WHAT'S SUITABLE FOR THE GOOSE IS NOT ALWAYS SO FOR THE GANDER

Automated External Defibrillators and Survival After In-Hospital Cardiac Arrest, November 17, 2010, Chan et al. 304 (19): 2129 — JAMA

This interesting JAMA paper published online recently is an extreme example of the deleterious effect of over protocolisation of a procedure/response. I can only assume that AED use was associated with a worse outcome because those attending the cardiac arrest relied too heavily on the device to tell them what to do resulting in loss of seconds/minutes in a situation when seconds really matter. These protocols were surely designed for members of the public when the alternative is no response - unlike in a hospital where the users have expert knowledge of resuscitation. So always remember who your target population is when designing a protocol!