I. Introduction: Cardiac arrest (CA) is a leading cause of death in the U.S. An estimated 70-90% of people experiencing out-of-hospital CA die before reaching the hospital. Applying cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED) within minutes of CA can dramatically raise survival rates. Public Access Defibrillation (PAD) laws can facilitate rapid AED application by lay bystanders. This study assesses whether existing state laws align with best available evidence for PAD implementation to assist decision makers in strengthening existing PAD policies.
II. Methods: Two analysts applied CDC’s Quality and Impact of Component (QuIC) Evidence Assessment to appraise the strength of evidence bases for 9 PAD program “policy components,” defined as discrete requirements, provisions, or other elements within a public health policy. Analysts utilized subject matter experts (SME), PubMed, and grey literature to collect evidence and identify 9 policy components. Analysts independently coded evidence across 8 dimensions of evidence quality and public health impact. Resulting scores were used to rank the policy component evidence bases into 3 categories; best, promising or emerging.
To identify policy components found in state law, two legal researchers reviewed PAD peer-reviewed and grey literature and analyzed 10 states’ laws using Westlaw. The results were used to construct variables for a legal dataset. Researchers coded and categorized the components in statutes and regulations for all 50 states and Washington, D.C, in effect as of December 31, 2015. Researchers conducted descriptive analysis of the legal dataset and examined correlations with the QuIC policy component results.
III. Results: Fifty jurisdictions had PAD laws in effect as of December 31, 2015, authorizing at least one of the 9 evidence-informed PAD policy components (maximum: 8; median: 6). The QuIC assessment categorized 3 components “best”, 4 “promising” and 2 “emerging.” The most common components found in law were PAD use training (best), EMS coordination (best) and lay bystander limited liability (emerging). No state authorized all 9 components. However, 3 states authorized 8 components and 12 states authorized all 3 best components. Two states authorized only lay bystander limited liability (emerging).
IV. Implications: There is strong evidence of potential public health impact for targeted AED placement, user training, and EMS PAD coordination, yet two thirds of states have not enacted all three policy components. The Institute of Medicine recommends developing policy strategies and addressing legal barriers to bystander CPR and defibrillation to improve CA outcomes. Studies directly evaluating the role of PAD law in cardiac arrest response and associated health outcomes are needed to determine the best policy approaches to meet state needs and contexts.