Accessible Automated External Defibrillators Research Articles

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study.

Intervention by members of the public during an out of hospital cardiac arrest (OHAC) including resuscitation attempts and accessible automated external defibrillator (AED) has been shown to improve survival. This study aimed to investigate the OHCA and AED knowledge and confidence, and barriers to intervention, of the public of North East England, UK. This study used a face-to-face cross-sectional survey on a public high street in Newcastle, UK. Participants were asked unprompted to explain what they would do when faced with an OHCA collapse. Chi-Square analysis was used to test the association of the independent variables sex and first aid trained on the participants' responses. Of the 421 participants recruited to our study, 82.9% (n = 349) reported that they would know what to do during an OHCA collapse. The most frequent OHCA action mentioned was call 999 (64.1%, n = 270/421) and 58.2% (n = 245/421) of participants reported that they would commence CPR. However, only 14.3% (n = 60/421) of participants spontaneously mentioned that they would locate an AED, while only 4.5% (n = 19/421) recounted that they would apply the AED. Just over half of participants (50.8%, n = 214/421) were first aid trained, with statistically more females (57.3%, n = 126/220)than males (43.9%, n = 87/198)being first aiders (p = 0.01 χ2 = 7.41). Most participants (80.3%, n = 338/421) knew what an AED was, and 34.7% (n = 326/421) reported that they knew how to use one, however, only 11.9% (n = 50/421) mentioned that they would actually shock a patient. Being first aid trained increased the likelihood of freely recounting actions for OHCA and AED intervention. The most common barrier to helping during an OHCA was lack of knowledge (29.9%, n = 126/421). Although most participants reported they would know what to do during an OHCA and had knowledge of an AED, low numbers of participants spontaneously mentioned specific OHCA and AED actions. Improving public knowledge would help improve the public's confidence of intervening during an OHCA and may improve OHCA survival.

Regional variation in accessibility of automated external defibrillators in British Columbia.

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). 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. 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 79h per week. 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.

Association between distance to nearest automated external defibrillator and socioeconomic deprivation in Great Britain

Abstract Background Disparities in socioeconomic status manifest in death from out of hospital cardiac arrest (OHCA). Inequalities in access to automated external defibrillators (AED) due to socioeconomically determined location of AEDs may be associated with OHCA survival. Purpose To investigate distances between nearest AED location and postcode by socioeconomic deprivation for the population of Great Britain (GB). Methods AED location data for 2022 were drawn from the British Heart Foundation The Circuit registry. All 1,677,466 unit postcodes in Great Britain were linked to the Index of Deprivation for the corresponding Lower Layer Super Output Area using the 2019 Ministry of Housing Communities and Local Government tool. The median distance by road from the centre of each postcode to the nearest AED was calculated using geographic information systems. The proportion available 24/7 was also reported. Multilevel linear mixed regression models fit by country and adjusted for urban/rural status and clustering to calculate predicted marginal mean distances to the nearest active AED, and nearest AED accessible 24/7 by deprivation decile. Results 78,425 unique AED locations were included in the analysis (Table 1). The median distance to nearest AED was 762.1m (IQR 410.8 - 1221.0) in GB; 742.7m (407.2 - 1340.7) in Scotland, 738.8m (422.6 - 1223.5) in England, and 511.5m (282.9 - 937.3) in Wales. For 24/7 access AEDs, median distances were greater: 964.0m (524.7 - 1667.5), 994.1m (538.5 – 1832.3), 990.8m (544.9 - 1683.3), and 569.7m (316.8 - 1033.4), respectively. Overall, there was little evidence of a trend in nearest AED distance by deprivation (fig 1). In Scotland the nearest AED was, on average, 108m further away in the most compared with the least deprived areas. In England, the nearest AED was closer to postcodes in the least deprived areas of England (predicted mean 20m) and Wales (predicted mean 95m). In England, AEDs with 24/7 access were further from postcodes with increasing deprivation (predicted mean 99m further than least deprived areas). In Scotland, nearest 24/7 access AEDs were 317m further away in the most deprived areas, and 62m closer in Wales, but with no evidence of a linear trend. At a typical walking speed (1.31m/sec), on average in GB it would take 17 minutes to retrieve an AED and 21 minutes out of hours. In England and Scotland out of hours, those in the most deprived areas would be delayed access to an AED by 2.5 and 8 minutes respectively compared the least deprived. Conclusions Overall, the median distance to nearest AED across postcodes in GB is at odds with the likelihood of successful resuscitation. Graded social inequalities were not observed in AED access across GB. However, substantive differences were observed in 24/7 AED access between most and least deprived areas of England and Scotland. Greater and more equitable access to AEDs has the potential to save lives and improve outcomes for people with OHCA.

