Introduction: Hospitals are bound to provide a safe environment. Early defibrillation is a key factor in this respect. Outside in-hospital high-risk areas, the use of defibrillators is infrequent. However, even when rapid response teams (RRT) bring their own equipment, the benefit from early shocks strongly suggest their immediate availability. Currently there are no guidelines as to choice, placement strategies, or types/level of defibrillators for in-hospital settings, despite investment costs.

Purpose: Development of rational criteria for type and placement of defibrillators for in-hospital settings.

Methods: Literature research concerning the deployment of defibrillators in hospitals. We selected all hospitals and manufacturers in the Netherlands, using a standardized questionnaire, enquired as to their defibrillator investment and placement strategies. Using the literature and level-of competence legislation, we merged this into criteria for type and placement.
Results: We were unable to find validated arguments supporting type/placement of defibrillator (AED vs manual) with a wide range of devices-to-patient ratios. Guidelines support deployment of a defibrillator anywhere in the hospital within 3 minutes. All respondents noted low incidence of use coupled with a low sensitivity to costs. We found that nurses prefer ‘real’ AED’s over manual defibrillators with an AED function. 
Rational choice criteria were: a) population (in vs out of hospital), b) potential for collapse, c) user competence, d) arrival time RRT, e) time to retrieve, f) positioning same level within reasonable distance (visibility), g) “combination with everything needed” (crash cart).

Conclusions: A wide range of variation in placement strategies and type of defibrillators for the in-hospital setting in the Netherlands. (Cost) effective placement of defibrillators support use of AED’s over manual defibrillators in RRT-based systems even though they may have negative effects. Potential users influence type/placement strategies. Some rational criteria allow for suitable and safe strategies.

8 - Manual or automatic defibrillators for the in-hospital setting: suggested choice criteria