There are several cost factors involved but they are reasonable. They include:
- Acquiring the equipment
- Maintaining the equipment
- Supplies (batteries & pads)
Acquiring the equipment might appear to be a signicant cost in implementing early defibrillation but this is probably more a myth than reality. Most communities that have implemented defibrillation programs have had little trouble raising funds. The Rochester Police Department was fortunate enough to have avoided mostof this cost due to the generosity of various manufacturers that have supported the ongoing research of Dr. Roger White. Dr. White is a staff consultant with the Mayo Clinic, the co-director of Gold Cross Ambulance Service and also serves as our Police Department Medical Director. We purchased additional AEDs using Homeland Security Grants and only three using our operating budget.
The cost of equipment would be directly proportionate to the number of defibrillators that the community determined were needed to obtain an adequate response time. A good quality AED may cost from $1,900 to $2,500 depending upon the features.
The cost for your community could vary widely. It would be directly proportionate to the number of AEDs purchased and people to be trained. There may be ways to minimize the initial costs. Purchasing through state-wide contracts would be one way. Another might be to start small and expand the program over time. If you can only afford a few units then purchase what you can and add more later. We started with only 4 AEDs but we still managed to save quite a few lives. What is important is that you get started as soon as possible.
You can also get started just by helping to provide CPR training. Dr. White's research has shown that in the select group of patients that received early CPR that the survival rate in that group was 60%. Just making sure that officers are trained in CPR and respond to life-threatening medical calls will save lives in the community even without AEDs.
A few words of caution: You may notice that there are several types of defibrillators on the market – some are higher energy, monophasic and others are lower voltage, bi-phasic defibrillators. The cost for the monophasic equipment may be less than the bi-phasic devices. The Rochester Police Department recommends that anyone considering purchasing AED equipment should consult a knowledgeable and committed physician who can assume medical control and responsibility on this matter. Our program uses a lower energy, bi-phasic wave form defibrillator that has proven to be effective and is simple to operate and maintain. We do not recommend using monophasic AEDs.
You should also make sure that any defibrillator you consider is programmable and meets current AHA guidelines concerning sequencing of shocks. Some older equipment delivers shocks in sequences of three with no interruptions for ventilation and CPR . AHA guidelines now recommend "unstacking" these shocks, i.e. giving a single shock and then administering ventilations and compressions as needed for two minutes before re-analyzing for an additional shock.
Training expenses will vary from one jurisdication to another. In our experience the training costs have been inconsequential. This is due is part to the fact that our officers have served as first responders for many years. This is just a part of what we do. We do not even think of the expense. We do our training on duty. We utilize a train-the-trainer approach to support our ongoing training needs. The expense blurs into our regular operational budget. We make no attempt to track this cost because we realize that if we stopped this program our training budget and salary expense would remain the same. To attach a cost to ongoing training is a pointless exercise in cost accounting.
Initially we provided officers with a four-hour block of training in the use of the AED. Our officers were already trained in CPR (numerous states already require this for police officers). We conducted refresher training every 90 days. We soon found that this was overkill because the devices are so simple. Expenses for other jurisdictions could be greater if officers are not already trained in CPR or if this training cannot be accomplished on duty and will generate overtime.
Maintenance costs have been very minimal for the Rochester Police Department. We have budgeted up to $1,000 in past budgets for anticipated repairs for all of our units. To date we have had no repair costs. The devices have not failed yet. We have eliminated maintenance expenses from our budget. The equipment we use is very rugged and dependable.
Supplies include extra batteries and pads. The City of Rochester budgets for the purchase of one battery per device per year. The lithium-ion batteries retail at about $100 each but are somewhat less under our Minnesota state contract. They have a shelf life of about five years. When inserted into an AED they last about one year. A new battery will deliver about 100 shocks before needing replacement.
Pads cost about $25 each. We budget only a few hundred dollars each year for pads. We do not bother attempting to recover this minor cost from the patients we treat.
State or local financing of the initial purchase might be a challenge. Minnesota has now had two statewide grants to encourage establishing early defibrillation programs – one for law enforcement and one for volunteer ambulance services. If you do not live in Minnesota and your state legislature has not considered funding such initiatives, perhaps it is time that some pressure is applied through professional associations. State and local governments should not be hesitant to fund these purchases but they may need to be reminded that public budgets are really nothing more than their values expressed in terms of dollars. To illustrate this, the Rochester Police Department usually spends more than seven times the cost of maintaining our defibrillators on ammunition. Firearms training is essential and we do not intend to minimize the importance of that. It would be peculiar indeed if we were unwilling to spend the small amount we do on AEDs in order to save lives.
Private funding would not be difficult. This would seem like an ideal community service project for any one of the numerous benevolent or philanthropic organizations across the United States. Elks Lodges, Moose Lodges, Rotarians, Eagles Clubs and others might be excited to take on such a worthy program. We have actually turned down offers of financial support from one benevolent group as it was not needed.
Grants have been a good source for some jurisdictions. Rochester used Homeland Security funds to purchase some of our AEDs.
AED distributors and manufacturers are also usually well informed on grant opportunities. Some offer municipal financing programs as well.