The Sapienza University of Rome network of automated external defibrillators: a prototype webMap developed to speed access to community defibrillators and increase survival from out-of-hospital cardiac arrest.

In Italy, only around 10% of people who experience out-of-hospital cardiac arrest (OHCA) survive. A large portion of OHCA events in public settings are characterized by an initial shockable rhythm, which requires prompt defibrillation. We aimed to create a system to quickly locate nearby public access automated external defibrillators (AEDs) on the campus of Sapienza University of Rome, the largest public university in Europe. We developed the AED webMap through a 6-step process involving the: 1) collection of information and geographical coordinates for each AED from the university management system; 2) development of a new geolocation database; 3) integration of information contained in the new database with data provided by university departments; 4) geolocation of AEDs in the Google MyMaps environment; 5) graphic representation of all AEDs on digital map templates using specific symbols, with pop-ups containing additional information for each AED; and 6) publication of the webMap on the university website. The AED webMap was published on the university website (https://www.uniroma1.it/it/pagina/defibrillatori-sapienza-in-rete) and facilitates prompt identification of nearby AEDs by providing: 1) detailed AED geolocalization with interactive pop-up information for each AED, including whether the AED is located internally or externally; 2) the option to use different base maps (e.g., digital street map); 3) calculation and display of the route to reach the chosen AED; and 4) the possibility to migrate towards multiple platforms. The webMap can help bystanders quickly identify, locate, and reach nearby AEDs present on the campus of the largest public university in Europe, a measure that could help speed defibrillation and maximize the life-saving potential of AEDs in the event of OHCA.

Automated external defibrillator location and socioeconomic deprivation in Great Britain

ObjectiveThe early use of automated external defibrillators (AEDs) improves outcomes in out-of-hospital cardiac arrest (OHCA). We investigated AED access across Great Britain (GB) according to socioeconomic deprivation.MethodsCross-sectional observational study using...

Remote synchronous usability testing of public access defibrillators during social distancing in a pandemic

Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface.

Automated external defibrillator and emergency action plan preparedness amongst masters athletes

ABSTRACT Objectives Sudden cardiac arrest/death (SCA/D) is the leading medical cause of death in athletes. Masters athletes (≥35 years old) are increasing in numbers and are responsible for the vast majority of sport-related SCDs. Automated external defibrillators (AEDs) and emergency action plans (EAPs) have been shown to unequivocally reduce SCD, however, their prevalence in masters athletics remains unknown. We sought to identify the perceived AED accessibility and EAP preparedness amongst a group of masters athletes. Methods A 40-item survey was sent to 735 master athletes identified through the Masters Athlete Screening Study. Participants were athletes with no known significant cardiac history. The survey inquired on the availability and location of AEDs within exercise settings, the presence of EAPs, and participants’ cardiac concerns. Results Sixty-eight percent of athletes completed the survey. Ninety-seven percent and 99% of athletes believed CPR and AEDs were effective at saving lives, respectively. Thirty-eight percent of athletes were aware of an AED in proximity to where they exercise, with 40% aware of one available during competition events, and 28% during training events. Only 10% of athletes were aware of an EAP active in their place of exercise. Half of the athletes perceive their risk of cardiac arrest during exercise to be ≤0.5 in 100,000. Conclusions These findings indicate that nearly all athletes believe CPR and AED are effective at saving lives, but only a minority are aware of an AED near their place of exercise, with even fewer aware of an active EAP. Master athletes underestimate their own risk for exercise-related cardiac events, affirming the importance of educating masters athletes on their increased cardiac risk and the importance of EAPs.

