A survey of first-responder firefighters' attitudes, opinions, and concerns about their automated external...

To identify barriers to first-responder automated external defibrillator (AED) use by determining firefighter attitudes, opinions, and concerns about their AED program.

An anonymous survey was mailed to all firefighters in a municipal department that had had first-responder defibrillation for more than two years. A follow-up survey was mailed to all nonrespondents. The survey requested firefighter demographics, comfort and experience with AED, definition of DOA (dead on arrival), and opinion of the program.

Of 749 firefighters surveyed, 686 responded (92%). The respondents had an average of 12 +/- 8 years of experience; 66% felt very comfortable using the AED and 3% felt very uncomfortable. The respondents had applied an AED to a patient a median of 2 times (range 0-30); 24% had never applied an AED. Eighty-three percent reported they had been on the scene of an out-of-hospital cardiac arrest when their AED was not used for at least one patient. Predominant reasons for not applying an AED included the ambulance arrived "soon enough" (72%), the ambulance arrived first (63%), the patient was DOA (61%), and the patient had a do-not-resuscitate (DNR) order (32%). Eighty-one percent of the respondents correctly listed at least one clinical finding that defines DOA. Ninety-nine percent felt they should continue the AED program. The respondents gave numerous suggestions for improving the program, including being able to visualize the rhythm, increasing their level of care, and improved AED training.

Municipal first response firefighters view their AED program favorably despite infrequently applying an AED. The appropriateness of withholding defibrillation because a secondary response unit will arrive "soon enough" should be reviewed. The definition of DOA should be reviewed to ensure that viable patients are not denied defibrillation.