Cummins R O, Eisenberg M S, Moore J E, Hearne T R, Andresen E, Wendt R, Litwin P E, Graves J R, Hallstrom A P, Pierce J
Ann Emerg Med. 1985 Aug;14(8):755-60. doi: 10.1016/s0196-0644(85)80053-6.
Automatic external defibrillators (AEDs) will be used by spouses, family members, emergency first-responders, and the citizenry at large. Such use, however, raises a number of clinical, training, psychological, and public health issues. Clinical issues: Is cardiac arrest to be verified by the operator or the AED? Second verification systems, such as breath detectors, produce errors of omission, but greatly expand the pool of potential users. The relative merits of high sensitivity and low specificity in arrest verification must be defined by clinicians relative to the setting and the potential users. AEDs require cessation of basic CPR during their assessment periods; clinicians must determine the tradeoff between long interruption of basic life support and much earlier delivery of countershocks. Training issues: Criteria for those to be trained include consideration of who the patient will be and who the AED operator might be. AEDs pose a familiar adult education problem, that is, acquisition of a new psychomotor skill and retention of that skill for long periods before performance. What are the best teaching techniques? Currently available AEDs have different designs for device-operator interaction. Which design is most likely to assure proper performance during an actual arrest? Psychological issues: What are the psychological effects of learning about, living with, and eventually using an AED? The development of the automatic external defibrillator constitutes the most recent attempt to achieve early defibrillation of patients in cardiac arrest. The potential public health effect of such devices is enormous.
自动体外除颤器（AED）将由配偶、家庭成员、应急急救人员以及广大民众使用。然而，这种使用引发了一些临床、培训、心理和公共卫生问题。临床问题：心脏骤停是由操作人员还是AED来确认？诸如呼吸探测器之类的二次确认系统会产生漏诊错误，但会极大地扩大潜在使用者群体。在心脏骤停确认中高灵敏度和低特异性的相对优缺点，必须由临床医生根据具体情况和潜在使用者来确定。AED在评估期间需要停止基本心肺复苏；临床医生必须确定在长时间中断基本生命支持与更早进行电击除颤之间的权衡。培训问题：确定培训对象的标准包括考虑患者是谁以及AED操作人员可能是谁。AED带来了一个常见的成人教育问题，即掌握一项新的心理运动技能并在实际操作前长时间保持该技能。最佳教学方法是什么？目前可用的AED在设备与操作人员的交互设计上有所不同。哪种设计最有可能确保在实际心脏骤停时正确操作？心理问题：了解、长期接触并最终使用AED会产生哪些心理影响？自动体外除颤器的研发是实现心脏骤停患者早期除颤的最新尝试。此类设备对公共卫生的潜在影响巨大。