Abstract 11560: Systematic Deployment of AEDs in BC Schools: A Utility and Cost-Effectiveness Study of In-School and Nearby OHCAs

Background: While pediatric out-of-hospital cardiac arrests (OHCAs) are relatively uncommon, they have a much higher number of potential years of life lost per event. School-located public access automated external defibrillators (AED) may be beneficial to school-aged OHCAs, but also other OHCAs within the school and in the surrounding community. We sought to identify the incidence of OHCAs within and nearby schools in British Columbia (BC), to estimate the number that may benefit from school-located AEDs. Methods: We used prospectively-collected data from the BC OHCA Registry from 2013 to 2018. We examined the addresses of all OHCAs to determine those occurring in public primary and secondary schools. We geo-plotted all OHCAs to identify the number of OHCAs within walking distance of a school. Assuming an average pedestrian speed for AED retrieval of 1.8 m/second, we calculated the number of school-vicinity OHCAs for which a bystander could retrieve an AED prior to a 6.5 minute emergency medical system response interval, assuming that AEDs would be located on the exterior of a school building. Results: There were a total of 401,423 children enrolled at 824 schools annually in the study footprint. Of a total of 12,480 EMS-treated OHCAs (220 aged < 18 years), 20 were in in schools, of which 4 were <18 years of age. Of school located OHCAs, 14 (70%) had initial shockable rhythms, 4 (20%) had an AED applied (of whom 3 survived), and 10 (50%) survived. Of the four school-located pediatric OHCAs, three were witnessed (75%), two had initial shockable rhythms (50%), and two (50%) survived until hospital discharge. A total of 1128/12,480 (9%) OHCAs were within retrieval distance of a school, corresponding to 0.228 per school per year (95% CI 0.201-0.255 year-to-year) , which is above current thresholds for cost-effectiveness. Conclusion: Outcomes of school-located OHCAs are encouraging, especially those with AED application. While the incidence of school-located OHCAs is low, a substantial proportion of OHCAs occur within a retrievable distance to a school, and thus accessible external school-located AEDs may improve overall OHCA outcomes of a community.

Abstract 13237: Motivations and Barriers to Join an Automated External Defibrillator Network: A Nationwide Survey

Introduction: Since 2007, citizens have been able to register an automated external defibrillator (AED) with the Danish AED Network, which holds >23,000 AEDs (394 AEDs/100,000 inhabitants) linked directly to the Emergency Medical Dispatch Centers. In 2019, 60.8% of sold AEDs were registered in the network. This study aimed to identify motivations and barriers for registration with the nationwide Danish AED Network. Methods: A cross-sectional survey among owners of newly registered AEDs in the Danish AED Network was carried out from September 2017 to December 2020. Each month, 30-50 random AED-owners participated. The survey included items on motivations and barriers to join the AED network and items on AED accessibility. Results: In total, 1,540 AED-owners were included (25.3 % of newly registered in the period (n=6087)). The time from AED-purchase to AED-registration was “<1week” in 25.7%, “<1month” in 23.4%, “1month-1year” in 28.6%, “>1year” in 20.4%, and “Do not know” in 1.9%. Knowledge about the AED network is illustrated in Figure 1. Over half of the AED-owners registered their AED because they felt it was a ‘good cause’ (64.0%), followed by ‘registering upon request’ (20.6%), and ‘after a first aid course’ (5.5%). Of newly registered AEDs, 73.8% (n=1137) were 24/7-accessible. The most frequent reason for choosing limited AED accessibility (AED placed indoors/not available 24/7, n=403) was “greater expenses” (26.8%), whereas “fear of theft/vandalism” only accounted for 12.4%. Conclusion: Among AED-owners registering their AED to the Danish AED Network, most heard about the registry through word of mouth, registered their AED within the first year of purchase, and registered primarily because they felt it was a good cause. Most newly registered AEDs were 24/7-accessible. The biggest expressed barrier to AED accessibility was increased expenses whereas fear of theft or vandalism was a minor issue.

