450 nouveaux DEA seront déployés à travers le Québec
(English version of this article follows the french)
(14-03-2025)
J’ai discuté avec Eddy Afram, directeur de DEA-Québec à la Fondation Jacques-de-Champlain, à propos de l’état actuel des défibrillateurs externes automatisés (DEA) et des changements à venir dans un avenir proche.
Newman: Où en sommes-nous actuellement avec les DEA au Québec et où allons-nous?
Afram: L’idéal pour nous, la solution parfaite, ce serait une législation. On sait que ça s’en vient. Le gouvernement du Québec a tenu plusieurs rencontres et a confirmé son intention d’aller de l’avant. Je pense qu’on est rendu à l’étape où il faut simplement le concrétiser. On est à un cheveu de la ligne d’arrivée avec une occasion d’adopter une loi, et comme j’aime bien le dire, “Je ne crois pas qu’on ait déjà vu une législation capable de sauver 200, 300 vies par année comme celle-ci.”
Je ne vois pas pourquoi on ne pourrait pas le faire. D’autres pays qui ont adopté des lois sur l’accès public aux défibrillateurs l’ont fait avec succès. Je parle de l’Italie, l’Espagne, la Norvège, le Danemark, la France, Israël et le Japon. Ces pays l’ont bien implanté. On comprend qu’il y a un coût. C’est là que le Québec a l’opportunité d’être créatif en mettant en place une forme de soutien financier. »
Ce qu’ils ont fait, c’est nous permettre d’acheter 1000 DEA pour les offrir gratuitement dans les communautés. Il y a deux ans, nous en avons placé une centaine dans des succursales de la Banque Nationale et de Desjardins dans le cadre d’un projet pilote. Nous avons ciblé principalement la Mauricie, la Montérégie et l’Estrie. C’était une façon pour nous de documenter et d’évaluer l’impact de l’accès public aux défibrillateurs. »
On vient tout juste de lancer la phase 2, où nous finalisons l’acquisition de 450 DEA, et un autre 450 seront achetés l’an prochain. Dans les prochaines semaines, nous lancerons une grande campagne pour inviter les gens à voir s’ils peuvent se qualifier pour recevoir gratuitement un de ces appareils, et comment ils peuvent en faire la demande via notre site web. Nous prévoyons que 450 DEA seront déployés d’ici le 31 décembre 2025. C’est un projet assez ambitieux. Nous avons complété le processus d’achat. Le fournisseur commercial a été identifié pour nous livrer ces appareils, et maintenant, on règle les derniers détails. »
Un engagement du gouvernement du Québec
Newman : C’est une excellente nouvelle, surtout sachant qu’il n’y a pas si longtemps, le gouvernement du Québec semblait hésitant quant à la phase 2 et la phase 3 du déploiement des DEA.
Afram : Ils n’ont jamais vraiment hésité. Ils cherchaient surtout la meilleure façon d’optimiser l’impact du budget alloué à ce projet. Fallait-il privilégier des subventions ou l’achat direct d’appareils ? Pour accélérer le processus, ils ont opté pour l’achat d’appareils plutôt qu’un programme de subventions. La vraie question était comment faire en sorte que ce soit le plus efficace possible.
On sait que la législation est presque prête à être rendue publique. En fait, elle l’était déjà il y a des mois, voire un an. On attendait seulement qu’elle soit inscrite à l’agenda politique pour être présentée et adoptée. On est prudemment optimistes. Nous avons reçu des signaux positifs du cabinet du ministre de la Santé indiquant que ça pourrait avancer bientôt. On va leur laisser la chance d’aller au bout de ce projet. Je pense qu’on a ici un bon partenaire engagé. Poussons ensemble jusqu’à la ligne d’arrivée.
L’importance des DEA et les progrès du projet
Newman : Parlons de l’importance des DEA et des progrès réalisés par votre projet.
Afram : Il y a un engouement, tant au niveau politique que dans la société, pour le premier maillon de la chaîne de survie : les bons samaritains, les citoyens et les secouristes. C’est une bonne base. On a vu que le plan du gouvernement du Québec en matière de soins préhospitaliers d’urgence reflète bien cette vision.
