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?

andreas stange