Abstract 13298: Density, Coverage and Usage of Automated External Defibrillators in Out-of-Hospital Cardiac Arrest Across Europe

Introduction: Though deployment of Automated External Defibrillators (AEDs) is increasing rapidly, AEDs are often deployed in an un-strategic manner. Consequently, little is known about the association between AED density, AED coverage of out-of-hospital cardiac arrest (OHCA), and bystander defibrillation across different countries. This study aimed to investigate the differences in AED densities (AEDS/100,000 inhabitants/1,000 km2), the AED coverage of OHCAs, and bystander defibrillation across Europe. Hypothesis: AED density is directly associated with degree of bystander defibrillation across Europe. Methods: The study is a European Sudden Cardiac Arrest network towards Prevention, Education, New Effective Treatment (ESCAPE-NET) project. We included data from Ticino (Switzerland), Lombardy (Italy), and The Capital Region (Denmark) from 2019, covering over 3.7 million inhabitants. AED accessibility was defined as the AED being accessible 24/7 or not and AED coverage was defined as the OHCA being covered by an AED within 100, 250 and 500 meters. AED coverages were calculated the same way by all participants using a free software program (QGIS). Results: AED densities were: 87.3 for Ticino, 15.2 for Lombardy, and 139.4 for The Capital Region. The percentages of OHCAs covered by any AED and by 24/7 accessible AEDs are shown in Figure 1. The calculated AED density per 1% bystander defibrillation (for the percentage of OHCAs bystander defibrillated within 100, 250 and 500m of an AED) were 34.9, 17.5 and 15.6 for Ticino, 76.0, 50.7 and 38.0 for Lombardy and 19.4, 12.6 and 11.2 for The Capital Region. Conclusion: We found great variation in both AED coverage and 24/7 AED accessibility across regions, as well as marked differences in bystander defibrillation according to local AED density. Other factors like geographical differences in the regions, optimal AED placement and citizen responder programs for AED use might explain the observed differences.

Emergency Action Planning in School-Based Athletics: A Systematic Review.

IntroductionA significant number of preventable catastrophic injuries occur in secondary school athletics. Compliance to Emergency Action Plan (EAP) recommendations is not well documented. The purpose of this systematic review was to identify compliance to EAP recommendations, access to an athletic trainer (AT) and automated external defibrillator (AED), and current legislative mandates in school-based athletics.MethodsElectronic databases were searched to identify articles that met criteria for inclusion. Studies in English that focused on adoption, implementation, or compliance with EAPs or other national guidelines pertaining to athlete health were eligible for inclusion. Quality and validity were examined in each article and data were grouped based on outcome measures.ResultsOf 12,906 studies, 21 met the criteria for inclusion and full text review. Nine studies demonstrated EAP adoption rates ranging from 55% – 100%. Five studies found that EAPs were rehearsed and reviewed annually in 18.2% – 91.6% of schools that have an EAP. At total of 9.9% of schools were compliant with all 12 National Athletic Trainers Association (NATA) EAP guidelines. A total of 2.5% – 27.5% of schools followed NATA exertional heat illness guidelines and 50% – 81% of schools had access to an athletic trainer. In addition, 61% – 94.4% of schools had an AED available at their athletic venues. Four of 51 state high school athletic association member schools were required to meet best practice standards for EAP implementation, 7 of 51 for AED access, 8 of 51 for heat acclimation, and 3 of 51 for concussion management.ConclusionsThere was a wide range of EAP adoption and a low rate of compliance to EAP guidelines in U.S. schools. Barriers to EAP adoption and compliance were not well documented and additional research should aim to identify impeding and facilitating factors.

