivery. Human studies have shown monophasic delivery to be equivalent to biphasic shocks for electrophysiologic study-induced (EPS-induced) and prehospital VF and VT. [7] Also, studies have shown that a biphasic waveform of 115 J is equivalent to a monophasic wave of about 200 J. Because of the decreased energy needed, most internal cardioversion defibrillators now use biphasic waveforms. Most manufacturers are converting to biphasic AEDs, as the lower amount of energy used can result in both longer battery life and a shorter time to full charge.
While there may be a theoretical clinical advantage to using biphasic defibrillation, most patient studies and reports have shown equivalency and not superiority of one form when using equivalent dosages (biphasic dosages are lower).
Studies with implantable defibrillators have shown a difference in outcome related to electrode polarity. The only prospective study with AEDs, which was performed by Weaver in 1993, showed no difference in survival related to polarity while using a monophasic unit. [8]
Seattle (Suburban EMT AED better than manual defibrillation)
In 1987, Cummins et al reported a controlled study comparing the effectiveness of EMTs with automatic external defibrillators (AEDs) and EMTs with manual defibrillators in treating 147 patients in ventricular fibrillation (VF) in suburban Seattle, Washington. No statistically significant differences in rates of admission (54% AED; 50% manual) or survival to discharge (30% AED; 23% manual) were noted. [9]
In 1988, Weaver et al reported on the use of AEDs primarily by non-EMT first responders (3.3-min response time) followed by paramedics (8.8-min response), compared with basic EMTs (3.4-min response) followed by paramedics (5.1-min response). A prototype AED was used and modified halfway through the study. The combined results of 504 patients in VF showed no difference in admission rates (59% AED; 53% EMT) but a higher rate of survival to discharge in the AED group (30% versus 19%). [10]
Iowa (Rural AED better than manual defibrillation)
In 1986, Stults et al reported on a study comparing AEDs used by EMTs with manual defibrillators used by EMTs. The results of 88 patients in VF showed no significant difference in rates of admission (29% AED; 32% manual) or survival to discharge (17% AED; 13% manual). [11]
Minnesota (No rural AED survivors)
Bachman et al failed to confirm the results from Iowa and Seattle in rural northeast Minnesota. [12] They reported survival to discharge rates of 11% for paramedics, 5% for EMTs with manual defibrillators, and 2.5% for cardiac arrests handled by basic EMTs. Separate analysis for VF was not performed. They found no unwitnessed arrest survivors as earlier studies had, and results caused them to question the use of AEDs in rural areas.
In contrast, Vukov studied EMT defibrillation in rural southeast Minnesota in 1988. [13] In a report of 63 patients, EMTs with AEDs had significantly greater admission rates (30% versus 12%) and survival to discharge rates (17% versus 4%) than EMTs without AEDs.
Detroit, Chicago, and New York (Poor urban results)
In data that have been presented but not published, basic EMTs with AEDs treated 595 patients who were in cardiac arrest in Detroit. Only about 20% were found in VF. About 5% were admitted, and none survived to discharge. Possible factors contributing to the low initial VF and survival rates were an EMS response time of more than 10 minutes and an estimated 5-10 minute time from collapse until EMS was summoned.
Similar studies reported a 4% survival rate from VF in Chicago and a 5% survival rate in New York. Average response times were greater than 10-12 minutes.
Stults and Brown looked at the question of EMTs handling defibrillation without paramedic backup. [14] Of the 271 patients with VF who were shocked, 111 patients who initially converted to organized rhythms after defibrillation were analyzed. Of these, 19 (17%) refibrillated and 11 were reconverted by the EMT-Ds. Among the 111 who initially converted, admission rates were lower (53% versus 76%) but not statistically significantly lower (P > 0.05) for those who refibrillated. Survival to discharge rates were similar (37% refibrillation versus 35% nonrefibrillation).
