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Tarnovski L, Šantek P, Rožić I, Čučević Đ, Mahečić LM, Marić J, Lovaković J, Martinić D, Rašić F, Rašić Ž. Out-of-Hospital Cardiac Arrest in the Eye of the Beholder and Emergency Medical Service. Open Access Emerg Med 2024; 16:91-99. [PMID: 38699221 PMCID: PMC11063469 DOI: 10.2147/oaem.s449157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose Out-of-hospital cardiac arrest (OHCA) remains a global healthcare problem, with low survival and bystander cardiopulmonary resuscitation (CPR) rates. This study aimed to identify event-related factors in OHCA and their impact on return of spontaneous circulation (ROSC) achievement and maintenance until hospital admission. Patients and Methods All data were collected from Utstein Resuscitation Registry Template for OHCA from The Institute of Emergency Medicine of Zagreb from January 2012 to August 2022. This cross-sectional research analyzed 2839 Utstein reports, including 2001 male, 836 female, and 8 subjects of unknown gender. The average age was 65.4 ± 16.2 years. Results The most frequent place of collapse was private residence, and 27% of collapses were unwitnessed. Dispatcher-provided CPR instructions were provided in 39.7% of cases until the arrival of the emergency service team, which showed a very strong effect on bystander-provided CPR, and were followed in 68.4% of cases, while non-instructed bystander CPR was provided in only 7.9% of cases. Bystander CPR is more likely to be provided in public places than in private residences, often with both compression and ventilation. Bystander CPR was also more likely to be provided to men. Cases with bystander CPR, and compressions with ventilation compared to compression only CPR, showed a significantly greater success in maintaining ROSC later in CPR, both with moderate effects. Conclusion Bystander CPR has been shown to have a significant role in achieving and maintaining ROSC until hospital admission. However, our results showed a location-dependent nature of bystanders' willingness to perform CPR as well as sex disparities in patients receiving CPR. With deficient education in basic life support in Croatia, dispatchers need to insist on and instruct bystander CPR performance.
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Affiliation(s)
| | - Porin Šantek
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
| | - Ivana Rožić
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
| | - Đivo Čučević
- Department of Anesthesiology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Jana Marić
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
| | - Josip Lovaković
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Fran Rašić
- Department of Obstetrics and Gynecology, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Žarko Rašić
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital “Sveti Duh”, Zagreb, Croatia
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Li ZH, Heidet M, Bal J, Ly S, Yan T, Scheuermeyer F, Stambulic M, Deakin J, Chakrabarti S, MacPherson A, Christenson J, Grunau B. Regional variation in accessibility of automated external defibrillators in British Columbia. CAN J EMERG MED 2024; 26:23-30. [PMID: 37976027 DOI: 10.1007/s43678-023-00610-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Bystander-applied Automated External Defibrillators (AED) improve outcomes for out-of-hospital cardiac arrest. AED placement is often driven by private enterprise or non-for-profit agencies, which may result in inequitable access. We sought to compare AED availability between four regions in British Columbia (BC). METHODS We identified AEDs (confirmed to be operational) and emergency medical system (EMS)-treated out-of-hospital cardiac arrests (OHCA) from provincial registries. We compared AED availability between BC's four most populous regions. The primary outcome was the total regional weekly accessible AED-hours per 100,000 population. We also examined: AEDs per 100,000 population and per km2, the ratio of AEDs to OHCA, and the distance from each OHCA to the closest AED. RESULTS From provincial registries, we included 879 AEDs from BC's four most populous regions, where 9333 EMS-treated OHCA occurred over a 5-year period. The most common AED location types were stores, public community centres, and office buildings. Ten percent of AEDs were accessible for all hours. Weekly accessible AED-hours/100,000 population in the four regions were: 3845, 1734, 1594, and 1299. AEDs/100,000 population ranged from 22 to 48, and AEDs/km2 ranged from 0.0048 to 0.20. The number of OHCAs per AED per year ranged from 1.1 to 2.8. The median OHCA-to-closest AED distance ranged from 503 (IQR 244, 947) to 925 (IQR 455, 1501) metres. The regional mean accessibility of individual AEDs ranged between 59 and 79 h per week. CONCLUSION BC's four most populous regions demonstrate substantial variability in AED accessibility. Further benefit could be derived from AEDs if placed in locations accessible all hours. Our data may encourage community planning efforts to use data-based strategies to systematically place AEDs in optimal locations with strategies to maximize accessibility.
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Affiliation(s)
- Zhang Hao Li
- Division of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Université Paris-Est Créteil (UPEC), CIR (EA-3956), Créteil, France
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
| | - Joban Bal
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sophia Ly
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tyler Yan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Frank Scheuermeyer
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | | | - Jon Deakin
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Santabhanu Chakrabarti
- St. Paul's Hospital, Vancouver, BC, Canada
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Andrew MacPherson
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Jim Christenson
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian Grunau
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada.
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- St. Paul's Hospital, Vancouver, BC, Canada.
- British Columbia Emergency Health Services, Vancouver, BC, Canada.
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Juul Grabmayr A, Malta Hansen C, Bo N, Sheikh AP, Hassager C, Ersbøll A, Kjaergaard J, Lippert F, Tjørnhøj-Thomsen T, Gislason G, Torp-Pedersen C, Folke F. Community intervention to improve defibrillation before ambulance arrival in residential neighbourhoods with a high risk of out-of-hospital cardiac arrest: study protocol of a cluster-randomised trial (the CARAMBA trial). BMJ Open 2023; 13:e073541. [PMID: 37816557 PMCID: PMC10565309 DOI: 10.1136/bmjopen-2023-073541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION In Denmark, multiple national initiatives have been associated with improved bystander defibrillation and survival following out-of-hospital cardiac arrest (OHCA) in public places. However, OHCAs in residential neighbourhoods continue to have poor outcomes. The Cardiac Arrest in Residential Areas with MoBile volunteer responder Activation trial aims to improve bystander defibrillation and survival following OHCA in residential neighbourhoods with a high risk of OHCA. The intervention consists of: (1) strategically deployed automated external defibrillators accessible at all hours, (2) cardiopulmonary resuscitation (CPR) training of residents and (3) recruitment of residents for a volunteer responder programme. METHODS AND ANALYSIS This is a prospective, pair-matched, cluster-randomised, superiority trial with clusters of 26 residential neighbourhoods, testing the effectiveness of the intervention in a real-world setting. The areas are randomised for intervention or control. Intervention and control areas will receive the standard OHCA emergency response, including volunteer responder activation. However, targeted automated external defibrillator deployment, CPR training and volunteer responder recruitment will only be provided in the intervention areas. The primary outcome is bystander defibrillation, and the secondary outcome is 30-day survival. Data on patients who had an OHCA will be collected through the Danish Cardiac Arrest Registry. ETHICS AND DISSEMINATION Approval to store OHCA data has been granted from the Legal Office, Capital Region of Denmark (j.nr: 2012-58-0004, VD-2018-28, I-Suite no: 6222, and P-2021-670). In Denmark, formal approval from the ethics committee is only obtainable when the study regards testing medicine or medical equipment on humans or using genome or diagnostic imagine as data source. The Ethics Committee of the Capital Region of Denmark has evaluated the trial and waived formal approval unnecessary (H-19037170). Results will be published in peer-reviewed papers and shared with funders, stakeholders, and housing organisations through summaries and presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04446585).
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Annam Pervez Sheikh
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Ersbøll
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Population Health and Morbidity, National Institute of Public Health, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
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Paratz E, Page GJ, Jennings GL. Defibrillator access across Australia: the first step in avoiding a chain of fatality. Med J Aust 2023; 219:146-148. [PMID: 37517008 DOI: 10.5694/mja2.52041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023]
Affiliation(s)
| | | | - Garry Lr Jennings
- Baker Heart and Diabetes Institute, Melbourne, VIC
- University of Sydney, Sydney, NSW
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Horning J, Griffith D, Slovis C, Brady W. Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:413-432. [PMID: 37391242 DOI: 10.1016/j.emc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Lay rescuers play a pivotal role in the recognition and initial management of out-of-hospital cardiac arrest. The provision of timely pre-arrival care by lay responders, including cardiopulmonary resuscitation and the use of automated external defibrillator before emergency medical service arrival, is important link in the chain of survival and has been shown to improve outcomes from cardiac arrest. Although physicians are not directly involved in bystander response to cardiac arrest, they play a key role in emphasizing the importance of bystander interventions.
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Affiliation(s)
- Jillian Horning
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Daniel Griffith
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Corey Slovis
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA; Department of Emergency Medicine, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - William Brady
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
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Jonsson M, Berglund E, Baldi E, Caputo ML, Auricchio A, Blom MT, Tan HL, Stieglis R, Andelius L, Folke F, Hollenberg J, Svensson L, Ringh M. Dispatch of Volunteer Responders to Out-of-Hospital Cardiac Arrests. J Am Coll Cardiol 2023; 82:200-210. [PMID: 37438006 DOI: 10.1016/j.jacc.2023.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Systems for dispatch of volunteer responders to collect automated external defibrillators and/or to provide cardiopulmonary resuscitation (CPR) in cases of nearby out-of-hospital cardiac arrest (OHCA) are widely implemented. OBJECTIVES This study aimed to investigate whether the activation of a volunteer responder system to OHCAs was associated with higher rates of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. METHODS This was a retrospective observational analysis within the ESCAPE-NET (European Sudden Cardiac Arrest network: Towards Prevention, Education, New Effective Treatment) collaborative research network. Included were cases of OHCA between 2015 and 2019 from 5 European sites with volunteer responder systems. At all sites, systems were activated by dispatchers at the emergency medical communication center in response to suspected OHCA. Exposed cases (system activation) were compared with nonexposed cases (no system activation). Risk ratios (RRs) were calculated for the outcomes of bystander CPR, bystander defibrillation, and 30-day survival after inverse probability treatment weighting. Missing data were handled using multiple imputation. RESULTS In total, 9,553 cases were included. In 4,696 cases, the volunteer responder system was activated, and in 4,857 it was not. The pooled RRs were 1.30 (95% CI: 1.15-1.47) for bystander CPR, 1.89 (95% CI: 1.36-2.63) for bystander defibrillation, and 1.22 (95% CI: 1.07-1.39) for 30-day survival. CONCLUSIONS Activation of a volunteer response system in cases of OHCA was associated with a higher chance of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. A randomized controlled trial is necessary to determine fully the causal effect of volunteer responder systems.