Bystander cardiopulmonary resuscitation and automated external defibrillator use after out-of-hospital cardiac arrest: uncovering differences in care and survival across the urban-rural spectrum

Abstract Background Despite regional variation in survival following out-of-hospital cardiac arrest (OHCA), few studies have investigated urban-rural differences in the provision of care and outcomes after OHCA. To better understand the role of pre-hospital care across the urban-rural spectrum, we compared the effects of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use on survival after OHCA between geographical settings. Methods This retrospective study (2013–2019) used all adult, non-traumatic, and treated OHCAs registered in the Cardiac Arrest Registry to Enhance Survival. The urban/rural status of arrest locations were classified at the census tract level as urban, suburban, large rural, small town, or rural, using the Rural-Urban Commuting Area classification system (Figure). Bystander interventions were grouped into three categories, including no bystander intervention, bystander CPR alone, and bystander AED use (with CPR). The primary outcome of interest was survival to hospital discharge with good neurological outcome. Multivariable logistic regression models were developed to assess the association between bystander interventions and survival with good neurological outcome by urban/rural status, adjusting for relevant covariates. Results A total of 325,281 patients were included. Bystander CPR alone occurred most often in rural areas (50.8%), and least often in urban areas (35.4%). Bystander AED use varied by urban/rural status (1.7%-2.9%), with large rural (2.9%) and rural areas (2.4%) reporting the highest rates. Survival to hospital discharge with good neurological outcome differed for urban (8.1%), suburban (7.7%), large rural (9.1%), small town (7.1%), and rural areas (6.1%). In all areas, patients who received bystander AED use or bystander CPR alone were more likely to achieve survival with good neurological outcome than patients who received no bystander intervention. The effect of bystander AED use on survival was stronger than bystander CPR alone in urban, suburban, and rural areas (no overlap of confidence bands), whereas no significant differences between these two bystander intervention groups were observed in large rural areas or small towns (overlap of confidence bands) (Table). Conclusions Bystander CPR and AED use are critical components of the response to OHCA across the urban-rural spectrum. The relative impact of bystander interventions on survival varied based on the geographical location of arrests, despite adjusting for numerous potential confounding variables, such as response time. It is possible that unmeasured factors, such as time from collapse to bystander intervention, patient factors, AED accessibility, and CPR quality are contributing to these observed differences. Future research is needed to better understand the response to OHCA across the urban-rural spectrum, which may inform policies for community-specific emergency protocols and planning. Funding Acknowledgement Type of funding sources: None.

Implications for cardiac arrest coverage using straight-line versus route distance to nearest automated external defibrillator

AimQuantifying 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”. MethodsOHCAs (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. ResultsThe “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”. ConclusionsStraight-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.

Out-of-Hospital Cardiac Arrest Bystander Defibrillator Search Time and Experience With and Without Directional Assistance: A Randomized Simulation Trial in a Community Setting.

Probability of survival after out-of-hospital cardiac arrest (OHCA) doubles when a bystander initiates cardiopulmonary resuscitation and uses an automated external defibrillator (AED) rapidly. National, state, and community efforts have increased placement of AEDs in public spaces; however, bystander AED use remains less than 2% in the United States. Little is known about the effect of giving bystanders directional assistance to the closest public access AED. We conducted 35 OHCA simulations using a life-sized manikin with participants aged 18 through 65 years who searched for public access AEDs in 5 zones on a university campus. Zones varied by challenges to pedestrian AED acquisition and number of fixed AEDs. Participants completed 2 searches-first unassisted and then with verbal direction to the closest AED-and we compared AED delivery times. We conducted pretest and posttest surveys. In all 5 zones, the median time from simulated OHCA onset to AED delivery was lower when the bystander received directional assistance. Time savings (minutes:seconds) varied by zone, ranging from a median of 0:53 (P = 0.14) to 3:42 (P = 0.02). Only 3 participants immediately located the closest AED without directional assistance; more than half reported difficulty locating an AED. These findings may inform strategies to ensure that AEDs are consistently marked and placed in visible, accessible locations. Continued emphasis on developing strategies to improve lay bystanders' ability to locate and use AEDs may improve AED retrieval times and OHCA outcomes.