Grâce aux actions mises en place, nous avons reçu un financement important pour poursuivre notre travail. L’un des éléments clés est la croissance et la maintenance du registre des DEA au Québec. Nous avons commencé avec environ 4500 appareils enregistrés, et nous avons maintenant presque atteint les 9000. C’est une excellente nouvelle, surtout en l’absence d’une loi rendant l’enregistrement obligatoire. Ça signifie que le message passe : plus on sait où se trouvent ces appareils, plus on peut les utiliser pour sauver des vies.
Je suis aussi fier de dire que nous avons une excellente collaboration avec Urgences-santé, qui a pris les devants il y a quelques années en investissant dans une interface connectant notre base de données avec leur système de communication. Ainsi, ils peuvent guider les appelants vers le DEA le plus proche. En un an, nous avons déjà observé des dizaines d’appels où un DEA a été amené au chevet d’un patient en arrêt cardiaque.
L’application et l’accessibilité des DEA
Newman : Je voulais justement vous parler de l’application. Avez-vous remarqué une hausse des téléchargements et de la participation ?
Afram : Oui, on a vu une augmentation marquée des téléchargements. On a financé plusieurs campagnes de communication ces dernières années, et plus activement dans les 24 derniers mois. On a aussi lancé deux mises à jour récentes, la plus récente étant disponible depuis quelques semaines. Cette application ne sert pas seulement à localiser les DEA, elle permet aussi aux citoyens de signaler de nouveaux appareils.
La controverse sur le retrait des DEA dans certains établissements
Newman : De toute évidence, il n’y a aucune recommandation visant à retirer ces appareils de l’accès public. Et pourtant, c’est exactement ce qui s’est produit dans les résidences pour personnes âgées mentionnées dans l’article de Radio-Canada. Est-ce la première fois que vous entendez parler d’une chose pareille ?
Afram : J’aimerais pouvoir dire oui, mais la réalité, c’est non. Ce n’était pas la première fois que le sujet était soulevé. C’était la première fois qu’il l’était par un membre des médias. C’est l’entrevue que je ne pensais jamais avoir à donner dans ma carrière. C’est tellement absurde. L’appareil est là. Il est disponible. Il n’y a aucune raison logique de retirer cet appareil d’un établissement. Il n’existe pas un seul risque qui pourrait justifier de ne pas utiliser un DEA. Ces appareils sont sécuritaires à 100 %. Absolument. Ils sont conçus pour être utilisés sans danger, même par des enfants. Des enfants de sept ans les ont utilisés avec succès dans des études. Ils offrent des instructions visuelles et sonores qui les rendent entièrement accessibles. Et d’un point de vue légal, n’importe qui peut utiliser un DEA pour aider quelqu’un avant l’arrivée des paramédics et des premiers répondants. Je crois que j’ai utilisé le mot « négligence » lors de mon entrevue avec Radio-Canada. Ces appareils sont utiles et ils ne coûtent pratiquement rien à entretenir une fois qu’ils ont été acquis. On parle de changements de batteries, de changements d’électrodes (pads de choc). Et même là, les modèles les plus récents sur le marché, que ce soit Stryker, Samaritan, Zoll ou autres, ont une durée de vie allant jusqu’à 4 ou 5 ans. C’est complètement absurde.
Afram : De la même façon que vous ne verriez jamais quelqu’un dire : « Hé, vous savez quoi, arrêtons tout et retirons nos extincteurs aujourd’hui parce qu’on n’est pas certains qu’ils sont nécessaires. » La prévention des incendies fait partie de la culture aujourd’hui. Personne n’oserait dire une chose pareille. Le fait que nous acceptions cette situation revient à accepter que quelqu’un, un matin, décide de dire : « Hé, retirons le DEA », une décision qui sera directement liée à la mort de quelqu’un. Je veux dire, soit la personne est idiote, soit elle est gravement ignorante à propos de ces appareils. Et j’aime penser que les gens sont simplement mal informés.
450 more AEDs to be deployed across Québec in 2025
I spoke with Eddy Afram, Director of EAD-Quebec at the Fondation Jacques-de-Champlain about the current state of AEDs and what changes we might see in the near future.
Afram: The home run for us, the perfect solution, would be legislation. We know it’s coming. The Government of Quebec has met multiple times and has confirmed their intention of moving forward. I think now we’re just at the point where we have to deliver it. We’re this close from the finishing line where we have a legislation opportunity and as I like to say out loud, “I don’t believe we’ve ever seen legislation that has the capacity to save 200, 300 lives annually like that before.”