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Affiliation(s)
- Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
| | - Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Enrico Baldi
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, San Matteo Foundation Institute for Research, Hospitalization and Health Care, Pavia, Italy
| | - Maria Luce Caputo
- Division of Cardiology, Ticino Cardiocentro Institute, Cantonal Hospital Group, Lugano, Switzerland
| | - Angelo Auricchio
- Division of Cardiology, Ticino Cardiocentro Institute, Cantonal Hospital Group, Lugano, Switzerland
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Remy Stieglis
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
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AED delivery at night - Can drones do the Job? A feasibility study of unmanned aerial systems to transport automated external defibrillators during night-time. Resuscitation 2023; 185:109734. [PMID: 36791989 DOI: 10.1016/j.resuscitation.2023.109734] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND In their recent guidelines the European Resuscitation Council have recommended the use of Unmanned Aerial systems (UAS) to overcome the notorious shortage of AED. Exploiting the full potential of airborne AED delivery would mandate 24 h UAS operability. However, current systems have not been evaluated for nighttime use. The primary goal of our study was to evaluate the feasibility of night-time AED delivery by UAS. The secondary goal was to obtain and compare operational and safety data of night versus day missions. METHODS We scheduled two (one day, one night) flights each to ten different locations to assess the feasibility of AED delivery by UAS during night-time. We also compared operational data (mission timings) and safety data (incidence of critical events) of night versus day missions. RESULTS All missions were completed without safety incident. The flights were performed automatically without pilot interventions, apart from manually choosing the landing site and correcting the descent. Flight distances ranged from 910 m to 6.960 m, corresponding mission times from alert to AED release between 3:48 min and 11:20 min. Night missions (T¯m:night = 7:26 ± 2:29 min) did not take longer than day missions (T¯m:day = 7:59 ± 2:27 min). Despite slightly inferior visibility of the target site, night landings (T¯land:night = 64 ± 15 sec) were on average marginally quicker than day landings (T¯land:day = 69 ± 11sec). CONCLUSIONS Our results demonstrate the feasibility of UAS supported AED delivery during nighttime. Operational and safety data indicate no major differences between day- and night-time use. Future research should focus on integration of drone technology into the chain of survival.
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Factors affecting public access defibrillator placement decisions in the United Kingdom: A survey study. Resusc Plus 2023; 13:100348. [PMID: 36686326 PMCID: PMC9850057 DOI: 10.1016/j.resplu.2022.100348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Aim This study aimed to understand current community PAD placement strategies and identify factors which influence PAD placement decision-making in the United Kingdom (UK). Methods Individuals, groups and organisations involved in PAD placement in the UK were invited to participate in an online survey collecting demographic information, facilitators and barriers to community PAD placement and information used to decide where a PAD is installed in their experiences. Survey responses were analysed through descriptive statistical analysis and thematic analysis. Results There were 106 included responses. Distance from another PAD (66%) and availability of a power source (63%) were most frequently used when respondents are deciding where best to install a PAD and historical occurrence of cardiac arrest (29%) was used the least. Three main themes were identified influencing PAD placement: (i) the relationship between the community and PADs emphasising community engagement to create buy-in; (ii) practical barriers and facilitators to PAD placement including securing consent, powering the cabinet, accessibility, security, funding, and guardianship; and (iii) 'risk assessment' methods to estimate the need for PADs including areas of high footfall, population density and type, areas experiencing health inequalities, areas with delayed ambulance response and current PAD provision. Conclusion Decision-makers want to install PADs in locations that maximise impact and benefit to the community, but this can be constrained by numerous social and infrastructural factors. The best location to install a PAD depends on local context; work is required to determine how to overcome barriers to optimal community PAD placement.
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Heidet M, Freyssenge J, Claustre C, Deakin J, Helmer J, Thomas-Lamotte B, Wohl M, Danny Liang L, Hubert H, Baert V, Vilhelm C, Fraticelli L, Mermet É, Benhamed A, Revaux F, Lecarpentier É, Debaty G, Tazarourte K, Cheskes S, Christenson J, El Khoury C, Grunau B. Association between location of out-of-hospital cardiac arrest, on-scene socioeconomic status, and accessibility to public automated defibrillators in two large metropolitan areas in Canada and France. Resuscitation 2022; 181:97-109. [PMID: 36309249 DOI: 10.1016/j.resuscitation.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
AIM To compare walking access times to automated external defibrillators (AEDs) between area-level quintiles of socioeconomic status (SES) in out-of-hospital cardiac arrest (OHCA) cases occurring in 2 major urban regions of Canada and France. METHODS This was an international, multicenter, retrospective cohort study of adult, non-traumatic OHCA cases in the metropolitan Vancouver (Canada) and Rhône County (France) regions that occurred between 2014 and 2018. We calculated area-level SES for each case, using quintiles of country-specific scores (Q5 = most deprived). We identified AED locations from local registries. The primary outcome was the simulated walking time from the OHCA location to the closest AED (continuous and dichotomized by a 3-minute 1-way threshold). We fit multivariate models to analyze the association between OHCA-to-AED walking time and outcomes (Q5 vs others). RESULTS A total of 6,187 and 3,239 cases were included from the Metro Vancouver and Rhône County areas, respectively. In Metro Vancouver Q5 areas (vs Q1-Q4), areas, AEDs were farther from (79 % over 400 m from case vs 67 %, p < 0.001) and required longer walking times to (97 % above 3 min vs 91 %, p < 0.001) cases. In Rhône Q5 areas, AEDs were closer than in other areas (43 % over 400 m from case vs 50 %, p = 0.01), yet similarly poorly accessible (85 % above 3 min vs 86 %, p = 0.79). In multivariate models, AED access time ≥ 3 min was associated with decreased odds of survival at hospital discharge in Metro Vancouver (odds ratio 0.41, 95 % CI [0.23-0.74], p = 0.003). CONCLUSIONS Accessibility of public AEDs was globally poor in Metro Vancouver and Rhône, and even poorer in Metro Vancouver's socioeconomically deprived areas.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil (UPEC), EA-3956 (Control in Intelligent Networks [CIR]), Créteil, France.
| | - Julie Freyssenge
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), Lyon, France; Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France
| | | | - John Deakin
- British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Jennie Helmer
- British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Bruno Thomas-Lamotte
- Association pour le recensement et la localisation des défibrillateurs (ARLoD), Paris, France
| | - Mathys Wohl
- Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France
| | - Li Danny Liang
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Hervé Hubert
- Registre électronique des arrêts cardiaques (RéAC), Université de Lille, Lille, France; Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Valentine Baert
- Registre électronique des arrêts cardiaques (RéAC), Université de Lille, Lille, France; Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Christian Vilhelm
- Registre électronique des arrêts cardiaques (RéAC), Université de Lille, Lille, France
| | - Laurie Fraticelli
- Université Claude Bernard Lyon 1, Laboratoire Parcours Santé Systémique (P2S) UR 4129, Lyon, France
| | - Éric Mermet
- École des hautes études en sciences sociales (EHESS), Centre d'analyse et de mathématiques sociales (CAMS), Paris, France; Centre national de la recherche scientifique (CNRS), Institut des systèmes complexes (ISC-PIF), Paris, France
| | - Axel Benhamed
- Hospices civils de Lyon, SAMU 69 and Emergency Department, Lyon, France
| | - François Revaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux universitaires Henri Mondor, Créteil, France
| | - Éric Lecarpentier
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux universitaires Henri Mondor, Créteil, France
| | - Guillaume Debaty
- Université Grenoble Alpes, CNRS, TIMC, UMR 5525, Grenoble, France; Hôpital universitaire Grenoble Alpes, SAMU 38, Grenoble, France
| | - Karim Tazarourte
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), Lyon, France; Hospices civils de Lyon, SAMU 69 and Emergency Department, Lyon, France
| | - Sheldon Cheskes
- Sunnybrook Center for Prehospital Medicine, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Jim Christenson
- University of British Columbia, Department of Emergency Medicine, Vancouver, British Columbia, Canada; Saint Paul's Hospital, Emergency Department, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHEOS), RESURECT Group, Providence Research, Vancouver, British Columbia, Canada
| | - Carlos El Khoury
- Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France; Médipôle Hôpital Mutualiste, Emergency Department, Lyon-Villeurbanne, France
| | - Brian Grunau
- University of British Columbia, Department of Emergency Medicine, Vancouver, British Columbia, Canada; Saint Paul's Hospital, Emergency Department, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHEOS), RESURECT Group, Providence Research, Vancouver, British Columbia, Canada
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Location of out-of-hospital cardiac arrests and automated external defibrillators in relation to schools in an English ambulance service region. Resusc Plus 2022; 11:100279. [PMID: 35911779 PMCID: PMC9335389 DOI: 10.1016/j.resplu.2022.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) remains low both in England and worldwide. About a third of all OHCAs occur within 300 m of a school. Considering the usage rates of public access defibrillators there is significant potential for increasing their use. Improving access to automated external defibrillators (AED) in schools and their registration with Emergency Medical Services could lead to greater use. A strategy for placing AEDs in schools is likely to be cost-effective.