Bystander interventions and survival following out-of-hospital cardiac arrest at Copenhagen International Airport

AimTo examine incidence and outcome following out-of-hospital cardiac (OHCA) arrest in a high-risk area characterised by high density of potential bystanders and easy access to nearby automated external defibrillators (AEDs). MethodsThis retrospective observational study investigated pre-hospital and in-hospital treatment, as well as survival amongst persons with OHCA at Copenhagen International Airport between May 25, 2015 and May 25, 2019. OHCA data from pre- and in-hospital medical records were obtained and compared with public bystander witnessed OHCAs in Denmark. ResultsOf the 23 identified non-traumatic OHCAs, 91.3% were witnessed by bystanders, 73.9% received bystander cardiopulmonary resuscitation (CPR), and 43.5% were defibrillated by a bystander. Survival to hospital discharge was 56.5%, with 100% survival among persons with an initial shockable heart rhythm. Compared with nationwide bystander witnessed OHCAs, persons with OHCA at the airport were less likely to receive bystander CPR (73.9% vs. 89.4%, OR 0.33; 95% CI, 0.13–0.86), more likely to receive bystander defibrillation (43.5% vs. 24.8%, OR 2.32; 95% CI, 1.01–5.31), to achieve return of spontaneous circulation (78.2% vs. 50.6%, OR 3.51; 95% CI, 1.30–9.49), and survive to hospital discharge (56.5% vs. 45.2%, OR 1.58; 95% CI, 0.69–3.62). ConclusionWe found a high proportion of bystander defibrillation indicating that bystanders will quickly apply an AED, when accessible. Importantly, 56% of all persons, and all persons with a shockable heart rhythm survived. These findings suggest increased potential for survival following OHCA and support current guidelines to strategically deploy accessible AEDs in high-risk OHCA areas.

Public defibrillator accessibility and mobility trends during the COVID-19 pandemic in Canada

IntroductionThe 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. MethodsWe 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. ResultsWe 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. ConclusionA 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.

Abstract 220: Public Defibrillator Accessibility and Mobility Trends During the Covid-19 Pandemic in Canada

Introduction: The COVID-19 pandemic has led to widespread closures of non-essential businesses and buildings. The impact of such closures on public automated external defibrillator (AED) accessibility compared to mobility trends is unknown. Methods: We identified all publicly available online AED registries in Canada last updated May 1, 2019 or later. AEDs were classified by location type using addresses and registry notes, and deemed completely inaccessible, partially inaccessible, or unaffected using government-issued closure orders as of May 1, 2020. We mapped AED location types to categories used by Google’s COVID-19 Community Mobility Reports and calculated the median percent change in daily traffic between Feb. 15 - May 1, 2020 (excluding Apr. 10-12). We compared the percent of completely inaccessible AEDs to the median percent change in traffic for each category. Results: We identified three provincial (British Columbia, Alberta, Nova Scotia) and two municipal (Mississauga and Toronto in Ontario) online AED registries, collectively covering 13.1 million people. Of the 5,845 AEDs identified, 69.9% were completely inaccessible, 18.8% were partially inaccessible, and 11.3% were unaffected. AEDs in parks (n=141), almost all retail and recreational locations (n=1,539), and two-thirds of workplaces (n=3,633) were completely inaccessible, grocery and pharmacy-based (n=173) AEDs were partially inaccessible, and transit station (n=277) and residential (n=85) AEDs were unaffected. The largest discrepancies between AED accessibility and mobility occurred in parks (100% completely inaccessible vs. 10.5% traffic decrease), retail and recreation (99.0% completely inaccessible vs. 48.0% traffic decrease), and transit stations (100% unaffected vs. 63.0% traffic decrease). Conclusion: Government-mandated closures due to the COVID-19 pandemic have led to a greater reduction in AED accessibility than mobility in many locations across Canada.