I don’t see why we couldn’t do it. Other countries who deployed public access to defibrillator legislation did it successfully. I’m talking about Italy, Spain, Norway, Denmark, France, Israel, and Japan. These countries have successfully done it. There is a cost. We understand that. I think this is where Quebec has the opportunity to be creative by bringing up a form of financial support.
What they’ve done is that they have allowed us to purchase 1000 AEDs to give for free in communities. We put 100 of them into Banque Nationale and Desjardins banks as a pilot project two years ago. We targeted areas mainly in Mauricie, Monteregie and Estrie. It was a way for us to document and evaluate the effect of public access to defibrillators.
“We just launched Phase Two where we are in the process of finalizing the acquisition of 450 AEDs and another 450 will be purchased next year. In the upcoming weeks we will be launching a big campaign to see if people want to qualify to get these machines for free – and how they can apply to do so through our website. We expect 450 AEDs to be deployed by December 31st of 2025. That’s quite an extensive project. We have completed the purchasing process. The commercial partner has been identified to supply us with these devices and now we’re just finalizing the little details.
Newman: This is unexpectedly wonderful news because not that long ago, the government of Quebec seemed to be on the fence about phase two and phase three of the AED deployment.
Afram: They were never really on the fence about it. They were mainly just looking at what is the best way to maximize the effect of the budget we have for this project. So is it through subsidies or is it through devices? In order to accelerate the process, devices were considered instead of a subsidy. It was more of how are we going to do it so that it's more efficient. We know the legislation is almost ready to be made public. It was ready months ago, actually a year ago. We were just waiting to see it listed on the political agenda to be presented and then to be adopted. We're cautiously optimistic. We've received some good hints from the Health Minister's office that this might be moving forward soon. We're going to give them a chance. I think we have a good partner here who's committed. Let's push this to the finishing line together.
Newman: Let’s discuss the importance of AEDs and the progress made by your project.
Afram: There seems to be an enthusiasm both politically and from a society basis around the importance of the first link in the chain of survival, which are good Samaritans, citizens and first aiders. That's a good start. We saw that the plan of the government of Quebec for pre-hospital emergency care really reflected that.
As far as the actions being deployed right now, they've provided significant funding to the Foundation to allow us to carry over these actions on their behalf. One of them is to grow and maintain the AED registry for Quebec. We started with maybe about 4500 EADs initially, and we've seen tremendous growth where we have now reached almost 9000 devices registered. This is very good news because there is no law. This registration is done entirely voluntarily by EAD owners, which means the message is going out that these machines, if we know where they are and we can direct people in distress towards them, will lead to an increase in the number of lives saved.
I'm proud to report that we also have a very good relationship with Urgences-sante who really took the lead on this a few years ago and decided to invest on their own. A connector to bring in our data into their system, the communications data, which allows them to direct callers to AEDs. We have seen probably a few dozen calls now in over a year where the EAD was brought to the bedside of the patient. We don't have data or the means to track the data entirely to know if the EAD was used and what kind of shock was given. But at least we know now that these machines are being brought over. The second phase of the good news is that now more and more calls and 9-1-1 centers are connecting to our data, and that means more people get to use and benefit from the location of these machines.
Newman: I was going to ask you about the app. Are you seeing more downloads and are you seeing more participation?
Afram: Yes, we've seen a tremendous growth of downloads. We've sponsored several communications campaigns over the last few years more actively, let's say in the last 24 months. We've launched two updates since the last, maybe 18 to 24 months of that app, the latest being a few weeks ago. If not entirely rolled out, most users by now should have had an update on their App Store or their Google Store. And this really enforces both functionalities and also the reach. This app is not just an AED tracker app. It also features what we call a carte de visite. Basically, it enables the citizen to refer AEDs to us. The user of the app can say, hey, I found an AED and they don't need all of the information to do it. But by flagging it to us, we have our paid team of staff follow up with a goal of validating every new EAD brought to us by a human before it's allowed on the registry. Once a year, we try to revalidate pretty much all of the data to make sure it's accurate.
Newman: How does the App work?