Introduction This study sought to identify the availability of automated external defibrillators (AEDs) in schools in the region served by West Midlands Ambulance Service University NHS Trust (WMAS), United Kingdom, and the number of out-of-hospital cardiac arrests (OHCA) that occurred at or near to schools. A secondary aim was to explore the cost effectiveness of school-based defibrillators. Methods This observational study used data from the national registry for OHCA (University of Warwick) to identify cases occurring at or near schools between January 2014 and December 2016 in WMAS region (n = 11,399). A school survey (n = 2,453) was carried out in September 2017 to determine the presence of AEDs and their registration status with WMAS. Geographical Information System mapping software identified OHCAs occurring within a 300-metre radius of a school. An economic analysis calculated the cost effectiveness of school-based AEDs. Results A total of 39 (0.34%) of all OHCAs occurred in schools, although 4,250 (37.3%) of OHCAs in the region were estimated to have occurred within 300 metres of a school. Of 323 school survey responses, 184 (57%) had an AED present, of which 24 (13.0%) were available 24 h/day. Economic modelling of a school-based AED programme showed additional quality-adjusted life years (QALY) of 0.26 over the lifetime of cardiac arrest survivors compared with no AED programme. The incremental cost-effectiveness ratio (ICER) was £8,916 per QALY gained. Conclusion Cardiac arrests in schools are rare. Registering AEDs with local Emergency Medical Services and improving their accessibility within their local community would increase their utility.
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Network of Automated External Defibrillators in Poland before the SARS-CoV-2 Pandemic: An In-Depth Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159065. [PMID: 35897427 PMCID: PMC9331639 DOI: 10.3390/ijerph19159065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023]
Abstract
Introduction: Sudden cardiac arrest (SCA), which causes more than half of all cardiovascular related deaths, can be regarded as a common massive global public health problem. Analyzing out-of-hospital cardiac arrest (OHCA) cases, one of the key components is automatic external defibrillators (AEDs). Aim: The aim of this study was to analyze the use and distribution of AEDs in Polish public places. Materials and methods: The data were analyzed by using the Excel and R calculation programs. Results: The data represents 120 uses of automatic external defibrillators used in Polish public space in the period 2008–2018. The analysis describes 1165 locations of AEDs in Poland. It was noted that the number of uses in the period 2010–2016 fluctuated at a constant value, with a significant rise in 2017. When analyzing the time of interventions in detail the following was noted: the highest percentage of interventions was observed in April, and the lowest in November; the highest number of interventions was observed on a Friday, while the least number of interventions was observed on a Sunday; most occurred between 12:00 to 16:00, and least between 20:00 to 8:00. Conclusions: The observed growth in the number of cases of AED use in public places is associated with the approach to training, the emphasis on public access to defibrillation, and, therefore, the growth of social awareness. This study will be continued. The next analysis would include 2020–2022 and would be a comparative analysis with the current research.
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Kim TY, Jung YK, Yoon SH, Kim SJ, Cha KC, Jung WJ, Roh YI, Kim S, Kim SH, Kang DR, Hwang SO. Trends in maintenance status and usability of public automated external defibrillators during a 5-year on-site inspection. Sci Rep 2022; 12:10738. [PMID: 35750888 PMCID: PMC9232625 DOI: 10.1038/s41598-022-14611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to assess the trend of the maintenance status and usability of public automated external defibrillators (AEDs). Public AEDs installed in Seoul from 2013 to 2017 were included. An inspector checked the maintenance status and usability of the AEDs annually using a checklist. During the study period, 23,619 AEDs were inspected. Access to the AEDs was improved, including the absence of obstacles near the AEDs (from 90.2% in 2013 to 99.1% in 2017, p < 0.0001) and increased AED signs (from 34.3% in 2013 to 91.3% in 2017, p < 0.0001). The rate of AEDs in normal operation (from 94.0% in 2013 to 97.6% in 2017, p < 0.0001), good battery status (from 95.6% in 2013 to 96.8% in 2017, p = 0.0016), and electrode availability increased (from 97.1% in 2013 to 99.0% in 2017, p < 0.0001); the rate of electrode validity decreased (from 90.0% in 2013 to 87.2% in 2017, p < 0.0001). The overall rate of the non-ready-to-use AEDs and AEDs with less than 24-h usability accounted for 15.4% and 44.1% of the total number of AEDs, respectively. Although most AEDs had a relatively good maintenance status, a significant proportion of public AEDs were not available for 24-h use. Invalid electrodes and less than 24-h accessibility were the main reasons that limited the 24-h usability of public AEDs.
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Affiliation(s)
- Tae Youn Kim
- Department of Emergency Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | | | - Sun Hwa Yoon
- Korean Association for Safe Communities, Seoul, South Korea
| | - Sun Ju Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 26427, South Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 26427, South Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 26427, South Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 26427, South Korea
| | - Soyeong Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 26427, South Korea
| | - Sung Hwa Kim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 26427, South Korea.
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Ball S, Morgan A, Simmonds S, Bray J, Bailey P, Finn J. Strategic placement of automated external defibrillators (AEDs) for cardiac arrests in public locations and private residences. Resusc Plus 2022; 10:100237. [PMID: 35515011 PMCID: PMC9065707 DOI: 10.1016/j.resplu.2022.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
We ranked businesses for their ability to fill gaps in the AED landscape. 23% of OHCAs in public, and 4% in homes, were within 100 m of an existing AED. Many businesses can simultaneously improve coverage of arrests in public and homes. Rankings were largely robust to the coverage radius used (100 m, 200 m, and 500 m). Even if all 5006 business locations hosted AEDs, large gaps in OHCA coverage remain.
Aim Methods Results Conclusion
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Affiliation(s)
- S. Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- St John Western Australia, Belmont, WA 6104, Australia
- Corresponding author at: Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - A. Morgan
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
| | - S. Simmonds
- St John Western Australia, Belmont, WA 6104, Australia
| | - J. Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - P. Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- St John Western Australia, Belmont, WA 6104, Australia
| | - J. Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- St John Western Australia, Belmont, WA 6104, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia
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Functionality of Registered Automated External Defibrillators. Resuscitation 2022; 176:58-63. [DOI: 10.1016/j.resuscitation.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022]
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation 2022; 145:e776-e801. [PMID: 35164535 DOI: 10.1161/cir.0000000000001013] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation 2022; 172:204-228. [PMID: 35181376 DOI: 10.1016/j.resuscitation.2021.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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van Diepen S, Hansen CM. Modeling optimal AED placement to improve cardiac arrest survival: The challenge is implementation. Resuscitation 2022; 172:201-203. [DOI: 10.1016/j.resuscitation.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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18
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Assessing Trauma Center Accessibility for Healthcare Equity Using an Anti-Covering Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031459. [PMID: 35162486 PMCID: PMC8835095 DOI: 10.3390/ijerph19031459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023]
Abstract
Motor vehicle accidents are one of the most prevalent causes of traumatic injury in patients needing transport to a trauma center. Arrival at a trauma center within an hour of the accident increases a patient's chances of survival and recovery. However, not all vehicle accidents in Tennessee are accessible to a trauma center within an hour by ground transportation. This study uses the anti-covering location problem (ACLP) to assess the current placement of trauma centers and explore optimal placements based on the population distribution and spatial pattern of motor vehicle accidents in 2015 through 2019 in Tennessee. The ACLP models seek to offer a method of exploring feasible scenarios for locating trauma centers that intend to provide accessibility to patients in underserved areas who suffer trauma as a result of vehicle accidents. The proposed ACLP approach also seeks to adjust the locations of trauma centers to reduce areas with excessive service coverage while improving coverage for less accessible areas of demand. In this study, three models are prescribed for finding optimal locations for trauma centers: (a) TraCt: ACLP model with a geometric approach and weighted models of population, fatalities, and spatial fatality clusters of vehicle accidents; (b) TraCt-ESC: an extended ACLP model mitigating excessive service supply among trauma center candidates, while expanding services to less served areas for more beneficiaries using fewer facilities; and (c) TraCt-ESCr: another extended ACLP model exploring the optimal location of additional trauma centers.
