Sudden cardiac arrest (SCA) is unpredictable because it happens without any symptoms. Additionally, many cardiac arrests occur outside the hospital where it is difficult for emergency medical services (EMS) to reach within 3-5 minutes of the prime response time. ^[1] An automated external defibrillator (AED) was created to address these situations and encourage bystanders to provide timely onsite defibrillation to out-of-hospital cardiac arrests (OHCA). As countries worldwide increasingly attach importance to OHCA, more and more public places, such as transportation hubs, are being required to install AED equipment.

One AED case in point is that Dutch Railways announced a plan to deploy 715 AED devices in stations across the country in July 2021. ^[2] Prior to this, half of the stations in the Netherlands were without AEDs or a call system for AED available 24/7, which is not conducive to the timely rescue of SCA patients at stations. Station Manager Tosh Hol and Operations Director NS Eelco van Asch then agreed with Heart Foundation that expanding AED coverage from 50 to all stations would help increase the chances of survival for cardiac arrest patients in or around stations. Meanwhile, it would be a contribution to the Netherlands in areas still not populated with AED equipment.

The initiative to deploy AED equipment in all Dutch stations was launched on July 14, 2021. Station Manager Tosh Hol and Operations Director NS Eelco van Asch entered into a first-of-its-kind partnership with Mindray to deploy two new Mindray AEDs at Culemborg station. The initiative, designed to improve the chances of survival of SCA and draw attention to AEDs in train stations, marks the beginning of a national AED network in the Netherlands. All stations in the Netherlands will be equipped with the new Mindray AEDs within nine months, by which time at least one AED will be available 24 hours a day at each station throughout the Netherlands.

As you can see from the AED case above, installing the AED in stations is more necessary than in any other public place because of the high daily traffic in stations bringing passengers from different age groups, countries and regions, which undoubtedly increases the likelihood of SCA in stations. Furthermore, some stations are well known as transportation hubs in the area, covering a large footprint. It is not feasible to quickly get the AED equipment to the patient from the office or station dispatch through the large crowds and complex routes in case of an emergency. Therefore, stations should not only be equipped with AEDs in a timely manner but also have multiple AEDs strategically located inside and outside to minimize response times.

Considering that the scenario characteristics of the station are different from other indoor places when choosing an AED solution for station, station managers should focus on the following aspects in conjunction with the AED case of Dutch stations and your situation, in addition to strategically placed multiple AEDs inside and outside the station.

? User friendly

The AED solution for station should be as user-friendly and easy to use as possible. Station managers should anticipate that there are still a large number of people who are unfamiliar with SCA rescue and AED devices. Therefore, choose an AED brand that provides audio and visual guidance whenever possible. If the AED device can intelligently provide real-time feedback based on the user's situation, it exerts great influence on smooth rescue for responders. For example, different feedback mechanisms are available for Mindray AED according to the user's proficiency. For novice users, Mindray AED provides more detailed voice and graphic explanations, while for skilled users, Mindray AED simplifies explanations and provides only key instructions.

Meanwhile, CPR and AED devices are considered the most effective solution for SCA rescue. The interaction of the two maximizes the success of SCA rescue. Thus, an AED solution for station with CPR feedback mechanisms would guide responders to adjust to the best possible situation immediately according to the feedback on the quality of CPR performed.

? Fast shock delivery

Rescue of SCA is imminent. Studies have shown that delivering the first shock to an SCA patient within 3-5 minutes has a tremendous contribution to the chances of survival.[1] However, due to the high population density and busy traffic in the station, the time the responder takes to find the AED device and bring it to the patient prolongs the response time for SCA patients, which requires the fastest shock delivery for the AED solution for station to improve the efficiency of the rescue.

? Effective for patients with high physical impedance

For passengers with high body impedance, a conventional shock of 200 joules may not be effective in a single session but rather require multiple shocks or an increase in the energy of the subsequent shock for successful defibrillation. ^[3] Therefore, an AED solution for station should be able to deliver high-energy shocks to patients with high body impedance. Conventional biphasic AED equipment on the market today is rated at 200 joules, but an AED that features 360J biphasic technology is thought to dramatically improve the success rate of defibrillation in patients with high body impedance.^[3]

? Wall-mounted solution

AEDs were previously installed inside the building or office in Dutch stations. However, emergencies will not always occur during business hours, so it requires installing outside the office room. AED is not placed directly on a desk or in a corner as for the installation, but be wall-mounted with a clear sign like a fire extinguisher so that responders can find it in time. Meanwhile, AED wall-mounted bracket is the best solution for outdoor and high-traffic areas such as stations to maximize protection from natural and man-made damage and reduce subsequent maintenance costs.

? AED training package provided

Station Manager Tosh Hol and Operations Director NS Eelco van Asch also organized free CPR and AED courses in the square in front of Culemborg station when the two new Mindray AEDs were deployed there. They also planned to offer free training sessions at 12 stations in 12 provinces. The AED case of the Dutch station further illustrates that the significance of station personnel, including passengers, learning how to administer CPR and AEDs not only facilitates more efficient handling of such emergencies but also draws attention to AEDs in stations. Therefore, an AED training kit is what an AED solution for stations should be equipped with.

? Internet-based connection for online management and maintenance

At least one AED machine is required to be kept on call 24 hours a day in the station, which can be guaranteed by an Internet-based AED solution. Also, multiple AEDs for station undoubtedly increase the cost and difficulty of management. However, the Internet-based AED solution allows station managers to manage and monitor multiple AED devices online simultaneously so that they can promptly respond to any exceptions. Therefore, choosing an AED solution with an internet-based connection is conducive to reducing the management and maintenance cost as no need to manually check each machine in person every day.

If an AED solution for station ideally includes the aspects mentioned above, a successful AED program in stations would be easy to achieve. An example of the case is Dutch Railways which cooperated with Mindray to deploy 715 AEDs across the nation. Mindray, as one of the world's leading AED manufacturers, has partnered with a great number of countries in the deployment of AED equipment to be your right option of AED solution for station.

In addition to providing basic voice and picture guidance, Mindray AED is equipped with patented ResQNaviTM technology and CPR feedback mechanisms that make AED simple to use for responders. In terms of fast shock delivery, while the shortest delivery time for the first shock of an AED device in the industry can be achieved in less than 20 seconds, Mindray is further upgraded to achieve in an industry-leading 8 seconds by integrating charging and heart rate analysis steps. What's more, Mindray has broken through the technical barriers to master 360 joules of biphasic defibrillation technology, which allows stations to handle more complex emergencies and people with high impedance. As for equipment management and maintenance, Mindray offers wall-mounted solutions and training packages to help better carry out your AED programs in stations. A daily routine self-test feature and the AED Alert System also assist you with the online management and maintenance of multiple AEDs in stations.

If you consider implementing an AED program for your transit system, Mindray AED could be an option for you.

References:

[1] Consensus document regarding cardiovascular safety at sports arenas: Position stand from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), section of Sports Cardiology. European Heart Journal, Volume 32, Issue 17, September 2011, Pages 2119¨C2124. Available at: https://doi.org/10.1093/eurheartj/ehr178 (Accessed: 22 December 2021)

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[2] Start plaatsen AED¡¯s op alle stations. Nieuws.ns.nl. 14 July 2021. Available at: https://nieuws.ns.nl/start-plaatsen-aeds-op-alle-stations/ (Accessed: 22 December 2021)

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[3] Part 6: Advanced Cardiovascular Life SupportSection 2: Defibrillation. AHA Journal, Volume 102, No.suppl_1, August 2000, Pages 90¨C94. Available at: https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.I-90 (Accessed: 22 December 2021)