The AHA does not make a recommendation as to whether AEDs in healthcare facilities should be secured against public access. Instead, it simply reminds AED owners that if AEDs are to be secured — whether locked in an office, in a wall-mounted cabinet, or by similar means — there must be a clear system with written policies and procedures governing access to the devices. For example, if a healthcare facility chooses to train all security staff as AED users, then all security staff should have access to the devices.

There are advantages and disadvantages to securing AEDs or leaving them accessible to the public. For instance, if AEDs are left unsecured, untrained staff or members of the public may attempt to use the devices on a patient and cause harm or may engage in horseplay and harm themselves or others. However, unsecured AEDs can likely be used more quickly by either facility-trained users (who will not have to take the time to unlock a cabinet) or other users (who will be able to simply take a unit off a wall mount and use it). AEDs do have safeguards that will prevent inadvertent discharge under most circumstances.

AED use should not be limited to advanced life support (ALS) providers; AHA has determined that it is more appropriate to train as many people as possible. AHA sponsors CPR and AED training nationwide; information on courses is available from its Web site at www.americanheart.org. Interested healthcare facilities can contact the AHA to set up staff training sessions. Also adhere to state requirements for training and who is permitted to use AEDs.

Healthcare facilities may choose to train a variety of employees in AED use. Direct care providers, such as registered nurses, who generally must maintain current basic life support for healthcare provider status, should receive AED training as part of their healthcare provider training. In addition, some facilities train security officers and other non-clinical staff. These workers are often witnesses to or the first to arrive on the scene of a sudden cardiac arrest in healthcare facilities. As such, they can be the most important staff to be trained in emergency response methods.

Other workers in healthcare facilities who have even less emergency response experience than security officers may also be trained in the use of AEDs (e.g., receptionists, volunteers, maintenance staff). Studies have shown that these individuals can be easily trained but that they require more frequent refresher training than healthcare workers. In addition, several studies have shown that without occasional use, even well trained staff may forget how to operate an AED. Therefore, at least annual refresher training should be considered for those trained in AED use.

Instructor-led training can be expensive. Computer or video training can be considered. Studies have been published that show that video-based and computer-based training can be quite successful and is less expensive than hiring an instructor. But having an instructor available can be advantageous and may be needed, for example, for skills checks for CPR.

As with many new or altered hospital programs, the first step is getting hospital-wide support for the changes. Administrative leadership support is important, but clinician leadership support (e.g., the chief nurse executive, nursing leaders, department managers, medical staff chief) is key. Facilities interested in launching AED programs get physicians and nurses on board most easily by speaking their language — by showing them that AHA endorses the use of AEDs and by talking about studies that show AEDs to be effective. Advocates should frame the discussion as an extension of existing emergency response procedures rather than as a new program.

In the past, there has been resistance from some clinicians unfamiliar with AEDs who regarded the devices as watered-down versions of manual defibrillators and incapable of delivering the same intervention. Should such resistance be encountered, showing reliable studies that demonstrate the sensitivity, specificity, and efficacy of AEDs and allowing these clinicians to observe the devices in use can help change their minds.