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Mottlau KH, Andelius LC, Gregersen R, Malta Hansen C, Folke F. Citizen Responder Activation in Out-of-Hospital Cardiac Arrest by Time of Day and Day of Week. J Am Heart Assoc 2022; 11:e023413. [PMID: 35060395 PMCID: PMC9238482 DOI: 10.1161/jaha.121.023413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background We aim to examine diurnal and weekday variations in citizen responder availability and intervention at out‐of‐hospital cardiac arrest (OHCA) resuscitation. Methods and Results We included confirmed OHCAs where citizen responders were activated by a smartphone application in the Capital Region of Denmark between September 1, 2017 and August 31, 2018. OHCAs were analyzed by time of day (daytime: 07:00 am–03:59 pm, evening: 4:00–11:59 pm, and nighttime: 12:00–06:59 am) and day of week (Monday–Friday or Saturday–Sunday/public holidays). We included 438 OHCAs where 6836 citizen responders were activated. More citizen responders accepted alarms in the evening (mean 4.8 [95% CI, 4.4–5.3]) compared with daytime (3.7 [95% CI, 3.4–4.4]) and nighttime (1.8 [95% CI, 1.5–2.2]) (P<0.001), and more accepted alarms during weekends (4.3 [95% CI, 3.8–4.9]) compared with weekdays (3.4 [95% CI, 3.2–3.7]) (P<0.001). Proportion of OHCAs where at least 1 citizen responder arrived before Emergency Medical Services were significantly different between day (42.9%), evening (50.3%), and night (26.1%) (P<0.001), and between weekdays (37.2%) and weekends (53.5%) (P=0.002). When responders arrived before Emergency Medical Services, there was no difference of bystander cardiopulmonary resuscitation or defibrillation between daytime, evening, and nighttime (P=0.75 and P=0.22, respectively) or between weekend and weekdays (P=0.29 and P=0.12, respectively). Conclusions Citizen responders were more likely to accept OHCA alarms during evening and weekends, with the highest proportion of responders arriving before Emergency Medical Services in the evening. However, there was no significant difference in delivering cardiopulmonary resuscitation or early defibrillation among cases where citizen responders arrived before Emergency Medical Services. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03835403.
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Affiliation(s)
- Katarina Høgh Mottlau
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark
| | - Linn Charlotte Andelius
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Denmark
| | - Rasmus Gregersen
- Department of Emergency Medicine Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark
| | - Fredrik Folke
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Denmark.,Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark
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Smith CM, Lall R, Fothergill RT, Spaight R, Perkins GD. The effect of the GoodSAM volunteer first-responder app on survival to hospital discharge following out-of-hospital cardiac arrest. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:20-31. [PMID: 35024801 PMCID: PMC8757292 DOI: 10.1093/ehjacc/zuab103] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022]
Abstract
AIMS Bystander cardiopulmonary resuscitation and defibrillation can double survival to hospital discharge in out-of-hospital cardiac arrest. Mobile phone applications, such as GoodSAM, alerting nearby volunteer first-responders about out-of-hospital cardiac arrest could potentially improve bystander cardiopulmonary resuscitation and defibrillation, leading to better patient outcomes. The aim of this study was to determine GoodSAM's effect on survival to hospital discharge following out-of-hospital cardiac arrest. METHODS AND RESULTS We collected data from the Out-of-Hospital Cardiac Arrest Outcomes Registry (University of Warwick, UK) submitted by the London Ambulance Service (1 April 2016 to 31 March 2017) and East Midlands Ambulance Service (1 January 2018 to 17 June 2018) and matched out-of-hospital cardiac arrests to GoodSAM alerts. We constructed logistic regression models to determine if there was an association between a GoodSAM first-responder accepting an alert and survival to hospital discharge, adjusting for location type, presenting rhythm, age, gender, ambulance service response time, cardiac arrest witnessed status, and bystander actions. Survival to hospital discharge was 9.6% (393/4196) in London and 7.2% (72/1001) in East Midlands. A GoodSAM first-responder accepted an alert for out-of-hospital cardiac arrest in 1.3% (53/4196) cases in London and 5.4% (51/1001) cases in East Midlands. When a responder accepted an alert, the adjusted odds ratio for survival to hospital discharge was 3.15 (95% CI: 1.19-8.36, P = 0.021) in London and 3.19 (95% CI: 1.17-8.73, P = 0.024) in East Midlands. CONCLUSION Alert acceptance was associated with improved survival in both ambulance services. Alert acceptance rates were low, and challenges remain to maximize the potential benefit of GoodSAM.
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Affiliation(s)
- Christopher M Smith
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Rachael T Fothergill
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK.,Clinical Audit and Research Unit, London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 8SD, UK
| | - Robert Spaight
- East Midlands Ambulance Service NHS Trust, 1 Horizon Place, Mellors Way, Nottingham NG8 6PY, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
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22
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Tijssen JGP, Zwinderman AH, Blom MT, Koster RW. Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home. Eur Heart J 2021; 43:1465-1474. [PMID: 34791171 PMCID: PMC9009403 DOI: 10.1093/eurheartj/ehab802] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/17/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Aims Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. Methods and results In residential areas, 785 AEDs were placed and 5735 volunteer responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analysed survival (primary outcome) and neurologically favourable survival to discharge, time to first defibrillation shock, and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Survival from OHCAs in residences increased from 26% to 39% {adjusted relative risk (RR) 1.5 [95% confidence interval (CI): 1.03–2.0]}. RR for neurologically favourable survival was 1.4 (95% CI: 0.99–2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR: 0.5, 95% CI: 0.3–0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (P < 0.001). Defibrillation by first responders in residences increased from 22 to 40% (P < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (P = 0.81). Time from emergency call to defibrillation decreased from median 11.7 to 9.3 min; mean difference –2.6 (95% CI: –3.5 to –1.6). Conclusion Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.
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Affiliation(s)
- Remy Stieglis
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Jolande A Zijlstra
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | | | | | - Jan G P Tijssen
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | - Marieke T Blom
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Rudolph W Koster
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
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Brown TP, Perkins GD, Smith CM, Deakin CD, Fothergill R. Are there disparities in the location of automated external defibrillators in England? Resuscitation 2021; 170:28-35. [PMID: 34757059 PMCID: PMC8786665 DOI: 10.1016/j.resuscitation.2021.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022]
Abstract
Background Early defibrillation is an essential element of the chain of survival for out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) programmes aim to place automated external defibrillators (AED) in areas with high OHCA incidence, but there is sometimes a mismatch between AED density and OHCA incidence. Objectives This study aimed to assess whether there were any disparities in the characteristics of areas that have an AED and those that do not in England. Methods Details of the location of AEDs registered with English Ambulance Services were obtained from individual services or internet sources. Neighbourhood characteristics of lower layer super output areas (LSOA) were obtained from the Office for National Statistics. Comparisons were made between LSOAs with and without a registered AED. Results AEDs were statistically more likely to be in LSOAs with a lower residential but higher workplace population density, with people predominantly from a white ethnic background and working in higher socio-economically classified occupations (p < 0.05). There was a significant correlation between AED coverage and the LSOA Index of Multiple Deprivation (IMD) (r = 0.79, p = 0.007), with only 27.4% in the lowest IMD decile compared to about 45% in highest. AED density varied significantly across the country from 0.82/km2 in the north east to 2.97/km2 in London. Conclusions In England, AEDs were disproportionately placed in more affluent areas, with a lower residential population density. This contrasts with locations where OHCAs have previously occurred. Future PAD programmes should give preference to areas of higher deprivation and be tailored to the local community.
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Affiliation(s)
- Terry P Brown
- NIHR Applied Research Collaboration West Midlands, Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK.
| | - Gavin D Perkins
- NIHR Applied Research Collaboration West Midlands, Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | | | - Charles D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Winchester SO21 2RU, UK; University Hospital Southampton NHS Foundation Trust, Southampton S16 6YD, UK
| | - Rachael Fothergill
- Clinical Audit & Research Unit, Clinical & Quality Directorate, London Ambulance Service NHS Trust, HQ Annexe, 8-20 Pocock Street, London SE1 0BW, UK
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Okazaki T, Yoshida T, Uchino S, Sasabuchi Y. Association of onset time of new-onset atrial fibrillation with in-hospital mortality among critically ill patients: A secondary analysis of a prospective multicenter observational study. IJC HEART & VASCULATURE 2021; 36:100880. [PMID: 34632043 PMCID: PMC8488237 DOI: 10.1016/j.ijcha.2021.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
Background New-onset atrial fibrillation (AF) in critically ill patients is associated with adverse outcomes. In non-critical settings, the circadian variation in paroxysmal AF is of significant interest; however, circadian variation in critically ill patients with new-onset AF has not been thoroughly studied. This study aimed to examine the association between AF onset time and in-hospital mortality. Methods This was a secondary analysis of a prospective multicenter observational study enrolling adult critically ill patients. According to AF onset time, patients were divided into nighttime (0:00–7:59), daytime (8:00–15:59), and evening (16:00–23:59). We conducted a multiple logistic regression analysis to assess the potential association between AF onset time and in-hospital mortality. We also assessed the distribution of AF onset, crude in-hospital mortality, and adjusted in-hospital mortality according to bihourly intervals. Results Of 423 patients, in-hospital mortality was 26%. During nighttime, 135 patients (32%) developed new-onset AF. AF emerged during daytime for 141 (33%) and during evening for 147 (35%). Daytime AF was significantly associated with an increased risk of in-hospital mortality (adjusted OR: 1.92; 95% CI: 1.07–3.44; p = 0.030). Bihourly interval analysis showed that adjusted in-hospital mortality was unevenly distributed and bimodal with troughs between 6:00 and 7:59 and between 18:00 and 19:59. A similar trend was seen in the distribution of the number of new-onset AF. Conclusions We found that the bihourly adjusted in-hospital mortality was distributed in a bimodal fashion. Further research is needed to determine the causes of the diurnal variation and its impact on patient outcomes.
