Adam E. Klein, MD - West Virginia State Medical Association

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Scientific Article |Automated External Defibrillators in West Virginia SchoolsChristopher W. Mercer, MDPediatric Resident, WVUSOM, MorgantownLarry A. Rhodes, MDProfessor of Pediatrics, Division of Pediatric CardiologyDepartment of Pediatrics, WVUSOM, WVU Children’sHospital, MorgantownJohn R. Phillips, MDAssociate Professor of Pediatrics, Division of PediatricCardiology, Department of Pediatrics, WVUSOM, WVUChildren’s Hospital, MorgantownAbstractIntroduction: Sudden death,particularly when occurring in children andadolescents, is a traumatic event not onlyfor the victim’s family, but for the entirecommunity. It has been shown thatschool-based automated externaldefibrillator (AED) programs provide ahigh survival rate for both students andnonstudents who suffer sudden cardiacarrest (SCA) on school grounds. The useof AEDs is becoming increasingly morecommon in schools in the United States.In West Virginia middle and high schools,we analyzed the prevalence and use ofAEDs, barriers to obtaining a device, andcases of sudden death on schoolgrounds.Methods: A mailed survey distributedto West Virginia high schools and middleschools collected general demographicdata, AED data, and occurrences ofsudden death on school grounds. Schoolsreporting a death were contacted toobtain details regarding the event. Forschools with a device, the number ofAEDs, length of possession, reasons forand means of obtaining the AED,personnel trained to operate the AED andthe number of device uses weredetermined. For schools without an AED,barriers to and interest in obtaining adevice were determined.Results: Two hundred and twenty-fiveof 312 surveys (72%) were returned. Onehundred and fifty-two schools (68%)currently have at least one AED and 73schools (32%) do not have an AED.Public high schools had the highestprevalence of AEDs (76%) compared topublic middle schools (62%) and privateschools (67%). Sixty-nine percent ofschools obtained their devices bydonations or grants and 32% obtainedthem using school funds. Barriers toobtaining a device included cost (82%),lack of trained personnel (45%),unfamiliarity with AED (22%), and liabilityissues (19%). There were a total of 23deaths on school premises reported by 20schools. There was one reportedoccurrence of an AED being used to savea life.Conclusion: Over two thirds of WestVirginia middle schools and high schoolscurrently have at least one AED on theirpremises. An AED is an effective way ofpreventing death following sudden cardiacarrest, and has saved at least one life in aWest Virginia school. While most schoolswithout AEDs cite cost as the maindeterrent, the majority of schools with adevice received them via donation orgrant. We submit that a number of suddendeaths on West Virginia school groundscould possibly have been averted by useof an AED.IntroductionSudden death of a child or youngadult has a devastating effect onthe victim’s family, school andcommunity. The most importantfactor in determining survivalfollowing sudden cardiac arrest(SCA) is time from collapse todefibrillation. 1-3 Survival benefithas been demonstrated with theuse of school-based automatedexternal defibrillators (AED) for bothstudents and nonstudents sufferingSCA. 1 In instances where earlydefibrillation can mean the differencebetween life and death, educationand training of school based AEDprograms are of utmost importance.The use of AEDs is becomingincreasingly more common inschools in the United States. Todate, there are at least 15 stateswith legislative mandates requiringor supporting AED placement inschools. 4 West Virginia is not yetone of those states. The AmericanHeart Association and other nationalorganizations have set guidelines forthe implementation of school-basedAED programs. 