Afram: The app allows someone who witnesses a cardiac arrest to query the location of the closest available AED in case of emergency, and the timeline to achieve the result is a few seconds. Now, obviously this assumes that the person will actually remember to use that app and is not the one calling 9-1-1. So let's be realistic here. I don't expect citizens to look at EAD Quebec when they have a vital emergency. Most people would get on their knees, start compressing, take their phone and call 9-1-1. By summer, I would say 80% of the province will be connected to the AED registry. So if you were a typical user, you would call 9-1-1. When you see someone collapse or in need of help, 9-1-1 will transfer you to a communication center to speak to an emergency medical dispatcher. And once a cardiac arrest is identified on the phone, the emergency medical dispatcher will have an AED locator tool that pops up where they can identify the closest device using the data. In our system, if there is an AED within a certain radius, that distance is defined regionally by the medical director based on the reality and parameters of their region.
Afram: The way it works is if an AED is identified and there's a second responder, we don't want to stop CPR from being performed by the caller. So if there's a second person calling or available, they're going to be told to go get that AED and they will be told, “hey, it's in the lobby of your building on the ground floor behind the doorman's desk.” AThen they can be directed and brought back to the patient’s side. As for any AED, if the user doesn't remember how to use it, despite the prompts that are vocal and visual, the emergency medical dispatcher can guide them through the steps. So we're really hopeful to see some results. We estimate that if we had AEDs pretty much everywhere in Quebec, based on parameters similar to what Manitoba has implemented as far as legislation goes, we would be seeing 150 to 300 lives saved a year on top of what we do already.
Newman: What’s the typical price for an AED – ballpark estimate with no particular brand in mind?
Afram: The typical price varies. It really comes down to finding a good supplier and negotiating your price. I would say the average price would be about $1,500. You can get something very decent. There's a lot of refurbished items that can be purchased at a lower price today. It really comes down to shelf life and accessory use. Some companies now even offer you to rent long term aids instead of upfront the cost, kind of a subscription based machine. If you buy more, you have more leverage to negotiate a better price.
Newman: I'm curious, can you tell me which municipalities have the highest concentration per capita of AEDs in Quebec?
Afram: The interesting thing is that this only reflects partial reality because it's based on what people voluntarily disclose to us. So it might not be the exact full reality. If I look at the data, as of today, we have 9139 AEDs registered as of noon today. If we look at the net amount of machines registered, Montreal and Monteregie have the two highest amounts. If we look at per capita it goes very high with the Gaspésie-Iles-de-la-Madeleine. But if you look in actual numbers it's 219 for Gaspésie. So it's a very small amount. It's just that their population ratio is so low and it alters the value. We have to be careful with these statistics because they also don't really reflect the area, the distances between villages and regions. And it also doesn't take into account the reality of first responders being available or not. So we're working on a model with the government of Quebec to improve resuscitation capacity.
Newman: Clearly there are no recommendations to withdraw these devices from public access. And yet this is what has happened in the retirement homes highlighted by the article in Radio Canada. Is this the first time you've ever heard of anything like that?
Afram: I wish I could say yes, but the reality is no. It wasn't the first time it was brought up. It was the first time it was brought up by a member of the media. This is the interview I didn't expect to ever have to make in my career. It's just so absurd. You have the machine. It's available. There's no common sense reason why this device should be removed from an establishment. There is not a single risk that could justify not using this AED. Those machines are 100% safe. Absolutely. Child proof use. Seven year olds have been using it successfully in studies. It has visual and auditory prompts making it entirely accessible. And as far as the law is concerned, anyone can use an AED to help someone before the arrival of paramedics and first responders. I think I used the term “negligence” in my interview with Radio Canada. These devices are useful and they don't really cost much to maintain once they've been acquired. We're talking battery changes, we're talking (shock) pads. And even then the latest models on the market, whether it's from Stryker, Samaritan, Zoll or whatsoever. They come with a shelf life of up to 4 to 5 years. So it's really absurd.
Afram: The same way you would never see someone argue and say, hey, you know what, let's turn off and remove our fire extinguishers today because we're not sure they are required. Fire prevention has been embedded in the culture today. Nobody would dare to say something like that. The fact that we are accepting and saying this is the fact that someone wakes up in the morning and says, “Hey, let's remove the AED” which will directly be linked to someone dying. I mean, either you're dumb or you are severely uneducated about these devices. And I'd like to think people are just not educated.
