Biphasic should replace Monophasic Defibrillators

I will attack his points, then follow up with my own. 1- The American Heart Association's study on triphasic defibrillation was inconclusive. My opponent claims that replacing both monophasic defibrillators as well as biphasic defibrillators is the "best thing to do", and bases this statement on a study by the American Heart Association for which he provides a link. This information is very familiar to me. The studies conducted by the AHA on triphasic defibrillation were experimental, and were not conducted with defibrillators, rather they were conducted with devices created for the purpose of the experiment, and the waveform was controlled by a "Macintosh computer". It is both impractical and illegal to employ these devices in a hospital setting, and it was these experiments which led to the development of biphasic defibrillators. Note- the development of triphasic defibrillators was not a result of the experiments, nor subsequent experiments employing 2- Some of the results listed in this 2000 article were from as early as 1983. It has been 25 years and triphasic external defibrillators have not been developed. If we are going to debate choices, and what is the best choice, the best choice should be one that is available. When referring to cardioversion, monophasic, and biphasic defibrillators, and within the context of "replacing monophasics with biphasics", it is important to note that I am referring to existing technology that is available and present within hospitals. Replacing both monophasic and biphasic defibrillators with non-existent triphasic defibs is impossible. 3- My opponent's contention that "most defibrillators that can deliver a biphasic waveform already contain the switches and other hardware necessary for delivery of a triphasic waveform" is untrue. He is citing an article published in 2000, which contains info from older studies. The various biphasic defibrillators on the market- Zoll, Philips, Physio Control, HP do not have the hardware or switches necessary for delivery of a triphasic waveform. Furthermore, they do not possess the controlling software. On top of that, alteration of an existing FDA approved medical device and making it a completely different device in which the dose and use would be severely altered is illegal. The FDA has a process for approving these devices, and triphasic external defibrillators have not been approved for use, and there is no proof that they are even in development. 4- My opponents contention, which I affirm is false, that biphasics possess the hardware to become triphasics would still require monophasics to be replaced with biphasics. "Therefore, slight alteration of the software in the defibrillator to switch the waveform a second time to deliver the third phase is the main change required for delivery of a triphasic shock". I don't believe this statement to be true, and would love to hear the electronics theory behind this, but if it IS true, and since triphasic defibrillators are not commercially available, you would still have to replace monophasics with biphasics if you wanted triphasics. It would be legally impossible, however, to alter a biphasic defibrillator to deliver a third phase. It is probably also electronically impossible, given that a biphasic operates essentially as an AC current (delivering one positive charge followed by a negative charge), to deliver a third purely positive charge that is part of the original complete waveform. My opponent cited a study without understanding the technology being cited within the study (implantable internal defibrillators). I would love to hear how an external defibrillator can be altered to deliver a third phase (electronically AND legally). Now, my opponent can argue that I did not specify external defibrillators, HOWEVER within the context of the study I referenced, my reference to monophasic defibrillators, etc. all make it obvious to the knowledgeable debater that I am referring to external defibrillators. Internal implantable defibrillators are commonly referred to as ICD's- implantable cardioverter defibrillators- rather than "defibrillator" which is the term used for the common external monophasic or biphasic defibrillators we see in hospitals, airports, train stations, ambulances, etc. , including AED's or Automated External Defibrillators which are already almost all (if not all) biphasic. If my opponent wants to implement the best possible technology then he must restate his entire argument, nullifying his R1 argument because quadriphasic waveforms are more efficient than triphasic waveforms. Alas, we are not discussing which waveform is more efficient, rather whether or not biphasic defibrillators- an available technology, should replace monophasic defibrillators- a widely used technology. The process is already taking place voluntarily at hospitals throughout the country. Lifepak 9, Lifepak 10, 11, and even early versions of the Lifepak 12 used monophasic technology, but even the Lifepak 12 has gone beyond it's recommended life cycle. With the recent Joint Commission Sentinel Alert warning about the use of outdated technology, it is time hospitals stop beating around the bush and replace their outdated defibrillators. Thank you.