Abstract 267: Neighborhood Socioeconomic Status Influences Rates of Pre-EMS Cardiac Arrest Resuscitation

Abstract

Introduction: Out-of-hospital cardiac arrest is a leading cause of both morbidity and mortality in the United States and globally. After cardiac arrest onset, emergency medical services (EMS) might not arrive before irreversible injury takes place. Thus, pre-EMS resuscitation - including CPR and automated external defibrillator (AED) use - is associated with improvements in outcomes. We sought to determine if rates of pre-EMS CPR and pre-EMS AED use vary across neighborhood socioeconomic status using a database of EMS activations throughout the United States. Methods: The National Emergency Medical Services Information System (NEMSIS) is a large and nationally-representative database of EMS activations populated from more than ten-thousand EMS agencies throughout the US. We examined cardiac arrests in adult patients (18+ years of age) between January 2017 and December 2019 where EMS providers documented the ZIP code of the arrest, whether CPR prior to EMS arrival was provided, and whether an AED was applied prior to EMS arrival. The ZIP code of the arrest was used to group arrests based on socioeconomic status data from the US Census Bureau. Rates of pre-EMS CPR and pre-EMS AED use were then compared, and ZIP codes with under 5% of residents below the poverty line served as benchmarks. Results: 366,280 cardiac arrests met inclusion criteria. Both Pre-EMS CPR and pre-EMS AED use were highest in ZIP Codes where less than 5% of the population is below the poverty line (p< .00001). Furthermore, a consistent decrease in rates of pre-EMS interventions was seen as the percent of individuals below the poverty line increased (Figure 1). Conclusion: We found a strong relationship between neighborhood socioeconomic status and pre-EMS cardiac arrest interventions. One explanation may be access to CPR training. Further studies should continue to interrogate cardiac arrest disparities that have already been reported and seek to identify new unreported disparities as well.