Letters to the Editor  |   June 2006
Cardiologic Milestone: The Automatic External Defibrillator
Author Affiliations
    Ludington, Mich
    Certified Physician Executive
Article Information
Emergency Medicine
Letters to the Editor   |   June 2006
Cardiologic Milestone: The Automatic External Defibrillator
The Journal of the American Osteopathic Association, June 2006, Vol. 106, 362-363. doi:10.7556/jaoa.2006.106.6.362
The Journal of the American Osteopathic Association, June 2006, Vol. 106, 362-363. doi:10.7556/jaoa.2006.106.6.362

The greatest thing in the world is not so much where we are, but in what direction we are moving. —Oliver Wendell Holmes, 1809–1894

To the Editor: One-rescuer cardiopulmonary resuscitation (CPR) evolved out of centuries of experimenting with chest compression methods.1 Over time, closed chest compression became an integral part of the practice of resuscitation.2 In the 1940s, Claude Beck, MD, documented successful electrical ventricular defibrillation.3 While CPR can be life saving and life sustaining, an electrical shock is the only effective treatment in certain cases.4 A defibrillatory shock must be administered within just a few minutes of collapse5; each lost minute decreases survival by 10%.4 
Today, defibrillation is not limited to use by physicians in hospitals.4 The development of the modern automatic external defibrillator (AED), which can potentially save lives outside the hospital emergency setting, is a major contribution to cardiac medicine. Approval and requirements for AED use in specific settings is varied, and ongoing research is needed to make these determinations. 
New York State has passed legislation requiring universal placement of AEDs in schools.6 In Michigan, an attorney whose teenaged daughter died during a school exercise activity established a fundraising program (The Kimberly Anne Gillary Foundation) to place AEDs in all public schools in his area, resulting in more than 200 high schools being equipped with AEDs.7 Another argument for equipping schools with AEDs is commotio cordis (ie, cardiac concussion),5,8 a condition whereby cardiac arrest results from blunt, nonpenetrating precordial chest trauma, which can occur during athletic activities.9 Other locations where AED placement would be beneficial include athletic centers, churches, commercial airlines, convention centers, and police cars. In Ireland, all ambulances are required to carry AEDs.10 I remember the time when very few fire extinguishers were kept in offices because it was thought that they were more expensive than a call for help. 
The American Red Cross (Washington, DC), the American Heart Association (Dallas, Tex), and the National Center for Early Defibrillation (Pittsburgh, Pa) are among the leaders and suppliers of up-to-date information on AEDs. Ongoing education through videos, discussions, and lecture programs are other ways of obtaining maintenance tips and updates. The book, Challenging Sudden Death,11 is helpful in addressing maintenance issues for AEDs. Ideally, equipment should be checked daily and documented. In addition, AEDs should be easily seen; storage in a clear-fronted cabinet on a wall is ideal for most public locations. 
Recently, in Norway, an AED training session was taking place for the facility's personnel, when an individual offstage lost consciousness. The speaker had just removed a brand new AED from its packing case and, after confirming ventricular fibrillation, used the AED to resuscitate the victim, who survived.12 Research is needed to answer questions about the appropriateness of base locations and individual home use. 
Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC), II: basic life support. JAMA. 1974;227(suppl):841 –851.
Kouwenhoven WB, Jude JR, Knickerbocker GG. Closedchest cardiac massage. JAMA. 1960;173:1064 –1067.
Claude Beck, defibrillation and CPR. Dittrick Medical History Center. Available at: Accessed March 13, 2006.
Cooke B. CPR and defibrillation forge a “chain of survival.” Chicago Tribune. February 10, 2002. Available at: Accessed March 20, 2006.
American Heart Association. Medical emergency response plan for schools. Circulation. 2004;109:278 –291.
New York State United Teachers. Automated external defibrillators (AEDs) in schools. December 2002. Available at: Accessed March 20, 2006.
Ager S. Sudden death moves parents to save others. Detroit Free Press. January 13, 2004. Available at: Accessed March 20, 2006.
Maron BJ, Gohman TE, Kyle SB, Estes NA III, Link MS. Clinical profile and spectrum of commotio cordis. JAMA. 2002;287:1142 –1146.
NCAA, NATA host productive summit on rare sudden death condition. The NCAA News. August 8, 2005. Available at: Accessed March 22, 2006.
Heart Health Task Force. Ireland's Changing Heart: Second Report on Implementation of the Cardiovascular Health Strategy. Stationery Office; 2003:114. Available at: Accessed March 13, 2006.
Newman MM, Christenson J. Challenging Sudden Death: A Community Guide to Help Save Lives. Carmel, Ind: Catalyst Research & Communications Inc; 1999.
Heart starter in nick of time. Aftenposten. April 22, 2005. Available at: Accessed March 14, 2006.