Early Seattle studies found a significant difference in time to defibrillation: 1.1 minutes for AEDs versus 2 minutes for EMTs with manual defibrillators. Bocka found that EMTs using fully automatic defibrillators in the field were on average 30 seconds faster than counterparts using semiautomatic devices. [15]
Patients must be medically unstable or pulseless before AED is applied. They should be pulseless before assessing the rhythm. This becomes increasingly important as more laypersons are given the opportunity to use AEDs.
Most states have passed a liability waiver for bystanders who use an AED to assist an unconscious patient. The principal risk is that another person may be touching the patient when the shock is administered.
To prevent inaccurate analysis, CPR should be halted while the unit is analyzing the rhythm. Most new units have a motion or CPR detector.
The AED should be used only with caution in a moving vehicle. [16] If being used on a patient in transport, frequent stops for pulse and AED monitoring checks should be made. Most units are designed to warn when motion or poor contact is detected.
As with manual defibrillation, the chest does not need to be shaved prior to electrode placement but, if wet, it should be dried off. Water spots or nicks in the skin result in areas of decreased resistance and could lead to local burns as well as uneven and ineffective defibrillation. Look for nitroglycerin patches and remove them to prevent possible explosive risk.
Proper maintenance is important. However, it is estimated that less than 10% of AED users maintain their AED or replace the batteries according to the manufacturer’s recommendations.
Repeated “check electrode” warnings when electrodes seem properly placed may be from fractured electrodes. Replace them and retry.
Caution should be used when applying AEDs in the presence of electromagnetic interference (EMI). One study showed a 2% false-positive rate, with shocks advised for sinus rhythm and 3.5% sensing motion artifact in the presence of EMI. [17]
Each AED should be programmed to the most current American Heart Association Defibrillation Guidelines. This should be checked, especially when purchasing an older or used AED. Arrangements should be made for reprogramming whenever changes are announced.
Several AED units have been recalled for various problems. The FDA posts summaries of information about the most serious recalls of medical devices, such as AEDs, on its List of Device Recalls Web page.
Concern has been raised about the safety of providers and AED assessment during CPR. However, a study Edelson et al concludes that continuing chest compression while the AED is charging is an underused technique in clinical practice, as it is associated with decreased hands-off time preceding defibrillation, with minimal risk to patients or rescuers. [18]
Population density : Stapczynski et al concluded that areas with a population density of fewer than 100 persons per square mile received little benefit from AEDs. [19] A study from Washington identified 172 sites of higher incidence (of 71,000 sites). Similar local assessments may aid in efficient public AED location.
It is becoming increasingly common for AEDs to be placed in locations with significant public traffic or density (see Public access defibrillation below), such as stadiums and other event venues and airports. American Airlines was the first to carry AEDs on aircraft during long overwater flights in 1997, and subsequent FAA regulations mandated aircraft to carry AEDs and for flight personnel to be trained in their use (amendment to part 121 of Aviation Medical Assistance Act of 1998).
Response time: On average, response time should be less than 4-6 minutes for the patient to benefit from the use of AEDs.
Tiers: Tiered response systems should have compatible equipment. If an AED is to be used by a first responder, defibrillators or their electrode wiring system should be compatible with the transporting units that follow.
Monitor: If the unit also is used by paramedics for monitoring and not just by AED technicians for cardiac arrest, a monitor screen is needed. Printout capabilities are also desirable.
Event recording: A paper recording of the event may be sufficient for medical control; however, the need for a full set of data should influence equipment choice, since the data need to be downloaded. Because most of the data downloaded by AED units are not interchangeable, a setting in which data from various agencies needs to be collected and combined must use similar AEDs that can communicate; if they do not have this capability, data must be collected by hand.
Good Samaritan Immunity and Local Requirements : While most states provide excellent liability immunity for proper use and have minimal requirements for placement, one should check local laws before placement. State requirements can be found at the American Heart AED Legistation page.
