I read with interest Alice Gordenker's column about the legal change that permits laypeople in Japan to operate the automated external defibrillator (AED), and the installation of AEDs in public places ("So what the heck is that?" April 17).
However, the article did not address what I consider the most important question: Has a layman ever successfully operated the AED to save someone's life? Placing the units in public places is certainly big business for AED manufacturers, but I wonder whether this money could be better spent on other public health measures.
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EDITOR'S NOTE: Dr. Hideo Mitamura, deputy director of Saiseikai Central Hospital in Tokyo and chair of the AED committee of the Japanese Circulation Society, responds:
To date, more than 40 victims of cardiac arrest in Japan have been rescued outside of hospitals
with the use of an AED. In about two-thirds of the cases, off-duty medical professions happened to be on
the scene and operated the AED.
You may have heard about one case in which a 17-year-old went into cardiac arrest when a baseball
hit him directly in the chest during a high-school game. He was lucky that his school had an AED, donated
two years earlier by graduates. An off-duty paramedic who was watching the game used the AED to restart
the boy's before an ambulance arrived.
In the remaining cases laypeople (such as railway workers and staff members at fitness clubs and
sports arenas) successfully used the AED to save the victim's life. These cases in Japan support the
findings of studies conducted in the United States that found that nontraditional responders such as
flight attendants and security guards are very effective AED users.
It is true that the cost effectiveness of AED dissemination hasn't yet been proved. We expect that as
more AEDs are sold, the price per unit will come down. And we are using creative means to keep down
costs, such as allowing advertising on the stand housing the AED.
Another cost-saving measure, described in Gordenker's article, is placing AEDs in vending machines.
I suspect most people would be willing to subsidize the cost of the AED through their drink purchases,
which is how the system works.
But in the end, it's very difficult to do a cost-benefit analysis. After all, what value can be
placed on a life?