Training lay-people to use automatic external defibrillators: Are all of their needs being met?

Abstract

This thesis draws upon data gathered during research undertaken with a grant from the Resuscitation Council (UK). It explores the use of Automatic External Defibrillators (AEDs) by laypeople, which is known as Public Access Defibrillation (PAD). Whilst an abundance of research has been undertaken about this phenomenon, it has predominately been conducted using quantitative methods; however the data I am using was collected using a qualitative approach. During the research, fifty-three semi-structured interviews were carried out. Most of these were with laypeople who had been trained to use AEDs, and nine involved those who delivered the training. These interviews were conducted at sites typical of those where these devices have been introduced, such as railway stations and airports. The geographical area of these locations covered the East and West Midlands, South and West Yorkshire, Lincolnshire and Essex. The aims of the research were quite broad and included exploring how to make training more realistic, how debriefing and support for those who had used an AED should be organised and how the interviewees perceived the technology inherent in the AED.This thesis reanalyses the data that was collected during that research and focuses on two themes. Firstly, some of the theories of technologies in transition are used to illustrate how AEDs were developed in a laboratory and progressed from that setting to become commonplace in public locations. The actor-network theory is adopted to argue that these technological devices exert an influence on the human actors in the networks that exist within society. Specifically, my analysis is informed by the work of Timmermans (1998; 1999; 1997) whose theories about external chest compressions I have developed and applied to AEDs. They suggest that these devices achieved universality, in part, through the influence of debates and medical protocols.One significant factor was that AEDs allowed for defibrillation to be redefined from a medical, to a first aid procedure. Eventually, using these devices was included in the protocols for first aid and this legitimised their use by laypeople. These theories are observable in the data through the interviewees" accounts of how they came to accept being trained to use AEDs. The experiences of those who had used an AED during a resuscitation attempt are provided and suggest that these are distressing and unpleasant events.Consequently, a key component of this thesis is a discussion of the necessity to provide psychological debriefing for those who have been involved in these incidents.The findings of this thesis suggest that laypeople who have used an AED usually have questions about the actions they took during the attempted resuscitation and need to address these with someone soon afterwards.

A qualitative study to identify barriers to deployment and student training in the use of automated external defibrillators in schools

“…However, there are no clear recommendations on what grade should undergo AED training in schools, and no studies have extensively discussed at what age children should be encouraged to use AEDs in real-life situations [23]. It is also noteworthy that medical experts have previously had the same concerns towards AEDs and have urged caution against allowing AEDs to be used by the general public [39]. It was not until 2000 that the AHA clearly acknowledged the value of AEDs and their safety for lay rescuers [40].…”

Community first responders and responder schemes in the United Kingdom: systematic scoping review

“…Two participants reported that, following the initial scheme establishment and training, there had been little follow-up by staff of any health-related service and that current first responders had not received ongoing training, leaving them feeling unsupported. Community members felt let down by state authorities and questioned whether volunteering should continue as it might be hindering provision of a statutory service.Harrison-Paul et al (2006) [15]To explore the experiences of lay people who have been trained to use automatic external defibrillators. The research questions were: (1) How can training courses help prepare people for dealing with real life situations?…”

“…CFRs felt their role was rewarding, although they expressed a need for praise for the work they did [4] and a concern about the limited opportunities for operational debriefing on their activities [10, 14, 15] CFRs felt they were limited in what they could do because they lacked the skills of paramedic staff. [1, 12] In some instances, this manifested in a concern that they were not doing the right thing [1], while some felt they could and should be able to do more to help patients [16].…”

“…CFRs felt that ongoing training was essential to enable them to progress. [12, 15]. However, retraining and keeping up to date in a timely manner was considered difficult [1, 15].…”

“…However, retraining and keeping up to date in a timely manner was considered difficult [1, 15]. CFRs expressed concerns that despite the ongoing training, this training would become less relevant if they had not been called out to patients [1, 12, 15] Furthermore, CFRs felt that provision of training demonstrated how their organisation valued the contribution they made to patient outcomes [12]. Conversely, a lack of training led to frustration among CFRs about not having the skills required to help patients [1].…”