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Affiliation(s)
- Tomoya Okazaki
- Emergency Medical Center, Kagawa University Hospital, Japan
| | - Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Japan.,Department of Intensive Care Medicine, Tokyo Women's Medical University, Japan
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Japan
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25
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Ślęzak D, Robakowska M, Żuratyński P, Synoweć J, Pogorzelczyk K, Krzyżanowski K, Błażek M, Woroń J. Analysis of the Way and Correctness of Using Automated External Defibrillators Placed in Public Space in Polish Cities-Continuation of Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9892. [PMID: 34574815 PMCID: PMC8468203 DOI: 10.3390/ijerph18189892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022]
Abstract
Immediate resuscitation is required for any sudden cardiac arrest. To improve the survival of the patient, a device to be operated by witnesses of the event-automated external defibrillator (AED)-has been produced. The aim of this study is to analyze the way and correctness of use of automated external defibrillators placed in public spaces in Polish cities. The data analyzed (using Excel 2019 and R 3.5.3 software) are 120 cases of use of automated external defibrillators, placed in public spaces in the territory of Poland in 2008-2018. The predominant location of AED use is in public transportation facilities, and the injured party is the traveler. AED use in non-hospital settings is more common in male victims aged 50-60 years. Owners of AEDs inadequately provide information about their use. The documentation that forms the basis of the emergency medical services intervention needs to be refined. There is no mention of resuscitation performed by a witness of an event or of the use of an AED. In addition, Poland lacks the legal basis for maintaining a register of automated external defibrillators. There is a need to develop appropriate documents to determine the process of reporting by the owners of the use of AEDs in out-of-hospital conditions (OHCA).
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Affiliation(s)
- Daniel Ślęzak
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.Ż.); (K.K.)
| | - Marlena Robakowska
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.R.); (K.P.)
| | - Przemysław Żuratyński
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.Ż.); (K.K.)
| | | | - Katarzyna Pogorzelczyk
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.R.); (K.P.)
| | - Kamil Krzyżanowski
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.Ż.); (K.K.)
| | - Magdalena Błażek
- Division of Quality of Life Research, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Jarosław Woroń
- Department of Clinical Pharmacology, Jagiellonian University, 31-531 Kraków, Poland;
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26
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Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.
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Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
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27
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Karam N, Jost D, Jouven X, Marijon E. Automated external defibrillator delivery by drones: are we ready for prime time? Eur Heart J 2021; 43:1488-1490. [PMID: 34438447 DOI: 10.1093/eurheartj/ehab565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicole Karam
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,Brigade Sapeurs-Pompiers de Paris, Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Eloi Marijon
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
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28
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Karlsson L, Sun CLF, Torp-Pedersen C, Wodschow K, Ersbøll AK, Wissenberg M, Malta Hansen C, Morrison LJ, Chan TCY, Folke F. Implications for cardiac arrest coverage using straight-line versus route distance to nearest automated external defibrillator. Resuscitation 2021; 167:326-335. [PMID: 34302928 DOI: 10.1016/j.resuscitation.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/14/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023]
Abstract
AIM Quantifying the ratio describing the difference between "true route" and "straight-line" distances from out-of-hospital cardiac arrests (OHCAs) to the closest accessible automated external defibrillator (AED) can help correct likely overestimations in AED coverage. Furthermore, we aimed to examine to what extent the closest AED based on true route distance differed from the closest AED using "straight-line". METHODS OHCAs (1994-2016) and AEDs (2016) in Copenhagen, Denmark and in Toronto, Canada (2007-2015 and 2015, respectively) were identified. Three distances were calculated between OHCA and target AED: 1) the straight-line distance ("straight-line") to the closest AED, 2) the corresponding true route distance to the same AED ("true route"), and 3) the closest AED based only on true route distance ("shortest true route"). The ratio between "true route" and "straight-line" distance was calculated and differences in AED coverage (an OHCA ≤ 100 m of an accessible AED) were examined. RESULTS The "straight-line" AED coverage of 100 m was 24.2% (n = 2008/8295) in Copenhagen and 6.9% (n = 964/13916) in Toronto. The corresponding "true route" distance reduced coverage to 9.5% (n = 786) and 3.8% (n = 529), respectively. The median ratio between "true route" and "straight-line" distance was 1.6 in Copenhagen and 1.4 in Toronto. In 26.1% (n = 2167) and 22.9% (n = 3181) of all Copenhagen and Toronto OHCAs respectively, the closest AED in "shortest true route" was different than the closest AED initially found by "straight-line". CONCLUSIONS Straight-line distance is not an accurate measure of distance and overestimates the actual AED coverage compared to a more realistic true route distance by a factor 1.4-1.6.
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Affiliation(s)
- Lena Karlsson
- Department of Anaesthesiology, Copenhagen University Hospital Herlev and Gentofte, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.
| | - Christopher L F Sun
- MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, USA; Healthcare Systems Engineering, Massachusetts General Hospital, Boston, MA, USA
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark; Department of Cardiology, Aalborg University, Aalborg, Denmark
| | - Kirstine Wodschow
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Annette K Ersbøll
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Mads Wissenberg
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
| | - Laurie J Morrison
- Rescu, Department of Emergency Medicine, St. Michael's Hospital, Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Timothy C Y Chan
- Rescu, Department of Emergency Medicine, St. Michael's Hospital, Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, Ontario, Canada
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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29
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Aeby D, Staeger P, Dami F. How to improve automated external defibrillator placement for out-of-hospital cardiac arrests: A case study. PLoS One 2021; 16:e0250591. [PMID: 34014960 PMCID: PMC8136701 DOI: 10.1371/journal.pone.0250591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/09/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction In out-of-hospital cardiac arrests (OHCAs), the use of an automatic external defibrillator (AED) by a bystander remains low, as AEDs may be misplaced with respect to the locations of OHCAs. As the distribution of historical OHCAs is potentially predictive of future OHCA locations, the purpose of this study is to assess AED positioning with regard to past locations of OHCAs, in order to improve the efficiency of public access defibrillation programs. Methods This is a retrospective observational study from 2014 to 2018. The locations of historical OHCAs and AEDs were loaded into a geodata processing tool. Median distances between AEDs were collected, as well as the number and rates of OHCAs covered (distance of <100 meters from the nearest AED). Areas with high densities of uncovered OHCAs (hotspots) were identified in order to propose the placement of additional AEDs. Areas over-covered by AEDs (overlays) were also identified in order to propose the relocation of overlapping AEDs. Results There were 2,971 OHCA, 79.3% of which occurred at home, and 633 AEDs included in the study. The global coverage rate was 7.5%. OHCAs occurring at home had a coverage rate of 4.5%. Forty hotspots were identified, requiring the same number of additional AEDs. The addition of these would increase the coverage from 7.5% to 17.6%. Regarding AED overlays, 17 AEDs were found to be relocatable without reducing the AED coverage of historical OHCAs. Discussion This study confirms that geodata tools can assess AED locations and increase the efficiency of their placement. Historical hotspots and AED overlays should be considered, with the aim of efficiently relocating or adding AEDs. At-home OHCAs should become a priority target for future public access defibrillation programs as they represent the majority of OHCAs but have the lowest AED coverage rates.
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Affiliation(s)
- Dylan Aeby
- Faculty of Medicine, University of Lausanne, Lausanne, Switzerland
| | - Philippe Staeger
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fabrice Dami
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- * E-mail:
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30
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Use of Public Automated External Defibrillators in Out-of-Hospital Cardiac Arrest in Poland. ACTA ACUST UNITED AC 2021; 57:medicina57030298. [PMID: 33809989 PMCID: PMC8004784 DOI: 10.3390/medicina57030298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
Background and objectives: National medical records indicate that approximately 350,000–700,000 people die each year from sudden cardiac arrest. The guidelines of the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) indicate that in addition to resuscitation, it is important—in the case of so-called defibrillation rhythms—to perform defibrillation as quickly as possible. The aim of this study was to assess the use of public automated external defibrillators in out of hospital cardiac arrest in Poland between 2008 and 2018. Materials and Methods: One hundred and twenty cases of use of an automated external defibrillator placed in a public space between 2008 and 2018 were analyzed. The study material consisted of data on cases of use of an automated external defibrillator in adults (over 18 years of age). Only cases of automated external defibrillators (AED) use in a public place other than a medical facility were analysed, additionally excluding emergency services, i.e., the State Fire Service and the Volunteer Fire Service, which have an AED as part of their emergency equipment. The survey questionnaire was sent electronically to 1165 sites with AEDs and AED manufacturers. A total of 298 relevant feedback responses were received. Results: The analysis yielded data on 120 cases of AED use in a public place. Conclusions: Since 2016, there has been a noticeable increase in the frequency of use of AEDs located in public spaces. This is most likely related to the spread of public access to defibrillation and increased public awareness.
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A goal to transform public access defibrillation to all access defibrillation. Resuscitation 2021; 162:417-419. [PMID: 33600856 DOI: 10.1016/j.resuscitation.2021.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 11/22/2022]
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Sarkisian L, Mickley H, Schakow H, Gerke O, Starck SM, Jensen JJ, Møller JE, Jørgensen G, Henriksen FL. Use and coverage of automated external defibrillators according to location in out-of-hospital cardiac arrest. Resuscitation 2021; 162:112-119. [PMID: 33581227 DOI: 10.1016/j.resuscitation.2021.01.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
AIMS To evaluate 1) the relative use of automated external defibrillators (AEDs) at different types of AED locations 2) the percentage of AEDs crossing location types during OHCA before use 3) the AED coverage distance at different types of AED locations, and 4) the 30-day-survival in different subgroups. METHODS From 2014-2018, AEDs used by bystanders during out-of-hospital cardiac arrest (OHCA) in the Region of Southern Denmark were collected. Data regarding registered AEDs was retrieved from the national AED-network. The OHCA site and AED placement was categorized into; 1) Residential; 2) Public; 3) Nursing home, 4) Company/workplace; 5) Institution; 6) Health clinic and 7) Sports facility/recreational. To evaluate 30-day-survival, groups 4-7 were pooled into one Mixed group. RESULTS In total 509 OHCAs were included. There was high relative usage of AEDs from public places, nursing homes, health clinics and sports facilities, and low relative usage from companies/workplaces, residential areas and institutions. Of AEDs used during residential OHCAs 39% were collected from public places. AEDs placed in residential areas and public places had a coverage of 575 m (IQR 130-1300) and 270 m (IQR5-550), respectively. Thirty-day- survival in public, residential and mixed groups were 49%, 14% and 67%, respectively. CONCLUSION The relative use of AEDs from public places, nursing homes, sports facilities and health clinics was high, and AEDs used during OHCA in residential areas were most frequently collected from public places. AEDs placed in both residential areas and public places may have a wider coverage area than proposed in current literature.