Public access defibrillation (PAD) has been shown to be an important part of successful chain of survival programs. [20, 21] Placement of AEDs has been most cost effective in select locations, including casinos, airports, stadiums, health clubs, universities, and senior centers. [22]
In the 1990s, AED use by lay personnel was approved by the FDA and Good Samaritan legislation soon followed. AED training was included in the American Red Cross basic CPR course beginning in March of 1999. In November 2002, the Phillips HeartStart AED was approved for home use with a prescription. The FAA mandated in April 2004 that all large passenger-carrying US airlines carry and have personnel trained in the use of AEDs.
In September 2004, the FDA began to allow home AED sales without a prescription. However, routine AED use in high-risk homes is controversial. On the other hand, its use in high-risk populated areas has resulted in numerous lives saved in casinos, schools, stadiums, and airports. In 2014, the California Supreme Court rule, in the case of Verdugo vs The Target Corporation (S207313), ruled unanimously that California law does not require retailers to have defibrillators available for medical emergencies. [23]
AED manufacturers include the following:
The FDA issued a: Requirement for Premarket Approval for Automated External Defibrillator System, which became effective on February 3, 2015, which represents a tailored approach to help manufacturers improve the quality and reliability of AEDs. The order requires manufacturers of AEDs and accessories to submit premarket approval (PMA) applications that focus specifically on the critical requirements necessary to ensure AEDs are safe and reliable. These have not yet met final approval.the filing of premarket approval applications (PMA) for AED systems, which consist of an AED and those AED accessories necessary for the AED to detect and interpret an electrocardiogram and deliver an electrical shock (eg, pad electrodes, batteries, adapters, and hardware keys for pediatric use).
Kouwenhoven WB. The development of the defibrillator. Ann Intern Med. 1969 Sep. 71(3):449-58. [Medline].
Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. 2010 Apr 20. 55(16):1713-20. [Medline]. [Full Text].
Beck CS, Pritchard WH, Feil SA. Ventricular fibrillation of long duration abolished by electric shock. JAMA. 1947. 135:985-989.
Zoll PM, Linenthal AJ, Gibson W, et al. Termination of ventricular fibrillation in man by externally applied electric countershock. N Engl J Med. 1956 Apr 19. 254(16):727-32. [Medline].
Alexander S, Kleiger R, Lown B. Use of external electric countershock in the treatment of ventricular tachycardia. JAMA. 1961 Sep 30. 177:916-8. [Medline].
Diack AW, Welborn WS, Rullman RG, et al. An automatic cardiac resuscitator for emergency treatment of cardiac arrest. Med Instrum. 1979 Mar-Apr. 13(2):78-83. [Medline].
Faddy SC, Jennings PA. Biphasic versus monophasic waveforms for transthoracic defibrillation in out-of-hospital cardiac arrest. Cochrane Database Syst Rev. 2016 Feb 10. 2:CD006762. [Medline].
Weaver WD, Martin JS, Wirkus MJ, Morud S, Vincent S, Litwin PE, et al. Influence of external defibrillator electrode polarity on cardiac resuscitation. Pacing Clin Electrophysiol. 1993 Feb. 16(2):285-90. [Medline].
Cummins RO, Eisenberg MS, Litwin PE, Graves JR, Hearne TR, Hallstrom AP. Automatic external defibrillators used by emergency medical technicians. A controlled clinical trial. JAMA. 1987 Mar 27. 257 (12):1605-10. [Medline].
Weaver WD, Hill D, Fahrenbruch CE, et al. Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med. 1988 Sep 15. 319(11):661-6. [Medline].
Stults KR, Brown DD, Kerber RE. Efficacy of an automated external defibrillator in the management of out-of-hospital cardiac arrest: validation of the diagnostic algorithm and initial clinical experience in a rural environment. Circulation. 1986 Apr. 73 (4):701-9. [Medline].
