A: Among the childcare directors I've heard from, the general consensus is that very few centers have automatic external defibrillators (AEDs). Those that have them focus on their use for adult cardiac emergencies. However, centers will be moving toward implementing these safety precautions in the future.

AEDs are used to treat sudden cardiac arrest—the sudden stopping of cardiac activity where the victim becomes unresponsive with no normal breathing and no signs of circulation. In children, sudden cardiac arrest is not a leading cause of emergency death. This poses a risk to fewer than one in 100,000 kids per year, which is less than 1 percent of adults' risk.

Most medical emergencies in children involve difficulty breathing or development of shock due to blood loss. These injuries require early activation of the Emergency Medical System (EMS), support of breathing and control of hemorrhage. They're unlikely to need treatment with an AED. However, sudden cardiac arrest can occur in children who have congenital heart conditions or acute medical conditions that cause inflammation of the heart. Sudden cardiac arrest can also result from a severe blow to the chest. This is most common in older children participating in athletics.

AEDs are computerized defibrillators designed for use by lay rescuers to treat sudden cardiac arrest. When attached to an unresponsive victim, the AED analyzes the victim's heart rhythm and determines if a shock is needed, charges to an appropriate shock dose and prompts the rescuer to deliver a shock. These are the recommendations regarding AEDs from The American Heart Association and National Association of EMS Physicians:

• Infants under 1 year of age:
  Using AEDs is not recommended because most cardiac arrest is due to respiratory failure or shock, and there is a concern that interrupting cardiopulmonary resuscitation (CPR) to use the AED may introduce more risk than benefit.
• Children 1 to 8:
  AEDs may be used with CPR for treatment of pre-hospital cardiac arrest. One minute of CPR should be provided before any other action, such as activating EMS or using the AED. There are several AEDs approved for use in children this age. When used with a designated pediatric pad-cable system, these AEDs deliver an energy dose smaller than that delivered with adult pads.
• Children 8 years and older:
  The use of CPR with AEDs is recommended for treatment of cardiac arrest. Studies have shown that immediate bystander CPR and defibrillation with the AED within three to five minutes can lead to 50 to 74 percent improvement in survival.

In deciding which safety precautions your childcare program should take, first make sure the staff is trained in first aid and CPR. The guidelines recommend you also consider implementing a lay rescuer AED program if your program has at least one of the following characteristics:

1. It's likely that a cardiac arrest will occur within five years based on having had at least one cardiac arrest there within the last five years.

2. There are children or adults at the school who are at high risk for sudden cardiac arrest. That includes children with congenital heart disease and a history of abnormal heart rhythms, children or adults who have had heart transplants and adults with a history of heart disease.

3. The time it would take to call EMS and for EMS to arrive and defibrillate the patient would not reliably be less than five minutes.

If your childcare program establishes an AED program, be sure to get medical advice and training for staff members in both CPR and use of the AED. Place the AED in a central location accessible at all times and located near a telephone so the rescuer can activate the EMS system and get the AED at the same time. Notify your EMS system about your AED program, the type of AED at the school and where it's located. Make sure the equipment is properly maintained over time. For information about establishing an AED program, call the American Heart Association (877-242-4277) or visit the AHA website (www.heart.org/HEARTORG/CPRAndECC/CPR_UCM_001118_SubHomePage.jsp).