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Affiliation(s)
- Laura Sarkisian
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Hans Mickley
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Henrik Schakow
- Emergency Medical Services, Region of Southern Denmark, Damhaven 12, 7100 Vejle, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Simon Michael Starck
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Jonas Junghans Jensen
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Jacob Eifer Møller
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Gitte Jørgensen
- Emergency Medical Services, Region of Southern Denmark, Damhaven 12, 7100 Vejle, Denmark.
| | - Finn Lund Henriksen
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
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Leung KHB, Alam R, Brooks SC, Chan TCY. Public defibrillator accessibility and mobility trends during the COVID-19 pandemic in Canada. Resuscitation 2021; 162:329-333. [PMID: 33482269 PMCID: PMC7816937 DOI: 10.1016/j.resuscitation.2021.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 11/15/2022]
Abstract
Introduction The COVID-19 pandemic has led to closures of non-essential businesses and buildings. The impact of such closures on automated external defibrillator (AED) accessibility compared to changes in foot traffic levels is unknown. Methods We identified all publicly available online AED registries in Canada last updated May 1, 2019 or later. We mapped AED locations to location types and classified each location type as completely inaccessible, partially inaccessible, or unaffected based on government-issued closure orders as of May 1, 2020. Using location and mobility data from Google’s COVID-19 Community Mobility Reports, we identified the change in foot traffic levels between February 15–May 1, 2020 (excluding April 10–12) compared to the baseline of January 3–February 1, 2020, and determined the discrepancy between foot traffic levels and AED accessibility. Results We identified four provincial and two municipal AED registries containing a total of 5848 AEDs. Of those, we estimated that 69.9% were completely inaccessible, 18.8% were partially inaccessible, and 11.3% were unaffected. Parks, retail and recreation locations, and workplaces experienced the greatest reduction in AED accessibility. The greatest discrepancies between foot traffic levels and AED accessibility occurred in parks, retail and recreation locations, and transit stations. Conclusion A majority of AEDs became inaccessible during the COVID-19 pandemic due to government-mandated closures. In a substantial number of locations across Canada, the reduction in AED accessibility was far greater than the reduction in foot traffic.
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Affiliation(s)
- K H Benjamin Leung
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Rejuana Alam
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Timothy C Y Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Luo W, Yao J, Mitchell R, Zhang X. Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals. Int J Health Geogr 2020; 19:52. [PMID: 33243272 PMCID: PMC7689650 DOI: 10.1186/s12942-020-00249-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Access as a primary indicator of Emergency Medical Service (EMS) efficiency has been widely studied over the last few decades. Most previous studies considered one-way trips, either getting ambulances to patients or transporting patients to hospitals. This research assesses spatiotemporal access to EMS at the shequ (the smallest administrative unit) level in Wuhan, China, attempting to fill a gap in literature by considering and comparing both trips in the evaluation of EMS access. METHODS Two spatiotemporal access measures are adopted here: the proximity-based travel time obtained from online map services and the enhanced two-step floating catchment area (E-2SFCA) which is a gravity-based model. First, the travel time is calculated for the two trips involved in one EMS journey: one is from the nearest EMS station to the scene (i.e. scene time interval (STI)) and the other is from the scene to the nearest hospital (i.e. transport time interval (TTI)). Then, the predicted travel time is incorporated into the E-2SFCA model to calculate the access measure considering the availability of the service provider as well as the population in need. For both access measures, the calculation is implemented for peak hours and off-peak hours. RESULTS Both methods showed a marked decrease in EMS access during peak traffic hours, and differences in spatial patterns of ambulance and hospital access. About 73.9% of shequs can receive an ambulance or get to the nearest hospital within 10 min during off-peak periods, and this proportion decreases to about 45.5% for peak periods. Most shequs with good ambulance access but poor hospital access are in the south of the study area. In general, the central areas have better ambulance, hospital and overall access than peripheral areas, particularly during off-peak periods. CONCLUSIONS In addition to the impact of peak traffic periods on EMS access, we found that good ambulance access does not necessarily guarantee good hospital access nor the overall access, and vice versa.
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Affiliation(s)
- Weicong Luo
- Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods, University of Glasgow, Glasgow, UK
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jing Yao
- Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods, University of Glasgow, Glasgow, UK.
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Richard Mitchell
- Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods, University of Glasgow, Glasgow, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Xiaoxiang Zhang
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK
- Department of Geographic Information Science, College of Hydrology and Water Resources, Hohai University, Nanjing, China
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Pei-Chuan Huang E, Chiang WC, Lu TC, Wang CH, Sun JT, Hsieh MJ, Wang HC, Yang CW, Lin CH, Lin JJ, Yang MC, Huei-Ming Ma M. Barriers to bystanders defibrillation: A national survey on public awareness and willingness of bystanders defibrillation ☆. J Formos Med Assoc 2020; 120:974-982. [PMID: 33218851 DOI: 10.1016/j.jfma.2020.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/10/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND After years of setting up public automated external defibrillators (AEDs), the rate of bystander AED use remains low all over the world. This study aimed to assess the public awareness and willingness of bystanders to use AEDs and to investigate the awareness on the Good Samaritan Law (GSL) and the factors associated with the low rate of bystander AED use. METHODS Using stratified random sampling, national telephone interviews were conducted using an author-designed structured questionnaire. The results were weighted to match the census data in Taiwan. The factors associated with public awareness and willingness of bystanders to use AEDs were analysed by logistic regression. RESULTS Of the 1073 respondents, only 15.2% had the confidence to recognise public AEDs, and 5.3% of them had the confidence to use the AED. Concerns on immature technique and legal issues remain the most common barriers to AED use by bystanders. Moreover, only 30.8% thought that the public should use AEDs at the scene. Few respondents (9.6%) ever heard of the GSL in Taiwan, and less than 3% understood the meaning of GSL. Positive awareness on AEDs was associated with high willingness of bystanders to use AEDs. Respondents who were less likely to use AEDs as bystanders were healthcare personnel and women. CONCLUSION The importance of active awareness and the barriers to the use of AEDs among bystanders seemed to have been underestimated in the past years. The relatively low willingness to use AEDs among bystander healthcare providers and women needs further investigation.
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Affiliation(s)
- Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chih Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Yang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jr-Jiun Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chin Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan.
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Karlsson L, Hansen CM, Vourakis C, Sun CLF, Rajan S, Søndergaard KB, Andelius L, Lippert F, Gislason GH, Chan TCY, Torp-Pedersen C, Folke F. Improving bystander defibrillation in out-of-hospital cardiac arrests at home. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:S74-S81. [DOI: 10.1177/2048872619891675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims:
Most out-of-hospital cardiac arrests occur at home with dismal bystander defibrillation rates. We investigated automated external defibrillator coverage of home arrests, and the proportion potentially reachable with an automated external defibrillator before emergency medical service arrival according to different bystander activation strategies.
Methods and results:
Cardiac arrests in homes (private/nursing/senior homes) in Copenhagen, Denmark (2008–2016) and registered automated external defibrillators (2007–2016), were identified. Automated external defibrillator coverage (distance from arrest to automated external defibrillator) and accessibility at the time of arrest were examined according to route distance to nearest automated external defibrillator and emergency medical service response time. The proportion of arrests reachable with an automated external defibrillator by bystander was calculated using two-way (from patient to automated external defibrillator and back) and one-way (from automated external defibrillator to patient) potential activation strategies. Of 1879 home arrests, automated external defibrillator coverage ≤100 m was low (6.3%) and a two-way bystander could potentially only retrieve an accessible automated external defibrillator before emergency medical service in 31.1% (n=37) of cases. If a bystander only needed to travel one-way to bring an automated external defibrillator (≤100 m, ≤250 m and ≤500 m), 45.4% (n=54/119), 37.1% (n=196/529) and 29.8% (n=350/1174) could potentially be reached before the emergency medical service based on current automated external defibrillator accessibility.
Conclusions:
Few home arrests were reachable with an automated external defibrillator before emergency medical service if bystanders needed to travel from patient to automated external defibrillator and back. However, nearly one-third of arrests ≤500 m of an automated external defibrillator could be reached before emergency medical service arrival if the bystander only needed to travel one-way from the automated external defibrillator to the patient.