Bachman JW, McDonald GS, O’Brien PC. A study of out-of-hospital cardiac arrests in northeastern Minnesota. JAMA. 1986 Jul 25. 256(4):477-83. [Medline].
Vukov LF, White RD, Bachman JW, et al. New perspectives on rural EMT defibrillation. Ann Emerg Med. 1988 Apr. 17(4):318-21. [Medline].
Stults KR, Brown DD. Refibrillation managed by EMT-Ds: incidence and outcome without paramedic back-up. Am J Emerg Med. 1986 Nov. 4(6):491-5. [Medline].
Bocka JJ, Swor R. In-field comparison between fully automatic and semi-automatic defibrillators. Prehospital Disaster Med. 1991. 6(4):415-420.
Ornato JP, Shipley J, Powell RG, et al. Inappropriate electrical countershocks by an automated external defibrillator. Ann Emerg Med. 1992 Oct. 21(10):1278-82. [Medline].
Fleischhackl R, Singer F, Nitsche W. Influence of electromagnetic fields on function of automated external defibrillators. Acad Emerg Med. 2006 Jan. 13(1):1-6. [Medline].
Edelson DP, Robertson-Dick BJ, Yuen TC, Eilevstjønn J, Walsh D, Bareis CJ. Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study. Resuscitation. 2010 Nov. 81(11):1521-6. [Medline].
Stapczynski JS, Svenson JE, Stone CK. Population density, automated external defibrillator use, and survival in rural cardiac arrest. Acad Emerg Med. 1997 Jun. 4(6):552-8. [Medline].
Ringh M, Hollenberg J, Palsgaard-Moeller T, Svensson L, Rosenqvist M,et al. The challenges and possibilities of public access defibrillation. J Intern Med. 2018 Mar. 283 (3):238-256. [Medline].
Bækgaard JS, Viereck S, Møller TP, Ersbøll AK, Lippert F, Folke F. The Effects of Public Access Defibrillation on Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review of Observational Studies. Circulation. 2017 Sep 5. 136 (10):954-965. [Medline].
Whitney-Cashio P, Sartin M, Brady WJ, Williamson K, Alibertis K, Somers G, et al. The introduction of public access defibrillation to a university community: The University of Virginia Public Access Defibrillation Program. Am J Emerg Med. 2011 Sep 9. [Medline].
Egelko B. Defibrillators not required in stores. San Francisco Chronicle. June 23, 2014. Available at https://www.sfgate.com/health/article/Court-takes-retailers-off-the-hook-for-5573226.php.
Bartimus HA, Rea TD, Eisenberg MS. Prevalence of automated external defibrillators at cardiac arrest high-risksites. Prehosp Emerg Care. 2004 Jul-Sep. 8(3):280-3. [Medline].
Becker L, Eisenberg M, Fahrenbruch C, et al. Public locations of cardiac arrest. Implications for public access defibrillation. Circulation. 1998 Jun 2. 97(21):2106-9. [Medline].
Caffrey SL, Willoughby PJ, Pepe PE. Public use of automated external defibrillators. N Engl J Med. 2002 Oct 17. 347(16):1242-7. [Medline].
Cummins RO, Chapman PJ, Chamberlain DA, Schubach JA, Litwin PE. In-flight deaths during commercial air travel. How big is the problem?. JAMA. 1988 Apr 1. 259(13):1983-8. [Medline].
Eisenberg MS, Copass MK, Hallstrom A, et al. Management of out-of-hospital cardiac arrest. Failure of basic emergency medical technician services. JAMA. 1980 Mar 14. 243(10):1049-51. [Medline].
Eisenberg MS, Copass MK, Hallstrom AP. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med. 1980 Jun 19. 302(25):1379-83. [Medline].
Eisenberg MS, Moore J, Cummins RO, Andresen E, Litwin PE, Hallstrom AP, et al. Use of the automatic external defibrillator in homes of survivors of out-of-hospital ventricular fibrillation. Am J Cardiol. 1989 Feb 15. 63(7):443-6. [Medline].
