Public health

Nursing

Cardiology

Intensive care medicine

Emergency medicine

Cardiopulmonary resuscitation

Chain of survival

Defibrillation

Resuscitation

Basic life support

Automated external defibrillator

Medical emergency

Medicine

Journal of Internal Medicine

Out‐of‐hospital cardiac arrest ( OHCA ) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in‐hospital. With the development of automated external defibrillators ( AED s), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AED s throughout most Western countries. Accordingly, current guidelines recommend that AED s should be deployed in places with a high likelihood of OHCA . Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AED s are that most OHCA s take place outside high incidence sites of cardiac arrest and that most OHCA s take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AED s to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.

The challenges and possibilities of public access defibrillation