Abstract
Introduction: Public access defibrillation (PAD) programs can improve survival from out-of-hospital cardiac arrest (OHCA). We aimed to identify high risk public locations which should be prioritized for automated external defibrillator (AED) placement. Objectives: 1) To determine the average annual incidence of cardiac arrest by location type within the study area, 2) To describe current registered PAD deployment by location type. Methods: An observational cohort study using the Resuscitation Outcomes Consortium Epistry database. We included all public location, non-traumatic, EMS-treated OHCAs from January 1, 2006 to June 30, 2010 in the City of Toronto. The total site counts in each location category were derived from a city planning database and used as the denominator in calculating average annual per site cardiac arrest incidence. AED locations were obtained from an EMS registry. Two investigators independently categorized each OHCA and AED location. Disagreements were resolved by consensus. Results: There were 1297 OHCAs, of which 571 occurred on streets and could not be associated with a specific location type, leaving 726 eligible cases. The average age was 58±17.5 years, 82.7% were male and 13.9% survived to hospital discharge. Of all included patients, 44.9% had bystander CPR attempted and 9.5% had a bystander apply a defibrillator. Table 1 contains data from the top 15 location types ranked on average annual OHCAs per individual site. There were 1616 AED covered locations in the City of Toronto. 57.3% of the registered AED sites were elementary and secondary schools, 16.0% were post secondary schools, 7.8% were offices and 4% were community or recreation centres. Conclusions: We have identified location types with highest risk for cardiac arrest. Most registered AEDs have been placed at Elementary and Secondary Schools which are relatively low risk for OHCA. Our data can guide future AED deployment to increase availability for use in public location OHCA.
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