In Place But Not Always Used: Automated External Defibrillators in Amateur Football

A sudden cardiac arrest (SCA) event is a condition in which the heart ceases its normal rhythm, disallowing normal circulation. SCA is one of the leading causes of death worldwide (21). Varying survival rates, ranging from 5% to 50%, have been found for patients experiencing an SCA (4). Additionally, neurological complications of varying degrees are often experienced after SCA survival (28). Bystander cardiopulmonary resuscitations (CPR) are only initiated in approximately 33% of all SCA events (17). Using an automated external defibrillator (AED) in the CPR process is associated with increased survival (15,19). SCA is the leading cause of sudden death among athletes (11,18). It is estimated that in the United States alone, one sports-related SCA occurs every 3 d (11,18). Since every day millions of people participate in sports activities, the incidence of an SCA can be high, and its impact is tragic (2,6,17). Automated external defibrillator availability in sport venues has become an important measure in adequate outof-hospital SCA treatment (8Y10,13,14,23). Close to all Dutch stadiums that host professional football games are equipped with AEDs (24) as well as approximately 80% of amateur sports clubs playing Gaelic football, football, or rugby in Ireland (7). However, to our knowledge, no research has been conducted on this matter among Dutch amateur football clubs. To fill this research gap, we conducted a systematic survey aimed at determining the availability, history, and knowledge of use of AEDs among amateur football clubs in the Netherlands. We designed an electronic quantitative survey with questions on baseline characteristics of participating amateur football clubs, availability of AEDs, history, and knowledge of use. An amateur football club was defined as a club where players are enrolled exclusively in a nonprofessional or unpaid manner. All Dutch amateur clubs affiliated with the Royal Netherlands Football Association (Dutch abbreviation: KNVB) were invited to participate in the survey via a massgenerated communication email sent by the KNVB. The survey was available for completion between May and June 2014. A total of 205 amateur football clubs participated in the survey. Most participating clubs (196, 95.6%) have 101 or more players. Most of these clubs have been in existence for more than 25 years (193, 93.6%) with only one club (0.5%) established during the past 5 yr. A total of 48 (23.4%) participating clubs have a formal medical team. Among these, 33 (68.7%) have a medical team consisting of one or two people, whereas 15 (31.2%) had three or more. Regarding AED ownership, 173 (84.4%) of the clubs have an AED, located mostly where the club teams play home games (72, 41.6%) or in the club canteen (74, 42.8%) (Table). Automated external defibrillators were either self-financed (70, 40.5%) or sponsored by another organization (63, 36.4%) (Table). The majority (167, 96.5%) of the clubs have AEDs available both for training activities and competitive games, and 138 (79.8%) of the clubs conduct regular maintenance on the AEDs (Table). Guidelines regarding the use of AED are available in 123 (71.1%) of the participating clubs that own an AED (Table), most of which were provided by the supplier of the AED (61, 49.9%) or by local health care institutions (47, 38.2%). A total of 117 (67.6%) clubs have a person knowledgeable on the use of AED, both during trainings and competition games, compared with 28 (16.2%) that only have them during competition games, and 28 (16.2%) that do not have them at all. Furthermore, a follow-up training on the use of AED was provided by 120 (69.4 %) clubs. A spectator, bystander, or player experienced an SCA during a sports activity in the history of 72 (35.1%) participating clubs. An AED was used only 20 times (27.8% of all SCA events, 10% for all clubs owning an AED). Of these 72 SCA events, 28 patients survived (38.9% of all SCA events), 39 (54.2% of all SCA events) did not, and for the remaining 5 (6.9% of all SCA events) the outcome was unknown.