3 These mandates,in concert with parental andcommunity efforts, coincide with anincreased prevalence and utilizationof AEDs in the nation’s schools.With this in mind, we aimed toassess the prevalence of AEDs inWest Virginia schools, examinebarriers to obtaining them, andanalyze occurrences of sudden deaththat occurred on school premisesin West Virginia. We also reviewedcurrent American Heart Associationrecommendations on AED programimplementation in schools.MethodsStudy DesignThis study is a cross-sectionalsurvey distributed to public andprivate high schools and middleschools in the state of West Virginia.The surveys were mailed to theprincipals of these schools, to becompleted by them or a designatedsubstitute. A second request surveywas sent one month later to theschools that did not initially respond.The decision to use mailed surveysinstead of electronic surveys via theInternet was made based on the lowresponse rate to electronic surveys inother similar studies. 5,6 Self addressedand stamped return envelopeswere included with the surveys.ParticipantsWest Virginia public highand middle schools, as well asprivate schools with a minimumenrollment of 50 total studentsgrades 5-12 were included in thestudy. School enrollment datawere obtained through the WestVirginia Department of Educationwebsite. Three hundred and twelveschools met criteria and wereincluded in the study (119 public18 West Virginia Medical Journal
| Scientific Articlehigh schools, 156 public middleschools, and 37 private schools).SurveyThe surveys collected generaldemographic data regarding theschool, such as county location,enrollment and grades represented.The presence of a school-basedemergency response program andAED was determined. For schoolswith an AED, the number of devices,length of possession, personneltrained to operate the AED, meansof obtaining, reasons for obtaining,and number of times the AED hadbeen used were collected. For schoolswithout AEDs, barriers to obtainingan AED and interest in obtaining adevice were determined. Informationon any occurrence of sudden deathor AED usage occurring on schoolpremises was requested. Schoolsthat reported a death or AED usagewere contacted to obtain details.ResultsGeneral DemographicsOf the 312 schools that were sentsurveys, 225 (72%) participatedrepresenting 54 of the 55 countiesin West Virginia. Public middleschools had the highest responserate at 74% (115 of 156), followedby public high schools with 72%(86 of 119) and private middle/high schools with 65% (24 of 37).In total, enrollment in schools thatcompleted a survey accounted for125,105 students, an average of 556per school. The majority of surveyswere completed by principals,followed by school nurses and otherstaff. Two hundred and six schools(92%) responded that they had anemergency response plan in place.Emergency response plans were morelikely to be in place in public schoolsthan private: 81 public high schools(94%), 107 public middle schools(93%) and 18 private schools (75%).Schools with AEDsOf the responding schools, 68%(n=152) had at least one AED,while 32% (n=73) of schools hadno AED. Of the schools with anAED, 68% (n=104) had one device,22% (n=33) had 2 devices, and 10%(n=15) had 3 or more. Public highschools were more likely to havean AED (76%) than public middleschools (62%) and private schools(67%). Forty-two percent of schoolshad a device for 2-5 years, 26% hadan AED for 1 – 2 years, 14% forgreater than 5 years, and 13% forless than 1 year. Sixty-nine percentof schools (n=105) obtained theirdevice through donations, includinggrants and those provided by thecounty, while 32% (n=48) usedschool funds. Several schools useda combination of donations andschool funds. Fifty of 55 counties inWest Virginia reported having anAED in at least one of their schools.The most common reasons forobtaining an AED were donation(34%), nurse recommendation(30%), faculty recommendation(24%), parental recommendation(5%), doctor recommendation (5%),and previous incident at school(5%). Only 55% of devices werereported to be registered with localEMS. Other schools were unsureif their AED was registered withEMS. School nurses were mostlikely to be trained in AED usage(n=129, 85%), followed by teachers(n=118, 78%), administrators (n=112,74%), and coaches (n=96, 63%).Schools without AEDsIn total, 73 of the 225 (32%) schoolsreturning the survey did not havean AED. Barriers to obtaining anAED included cost (n=60, 82%), lackof trained personnel (n=33, 45%),unfamiliarity with AED (n=16, 22%),liability issues (n=14, 19%), andschool board policy (n=1, 1%). Fiftyof the 73 schools were interested inobtaining an AED, but did not haveplans to do so. Seventeen schoolsJuly/August 2012 | Vol. 108 19
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