England H, Hoffman C, Hodgman T, Singh S, Homoud M, Weinstock J, et al. Effectiveness of automated external defibrillators in high schools in greater Boston. Am J Cardiol. 2005 Jun 15. 95(12):1484-6. [Medline].
Gentile D, Auerbach P, Gaffron J. Prehospital defibrillation by emergency medical technicians. Results of a pilot study in Tennessee. J Tenn Med Assoc. 1988 Mar. 81(3):144-8. [Medline].
Gray AJ, Redmond AD, Martin MA. Use of the automatic external defibrillator-pacemaker by ambulance personnel: the Stockport experience. Br Med J (Clin Res Ed). 1987 May 2. 294(6580):1133-5. [Medline].
Greene HL, DiMarco JP, Kudenchuk PJ, et al. Comparison of monophasic and biphasic defibrillating pulse waveforms for transthoracic cardioversion. Biphasic Waveform Defibrillation Investigators. Am J Cardiol. 1995 Jun 1. 75(16):1135-9. [Medline].
Hallstrom AP, Ornato JP, Weisfeldt M. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004 Aug 12. 351(7):637-46. [Medline].
Heber M. Out-of-hospital resuscitation using the “Heart-Aid”, an automated external defibrillator-pacemaker. Int J Cardiol. 1983 Jul. 3(4):456-8. [Medline].
Jaggarao NS, Heber M, Grainger R. Use of an automated external defibrillator-pacemaker by ambulance staff. Lancet. 1982 Jul 10. 2(8289):73-5. [Medline].
Lerner EB, Billittier AJ 4th, Newman MM, Groh WJ. Automated external defibrillator (AED) utilization rates and reasons fire and police first responders did not apply AEDs. Prehosp Emerg Care. 2002 Oct-Dec. 6(4):378-82. [Medline].
Lown B, Amarasingham R, Neuman J. Landmark article Nov 3, 1962: New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. By Bernard Lown, Raghavan Amarasingham, and Jose Neuman. JAMA. 1986 Aug 1. 256(5):621-7. [Medline].
Martinez-Rubio A, Kanaan N, Borggrefe M, et al. Advances for treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol. 2003 Feb 19. 41(4):627-32. [Medline].
Pantridge JF, Geddes JS. A mobile intensive-care unit in the management of myocardial infarction. Lancet. 1967 Aug 5. 2(7510):271-3. [Medline].
Scheatzle MD, Menegazzi JJ, Allen TL, et al. Evaluation of biphasic transthoracic defibrillation in an animal model of prolonged ventricular fibrillation. Acad Emerg Med. 1999 Sep. 6(9):880-6. [Medline].
Schneider T, Martens PR, Paschen H. Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims. Circulation. 2000 Oct 10. 102(15):1780-7. [Medline].
Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000 Oct 26. 343(17):1206-9. [Medline].
White RD, Blanton DM. Biphasic truncated exponential waveform defibrillation. Prehosp Emerg Care. 1999 Oct-Dec. 3(4):283-9. [Medline].
White RD, Vukov LF, Bugliosi TF. Early defibrillation by police: initial experience with measurement of critical time intervals and patient outcome. Ann Emerg Med. 1994 May. 23(5):1009-13. [Medline].
Joseph J Bocka, MD Attending Emergency Physician, OhioHealth MedCentral Health System; Emergency Medical Service Medical Director, Multiple EMS Service; Ohio EMS RPAB Region Chair
Joseph J Bocka, MD is a member of the following medical societies: American Academy of Emergency Medicine, Phi Beta Kappa, American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
A Antoine Kazzi, MD Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.
Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Sanz Laniado Medical Center, Netanya, Israel
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Edward Bessman, MD, MBA Chairman and Clinical Director, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine
Edward Bessman, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
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