Cardiac arrests in schools: assessing use of automated external defibrillators (AED) on school campuses

Abstract

Background: Sudden cardiac arrest in schools are infrequent, but emotionally charged events. The purpose of our study was to: (1) describe characteristics and outcomes of school cardiac arrests; and (2) assess the feasibility of conducting school bystander interviews to describe the events surrounding cardiac arrests, assess AED availability and use, and identify barriers to AED use.

Methods: We performed a telephone survey of bystanders to cardiac arrests occurring in K-12 schools in communities participating in the Cardiac Arrest Registry to Enhance Survival (CARES) database and a local cardiac arrest database. The study period was from 8/2005 to 8/2011 and continued in one community through 2011. Utstein style descriptive data and outcomes were collected. A structured telephone interview of a bystander or administrative personnel was conducted for each cardiac arrest event. We collected a descriptive event summary, including provision of bystander CPR, presence of an AED and information regarding AED deployment, training, and use and perceived barriers to AED use. Descriptive data are reported.

Results: During the study period there were 30,603 cardiac arrests identified at study communities, of which 47 (0.15%) events were at K-12 schools. Of these, 21 (45.7%) were at high schools, a minority (16, 34.0%) were children (<age 19), most (39, 83.0%) were witnessed arrests, a majority (36, 76.6%) received bystander CPR, and 27 (57.4%) were initially in ventricular fibrillation (VF). Most arrests (28/40, 70%) occurred during the school day (7a-5p). From this population, 15 (31.9%) survived to hospital discharge. A telephone interview was completed for 30 of 47 K-12 events. Nineteen schools had an AED on site. Most schools (84.2%) with AEDs reported that they had a training program, and personnel identified for its use. An AED was applied in 11 of 19 patients, of these 8 were in VF and 4 (all VF) survived to hospital discharge. Bystanders identified multiple reasons for non-use of the AED in the other eight patients.

Conclusions: Cardiac arrests in schools are rare events, most patients are adults and receive bystander CPR. AED application by laypersons was infrequent but resulted in excellent (4/11) survival. AEDs were not used in a substantial proportion of incidents and further attention must be paid to planning for emergency response on school campuses. We also identified the difficulty in assessing school emergency care and advocate for the development of methods to evaluate the provision of emergency care on school campuses.