Defibrillators plentiful in schools but not senior centers

A greater percentage of high schools had automated external defibrillators (AEDs) - devices that can be used to treat cardiac arrest victims - than senior centers, despite the fact that cardiac arrests appear more common in senior centers, according to a study by University of Iowa researchers.

The study, published in the October issue of the medical journal Prehospital Emergency Care, raises questions about how decisions are being made regarding which public locations merit these potentially lifesaving devices. The investigation was based on surveys of 147 high schools and 20 licensed senior centers in Iowa and California during the 2001-02 school year.

The investigators studied the issue because they noticed the press was reporting the frequent placement of AEDs in high schools, said Peter Cram, M.D., assistant professor of internal medicine in the University of Iowa Roy J. and Lucille A. Carver College of Medicine and the study's corresponding author.

"It seemed counter-intuitive that defibrillators were being placed in high schools, where the population is relatively healthy and rates of cardiac arrest are low," Cram said. "We wanted to find out how common cardiac arrests were in high schools and how available defibrillators were."

The team selected senior centers as a comparison because they are populated by older adults with relatively high rates of cardiac arrest. "Thus, intuitively, we would expect that there would be more defibrillators in senior centers than in schools," Cram said.

The survey responses revealed the opposite. The investigators found that cardiac arrests were relatively uncommon in high schools, with a rate of about 2 percent per year compared with a rate of 20 percent in senior centers.

"These findings regarding the frequency of cardiac arrests in schools and senior centers are generally consistent with other studies," Cram said.

However, the investigators also found that 37 percent of high schools reported having one or more defibrillators available on campus. In contrast, only 10 percent of the senior centers had defibrillators.

"In theory, you want to put the defibrillators in places like senior centers where there are more cardiac arrests," Cram said. "Instead, we saw more defibrillators in schools. This practice may not be maximizing the numbers of lives that could be saved."

The authors cited several possibilities that might explain their findings.

"It is possible that the public is putting defibrillators in schools rather than senior centers because society values the opportunity to prevent the death of a young person over the opportunity to prevent the death of an older person," Cram said. "Alternatively, people may not realize that cardiac arrests are more common in senior centers or health clubs than in high schools."

A co-author of the study, Elizabeth Jones, research health science specialist at the Center for Research in the Implementation of Innovative Strategies in Practice at the Veterans Affairs Iowa City Health Care System also commented.

"Having these devices readily available provides reassurance to a community. In purchasing these devices, school officials and parents value 'peace of mind' -- even when the chance of using the device is remote," Jones said.

The study did not specify the age of people who went into cardiac arrests at the 147 high schools, but the three reported cases included two students and one teacher. The 20 senior centers reported a total of four cardiac arrests.

In addition to examining where defibrillators might be placed, the study also raises the question of whether schools or the civic organizations that often cover the costs of defibrillators should use the money for that purchase or other needs.

In addition to the 37 percent of schools that already had a defibrillator, another 24 percent (35 schools) said they were considering the purchase of an AED, which costs about $2,000.

Cram noted that some state legislatures have mandated the placement of defibrillators in schools but these mandates are not always accompanied by the funds needed to purchase the devices.

"Where defibrillators should be placed, especially in a time of limited financial resources, involves an important debate," Cram said.

In addition to Cram and Jones, the study included researchers from the Ann Arbor Veterans Affairs Health Services Research and Development Field Program, the University of Michigan School of Medicine and the University of Michigan College of Public Health.