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Affiliation(s)
- Lena Karlsson
- Department of Anesthesiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
| | - Carolina M Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
| | | | - Christopher LF Sun
- MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, USA
- Department of Perioperative Services, Massachusetts General Hospital, Boston, USA
| | - Shahzleen Rajan
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
| | | | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Timothy CY Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Canada
- Li Ka Shing Knowledge Institute, Canada
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
- Department of Cardiology, Aalborg University, Aalborg, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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37
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Mermiri MI, Mavrovounis GA, Pantazopoulos IN. Drones for Automated External Defibrillator Delivery: Where Do We Stand? J Emerg Med 2020; 59:660-667. [DOI: 10.1016/j.jemermed.2020.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/04/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
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38
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Zègre-Hemsey JK, Grewe ME, Johnson AM, Arnold E, Cunningham CJ, Bogle BM, Rosamond WD. Delivery of Automated External Defibrillators via Drones in Simulated Cardiac Arrest: Users' Experiences and the Human-Drone Interaction. Resuscitation 2020; 157:83-88. [PMID: 33080371 DOI: 10.1016/j.resuscitation.2020.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest (OHCA) in the United States is approximately 10%. Automatic external defibrillators (AEDs) are effective when applied early, yet public access AEDs are used in <2% of OHCAs. AEDs are often challenging for bystanders to locate and are rarely available in homes, where 70% of OHCAs occur. Drones have the potential to deliver AEDs to bystanders efficiently; however, little is known about the human-drone interface in AED delivery. OBJECTIVES To describe user experiences with AED-equipped drones in a feasibility study of simulated OHCA in a community setting. METHODS We simulated an OHCA in a series of trials with age-group/sex-matched participant pairs, with one participant randomized to search for a public access AED and the other to call a mock 9-1-1 telephone number that initiated the dispatch of an AED-equipped drone. We investigated user experience of 17 of the 35 drone recipient participants via semi-structured qualitative interviews and analyzed audio-recordings for key aspects of user experience. RESULTS Drone recipient participants reported largely positive experiences, highlighting that this delivery method enabled them to stay with the victim and continue cardiopulmonary resuscitation. Concerns were few but included drone arrival timing and direction as well as bystander safety. Participants provided suggestions for improvements in the AED-equipped drone design and delivery procedures. CONCLUSION Participants reported positive experiences interacting with an AED-equipped drone for a simulated OHCA in a community setting. Early findings suggest a role for drone-delivered AEDs to improve bystander AED use and improve outcomes for OHCA victims.
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Affiliation(s)
- Jessica K Zègre-Hemsey
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460.
| | - Mary E Grewe
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, 160 North Medical Drive, Brinkhous-Bullitt Building, 2nd Floor #220-237, Chapel Hill, NC 27599-7064
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 410, Chapel Hill, NC 27516
| | - Evan Arnold
- Institute for Transportation Research and Education, North Carolina State University, 909 Capability Dr, Research IV, Raleigh, NC 27606
| | - Christopher J Cunningham
- School of Medicine, University of North Carolina at Chapel Hill, 321 South Columbia Street, Chapel Hill, NC 27516
| | - Brittany M Bogle
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 410, Chapel Hill, NC 27516
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 410, Chapel Hill, NC 27516
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Sun CLF, Karlsson L, Morrison LJ, Brooks SC, Folke F, Chan TCY. Effect of Optimized Versus Guidelines-Based Automated External Defibrillator Placement on Out-of-Hospital Cardiac Arrest Coverage: An In Silico Trial. J Am Heart Assoc 2020; 9:e016701. [PMID: 32814479 PMCID: PMC7660789 DOI: 10.1161/jaha.120.016701] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Mathematical optimization of automated external defibrillator (AED) placement may improve AED accessibility and out‐of‐hospital cardiac arrest (OHCA) outcomes compared with American Heart Association (AHA) and European Resuscitation Council (ERC) placement guidelines. We conducted an in silico trial (simulated prospective cohort study) comparing mathematically optimized placements with placements derived from current AHA and ERC guidelines, which recommend placement in locations where OHCAs are usually witnessed. Methods and Results We identified all public OHCAs of presumed cardiac cause from 2008 to 2016 in Copenhagen, Denmark. For the control, we computationally simulated placing 24/7‐accessible AEDs at every unique, public, witnessed OHCA location at monthly intervals over the study period. The intervention consisted of an equal number of simulated AEDs placements, deployed monthly, at mathematically optimized locations, using a model that analyzed historical OHCAs before that month. For each approach, we calculated the number of OHCAs in the study period that occurred within a 100‐m route distance based on Copenhagen’s road network of an available AED after it was placed (“OHCA coverage”). Estimated impact on bystander defibrillation and 30‐day survival was calculated by multivariate logistic regression. The control scenario involved 393 AEDs at historical, public, witnessed OHCA locations, covering 15.8% of the 653 public OHCAs from 2008 to 2016. The optimized locations provided significantly higher coverage (24.2%; P<0.001). Estimated bystander defibrillation and 30‐day survival rates increased from 15.6% to 18.2% (P<0.05) and from 32.6% to 34.0% (P<0.05), respectively. As a baseline, the 1573 real AEDs in Copenhagen covered 14.4% of the OHCAs. Conclusions Mathematical optimization can significantly improve OHCA coverage and estimated clinical outcomes compared with a guidelines‐based approach to AED placement.
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Affiliation(s)
- Christopher L F Sun
- Sloan School of Management Massachusetts Institute of Technology Cambridge MA.,Healthcare Systems Engineering Massachusetts General Hospital Boston MA
| | - Lena Karlsson
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen Denmark.,Copenhagen Emergency Medical Services University of Copenhagen Denmark
| | - Laurie J Morrison
- Division of Emergency Medicine Department of Medicine University of Toronto Canada.,Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada
| | - Steven C Brooks
- Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada.,Departments of Emergency Medicine and Public Health Sciences Queen's University Kingston Canada
| | - Fredrik Folke
- Healthcare Systems Engineering Massachusetts General Hospital Boston MA.,Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen Denmark
| | - Timothy C Y Chan
- Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada.,Department of Mechanical and Industrial Engineering University of Toronto Canada
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40
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Jonsson M, Berglund E, Djärv T, Nordberg P, Claesson A, Forsberg S, Nord A, Tan HL, Ringh M. A brisk walk—Real-life travelling speed of lay responders in out-of-hospital cardiac arrest. Resuscitation 2020; 151:197-204. [DOI: 10.1016/j.resuscitation.2020.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
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41
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Public access defibrillators: Gender-based inequities in access and application. Resuscitation 2020; 150:17-22. [PMID: 32126247 DOI: 10.1016/j.resuscitation.2020.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
AIM While public access automated external defibrillator (AED) programs appear to improve outcomes in out-of-hospital cardiac arrest (OHCA) it is unclear if men and women benefit equally. We examined gender-based differences in OHCA location to determine what proportion were potentially eligible for public access AED application, and if patient gender was associated with AED utilization. METHODS We analyzed data from the Resuscitation Outcomes Consortium registry (2011-2015). We compared differences in OHCA locations by gender. We fit multivariate logistic regression models, restricted to public location OHCAs and public-location cases with bystander intervention, to calculate the association between gender and public access AED application. RESULTS Among 61 473 cases, 34% were female and 50% had bystander resuscitation. The incidence of public OHCA was 8.8% for women and 18% for men (risk difference 9.2%, 95% CI 8.7-9.7%). Women had significantly fewer OHCAs on roadways, in public buildings, places of recreation, and farms, but more in homes, non-acute healthcare facilities, and residential institutions. Female gender was associated with a lower odds of AED application in public OHCA (adjusted OR 0.76, 95% CI 0.64-0.90) and public-location cases with bystander interventions (adjusted OR 0.83, 95% CI 0.71-0.99). CONCLUSION Women had fewer OHCA in public locations that may have public access AEDs. Even among public location OHCA with bystander interventions, women were less likely to have public access AED applied. Initiatives to optimize AED locations and to engage the public with gender-specific resuscitation training may improve outcomes in women with OHCA.
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42
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Risk-Based AED Placement - Singapore Case. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7303701 DOI: 10.1007/978-3-030-50423-6_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents a novel risk-based method for Automated External Defibrillator (AED) placement. In sudden cardiac events, availability of a nearby AED is crucial for the surviving of cardiac arrest patients. The common method uses historical Out-of-Hospital Cardiac Arrest (OHCA) data for AED placement optimization. But historical data often do not cover the entire area of investigation. The goal of this work is to develop an approach to improve the method based on historical data for AED placement. To this end, we have developed a risk-based method which generates artificial OHCAs based on a risk model. We compare our risk-based method with the one based on historical data using real Singapore OHCA occurrences from Pan-Asian Resuscitation Outcome Study (PAROS). Results show that to deploy a large number of AEDs the risk-based method outperforms the method purely using historical data on the testing dataset. This paper describes our risk-based AED placement method, discusses experimental results, and outlines future work.
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43
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Haskins B, Nehme Z, Cameron P, Bernard S, Parker-Stebbing L, Smith K. Coles and Woolworths have installed public access defibrillators in all their stores: It is time other Australian businesses followed their lead. Emerg Med Australas 2019; 32:166-168. [PMID: 31820576 DOI: 10.1111/1742-6723.13429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
Abstract
We welcome the recent announcement by Coles and Woolworths that public access defibrillators (PADs) are now available in their stores, as early defibrillation with PADs is associated with significantly increased survival from out-of-hospital cardiac arrests (OHCAs). From 2008 to 2018 there were 120 OHCAs in Victorian supermarkets, overall 26.6% survived; however, when defibrillated by a PAD 66.6% survived. For all OHCA in Victoria, survival for defibrillation by a PAD was also higher at 55.5%, compared to 28.8% for paramedic defibrillation. Using this state-wide PAD survival rate, we estimate an additional 12 patients could have survived had PADs been available in all supermarkets. In Victoria last year there were 421 potentially viable OHCAs in public locations, of these 132 patients survived; however, had PADs been available an additional 101 patients could have survived. We therefore strongly encourage local businesses to install PADs, to safeguard the well-being of their employees, customers and local communities.
