cONCEPTS, COMPONENTS & CONFIGURATIONS automatic external defibrillators Encouraging Early Defibrillation: The American Heart Association and Automated External Defibrillators [Cummins RO, Thies W, Paraskos J, Kerber RE, Billi JE, Seidel J, Jaffe AS, Flint L, Ornato JP, Abramson NS, Brown C, Chandra NC, Gonzalez ER, Newell L, Stults KR, Membrino GE, Pepe PE: Encouraging early defibrilla- tion: The American Heart Association and automated external defibrilla- tors. Ann Emerg Med November 1990;19:1245-1248.] "A National EMT-Defibrillation training curriculum should be developed ... Precise protocols must be developed so that the units (automated defibrilla- tors) are used properly, with minimal interruption of CPR... Local, regional, or statewide advanced training programs, if available, can be of assistance." JAMA 1986;255:2976.1 THE AMERICAN HEART ASSOCIATION'S CHALLENGE ON EARLY DEFIBRILLATION The American Heart Association's Emergency Cardiac Care (ECC) Com- mittee and its Subcommittee on Advanced Cardiac Life Support (ACLS) will soon issue a strong challenge to organized emergency medicine. In new educational materials to be published in the fall of 1990, the AHA re- emphasizes its position that systematic provision of early defibrillation must now be considered a prime goal of all prehospital care systems3,2 Early defibrillation has long been emphasized as the standard therapy for cardiac arrest patients in ventricular fibrillation. 2-4 The AHA will now give greater emphasis to the incorporation of specific early defibrillation programs into a community's emergency medical services (EMS) system and the critical role that automated external defibrillators (AEDs} must play in these programs. The challenge to emergency medicine will be to work to meet this goal of widespread availability of early defibrillation throughout the United States. To help implement such programs, the ACLS Subcommittee, the Basic Life Support (BLS) Subcommittee, and the ECC Committee of the AHA have developed educational materials on the use of AEDs. This informa- tion will be introduced through the ACLS training network and publica- tions. This route was chosen because providers of ACLS now require more knowledge of these devices. The new educational material will include information on the conduct of providers' courses for AED users. Curricula outlines, recommended instructional approaches, and treatment guidelines are provided. The target groups for this educational material are people trained in ALS plus any individuals trained in BLS who may need to oper- ate an AED. These target groups include both in-hospital and prehospital emergency responders. The AHA, however, will assume no responsibility to warrant proficiency in the use of these devices. Successful completion of courses that follow the AHA recommendations represents mastery of con- tent and confers no authorization or certification to use AEDs. The AHA has issued this challenge and provided this material because of several critical concepts that have now gained wide acceptance. The first is our understanding that defibrillation is the most important intervention available for the treatment of cardiac arrest. 1-4 All emergency personnel who respond to persons with cardiac arrest should be equipped to defibril- late J,4-6 This mandate is now possible to fulfill because of the new tech- nology of AEDs. 7 Finally, we now understand that to achieve maximum Richard O Cummins, MD, MPH, MSc Seattle, Washington William Thies, PhD Dallas, Texas Members of the Emergency Cardiac Care Committee and the Advanced Cardiac Life Support Subcommittee of the American Heart Association: John Paraskos, Richard E Kerber, John E Billi, James Seidel, Allan S Jaffe, Loring Flint, Joseph P Ornato, Norman S Abramson, Charles Brown, Nisha C Chandra, Edgar R Gonzalez, Larry Newell, Kenneth R Stults, George E Membrino, and Paul E Pepe Dallas, Texas From the Emergency Cardiac Care Committee and the Advanced Cardiac Life Support Subcommittee of the American Heart Association, Dallas, Texas. Received for publication June 19, 1990. Accepted for publication June 27, 1990. Address for reprints: William Thies, PhD, Science Advisor, American Heart Association, 7320 Greenville Avenue, Dallas, Texas 75231-4599. 19:11 November 1990 Annals of Emergency Medicine 1245/37