Public access defibrillators and fire extinguishers: are comparisons reasonable?

Sudden cardiac death is a major cause of mortality in the United States of America (Circulation 2008;117:e25-146) with approximately 310000 deaths related to coronary heart disease occurring in emergency departments or in the prehospital environment annually. Several organizations have directed resources toward the treatment of sudden cardiac arrest through a paradigm that has come to be known as the "chain of survival"-prompt activation of emergency response by telephone 911, early bystander cardiopulmonary resuscitation, early defibrillation, and timely advanced cardiac life support (Circulation 1991;83:1832-1847). The ready availability of automated external defibrillators (AEDs) has been advocated as a key component of this chain. Some authors have suggested a "fire extinguisher model" for AED deployment (Circulation 1998;98:2334-2351; Resuscitation 1995;30:151-156; Ann Intern Med 2001;135:990-998). In this model, AEDs are prominently displayed in public places for use by laypersons, much like fire extinguishers. For example, in Chicago's O'Hare Airport, AEDs are placed alongside fire extinguishers in the public concourse (N Engl J Med 2002;347:1242-1247). Advocates of this model suggest that advancing this practice would be a means to widely disbourse life-saving technology that is easy to use. Several experts have questioned this model, suggesting that the cost-effectiveness of distributing AEDs this widely would be prohibitive (BMJ 2002;325:515; Curr Opin Cardiol 2007;22:5-10; BMJ 2003;326:162; Int J Technol Assess Health Care 2007;23:362-367) and may not be more effective than more targeted distribution of AEDs. This literature review will examine the available data on both AEDs and fire extinguishers to determine if these comparisons are reasonable as a means of guiding public policy.