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Affiliation(s)
- Brian Haskins
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Peter Cameron
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Alfred Hospital, Melbourne, Victoria, Australia
| | - Stephen Bernard
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.,The Alfred Hospital, Melbourne, Victoria, Australia
| | - Laura Parker-Stebbing
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Karen Smith
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
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Affiliation(s)
- William J Brady
- From the Department of Emergency Medicine, University of Virginia Health System, Albemarle County Fire Rescue, Charlottesville (W.J.B.); the Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore (A.M.); and the Department of Emergency Medicine, Vanderbilt University Medical Center, the Metro Nashville Fire Department, and the Nashville International Airport Department of Public Safety - all in Nashville (C.M.S.)
| | - Amal Mattu
- From the Department of Emergency Medicine, University of Virginia Health System, Albemarle County Fire Rescue, Charlottesville (W.J.B.); the Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore (A.M.); and the Department of Emergency Medicine, Vanderbilt University Medical Center, the Metro Nashville Fire Department, and the Nashville International Airport Department of Public Safety - all in Nashville (C.M.S.)
| | - Corey M Slovis
- From the Department of Emergency Medicine, University of Virginia Health System, Albemarle County Fire Rescue, Charlottesville (W.J.B.); the Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore (A.M.); and the Department of Emergency Medicine, Vanderbilt University Medical Center, the Metro Nashville Fire Department, and the Nashville International Airport Department of Public Safety - all in Nashville (C.M.S.)
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Tsuda T, Geary EM, Temple J. Reply to correspondence article, correspondence on "Significance of automated external defibrillator in identifying lethal ventricular arrhythmias". Eur J Pediatr 2019; 178:1919-1920. [PMID: 31641853 DOI: 10.1007/s00431-019-03494-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA. .,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Elaine M Geary
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Joel Temple
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Kragh AR, Folke F, Andelius L, Ries ES, Rasmussen RV, Hansen CM. Evaluation of tools to assess psychological distress: how to measure psychological stress reactions in citizen responders- a systematic review. BMC Emerg Med 2019; 19:64. [PMID: 31684872 PMCID: PMC6827169 DOI: 10.1186/s12873-019-0278-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Dispatched citizen responders are increasingly involved in out-of-hospital cardiac arrest (OHCA) resuscitation which can lead to severe stress. It is unknown which psychological assessment tools are most appropriate to evaluate psychological distress in this population. The aim of this systematic review was to identify and evaluate existing assessment tools used to measure psychological distress with emphasis on citizen responders who attempted resuscitation. Methods A systematic literature search conducted by two reviewers was carried out in March 2018 and revised in July 2018. Four databases were searched: PubMed, PsycInfo, Scopus, and The Social Sciences Citation Index. A total of 504 studies examining assessment tools to measure psychological distress reactions after acute traumatic events were identified, and 9 fulfilled the inclusion criteria for further analysis. The selected studies were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network. Results The Impact of Event Scale (IES) and The Impact of Event Scale-Revised (IES-R) were the preferred assessment tools, and were used on diverse populations exposed to various traumatic events. One study included lay rescuers performing bystander cardiopulmonary resuscitation and this study used the IES. The IES and the IES-R also have proven a high validity in various other populations. The Clinical administered PTSD scale (CAPS) was applied in two studies. Though the CAPS is comparable to both the IES-R and the IES, the CAPS assess PTSD symptoms in general and not in relation to a specific experienced event, which makes the scale less suitable when measuring stress due to a specific resuscitation attempt. Conclusions The IES and the IES-R seem to be solid measures for psychological distress among people experiencing an acute psychological traumatic event. However, only one study has assessed psychological distress among citizen responders in OHCA for which the IES-R scale was used, and therefore, further research on this topic is warranted.
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Affiliation(s)
- Astrid Rolin Kragh
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Copenhagen, Denmark.
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Copenhagen, Denmark.,Department of Cardiology, Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900, Hellerup, Copenhagen, Denmark
| | - Linn Andelius
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Copenhagen, Denmark
| | - Emma Slebsager Ries
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Copenhagen, Denmark
| | - Rasmus Vedby Rasmussen
- Department of Cardiology, Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900, Hellerup, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Copenhagen, Denmark.,Department of Cardiology, Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900, Hellerup, Copenhagen, Denmark
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47
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Sun CL, Karlsson L, Torp-Pedersen C, Morrison LJ, Brooks SC, Folke F, Chan TC. In Silico Trial of Optimized Versus Actual Public Defibrillator Locations. J Am Coll Cardiol 2019; 74:1557-1567. [DOI: 10.1016/j.jacc.2019.06.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/06/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
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48
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Smith CM. Lay first-responders alerted to out-of-hospital cardiac arrest by smartphone app — Not so novel any longer, and it’s time to do more. Resuscitation 2019; 141:202-203. [DOI: 10.1016/j.resuscitation.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
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49
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Hansen SM, Hansen CM, Folke F, Rajan S, Kragholm K, Ejlskov L, Gislason G, Køber L, Gerds TA, Hjortshøj S, Lippert F, Torp-Pedersen C, Wissenberg M. Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations. JAMA Cardiol 2019; 2:507-514. [PMID: 28297003 DOI: 10.1001/jamacardio.2017.0008] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs). Objective To examine calendar changes in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation. Design, Setting, and Participants This nationwide study identified 18 688 patients in Denmark with first-time OHCA from June 1, 2001, to December 31, 2012, using the Danish Cardiac Arrest Registry. Patients had a presumed cardiac cause of arrest that was not witnessed by emergency medical services personnel. Data were analyzed from April 1, 2015, to December 10, 2016. Exposures Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher-assisted guidance of bystander resuscitation efforts. Main Outcomes and Measures The proportion of patients who received bystander defibrillation according to the location of the cardiac arrest and their subsequent 30-day survival. Results Of the 18 688 patients with OHCAs (67.8% men and 32.2% women; median [interquartile range] age, 72 [62-80] years), 4783 (25.6%) had a cardiac arrest in a public location and 13 905 (74.4%) in a residential location. The number of registered AEDs increased from 141 in 2007 to 7800 in 2012. The distribution of AED location was consistently skewed in favor of public locations. Bystander defibrillation increased in public locations from 3 of 245 (1.2%; 95% CI, 0.4%-3.5%) in 2001 to 78 of 510 (15.3%; 95% CI, 12.4%-18.7%) in 2012 (P < .001) but remained unchanged in residential locations from 7 of 542 (1.3%; 95% CI, 0.6%-2.6%) in 2001 to 21 of 1669 (1.3%; 95% CI, 0.8%-1.9%) in 2012 (P = .17). Thirty-day survival after bystander defibrillation increased in public locations from 8.3% (95% CI, 1.5%-35.4%) in 2001/2002 to 57.5% (95% CI, 48.6%-66.0%) in 2011/2012 (P < .001) in residential locations, from 0.0% (95% CI, 0.0%-19.4%) in 2001/2002 to 25.6% (95% CI, 14.6%-41.1%) in 2011/2012 (P < .001). Conclusions and Relevance Initiatives to facilitate bystander defibrillation were associated with a marked increase in bystander defibrillation in public locations, whereas bystander defibrillation remained limited in residential locations. Concomitantly, survival increased after bystander defibrillation in residential and public locations.
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Affiliation(s)
- Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark3Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark
| | - Linda Ejlskov
- Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark6The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark7The Danish Heart Foundation, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Søren Hjortshøj
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | | | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark3Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
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Public access of automated external defibrillators in a metropolitan city of China. Resuscitation 2019; 140:120-126. [PMID: 31129230 DOI: 10.1016/j.resuscitation.2019.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/27/2019] [Accepted: 05/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Public access of automated external defibrillator (AED) is an important public health strategy for improving survival of cardiac arrest. Major metropolitan cities in China are increasingly investing and implementing public access defibrillator programs, but the effectiveness of these programs remains unclear. This study aims to evaluate the public accessibility of AED in Shanghai, a major metropolitan city in China. METHODS From July 1 to September 30, 2018, all AED locations indicated by AED Access Map Apps were visited and investigated in three most densely distributing areas of AED (Huangpu District, Xuhui District, and Central Area of the Pudong New District) in Shanghai. Two AED Access Map APPs were used to identify the location of AEDs. Characteristics of and the barriers to access, the AED sites were recorded. Awareness and skills of first aid and AED among on-site staff of the AED installation sites were evaluated. RESULTS A total of 283 sites were marked on two AED Apps. One hundred and seventy (60%) locations were accessible, and 142 (50%) were actually with AEDs installed. Among those AED installed sites, 112 (79%) were completely identifiable to the information on the maps, 20 (14%) were inconsistent and 10 (7%) were inaccurate on the maps. Ninety-four (66%) AEDs had visible signs and information around the location, 7 (5%) AEDs had signs outside of the location, and 107 (75%) sites had educational instructions. In addition, 230 individuals who were around the AED site were interviewed. Among them, 79 (34%) had good knowledge of AED. After shown the picture of AED, 112 (49%) knew whether there was AED in the site, and 108 (47%) knew the AED's location. Eighty-seven (38%) staff have received first aid training, and among them 26 (30%) reported that they had skills in operating the AED. CONCLUSIONS Public placement and accessibility of AEDs, related public signs and information on AED, and staff's awareness about AED were not optimal in Shanghai. Continuing efforts should be made to improve public accessibility and public awareness, knowledge, and user skills of AED.
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