Drones for Automated External Defibrillator Delivery: Where Do We Stand?

Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and disability worldwide. The health care community hoped that, with the development of the automated external defibrillator (AED), the mortality and functional outcomes of patients with OHCAs would improve. Despite their effectiveness, their use in OHCA has not yet become common practice. Unfortunately, in 18-59% of cases, public access AEDs were deemed to be in poorly accessible areas or not available all of the time. We present the existing literature on the implementation of drone delivery of AEDs to improve the response time of the emergency medical services. Test flights and mathematical/geographic models have been used to assess the effectiveness of drones in delivering AEDs to patients with OHCA. The results of those studies showed promising outcomes given that drone usage led to improved delivery times of AEDs compared with emergency medical services delivery. While drones have the potential to dramatically improve cardiac arrest patient care, further studies are needed to evaluate their effectiveness in real-life clinical scenarios.

CPR and AEDs save lives: insuring CPR--AED education and CPR--AED access in schools.

Sudden cardiac arrest and sudden cardiac death are less common in children and adolescents than in the adult population. The outcomes from sudden cardiac arrest are generally quite poor in all ages and some data suggest that they are worse in the child and adolescent age group. In addition, the incidence of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use is generally quite low although it is somewhat variable across communities. This review has been written in order to review the data for pediatric bystander CPR and AED use as it relates to out-of-hospital cardiac arrest (OHCA) survival. The purpose of this article is also to review endeavors at CPR--AED education in the context of improving both community bystander CPR/AED interventions and OHCA survival. Finally, this review will attempt to suggest some potential educational interventions in order to increase both bystander CPR-AED use and OHCA survival in local communities. Findings from several recent studies suggest that the incidence of bystander CPR--AED intervention is relatively low and that OHCA survival is also quite low in most communities. Several studies also suggest that community educational efforts can increase bystander CPR--AED interventions. The increase in OHCA survival may be attributed to the community educational efforts, yet that increase in survival is relatively small. A prospective high-school study has shown that in this very specific environment, a high incidence of CPR--AED use can be achieved, and that as a result the OHCA survival can be relatively high. It would be beneficial to attempt to ensure that all schools have a CPR--AED program along with a group of individuals trained to do CPR and use an AED. Not only should all schools have a cardiac emergency response plan (CERP) but all schools should have CPR--AED programs and all students should learn CPR and AED use prior to graduation. This strategy will ensure that we will have a community of individuals who would perform CPR and use an AED in the community and that in so doing we could increase the incidence of bystander CPR/AED use and increase the OHCA survival rate.

P066: A quality improvement project to improve access to automated external defibrillators in the Niagara region community

Background: Over 35,000 Canadians lose their lives to cardiac arrest each year. CPR and automated external defibrillator (AED) use are modifiable factors. Survival rates drop by 7-10% each minute that defibrillation is delayed, and survival rates are less than 5% after 12 minutes of ventricular fibrillation which stresses the need for bystander AED use in out-of-hospital arrests. Niagara Region lacks a publicly accessible registry of AEDs. AED access is a major focus in King County, Washington which has higher survival rates and has all AEDs registered with Emergency Medical Services. Aim Statement: This project aims to log 100 or more AEDs within a year into a publicly accessible registry and to connect the registry information to medical trainees in the Niagara region and all employees of the Niagara Health System involved in patient care. Measures & Design: PulsePoint is an application used to register AEDs within the Niagara region. PulsePoint allows users to geotag AEDs while tracking data entries. Over 16 weeks, 4 PDSA cycles tested the effectiveness of logging methods for AEDs including opportunistic logging, daily emailed reminders, and contacting organizations with high likelihood of having an AED. Information about the project and registry was shared with residents and medical students in Niagara. A second phase of cycles involves relaying information to Niagara Health system employees and the medical community. A final cycle will target a broader group of local organizations with intermediate probability of having AEDs. Primary outcome measures include the numbers of regional AEDs logged and members reached by knowledge sharing cycles. Evaluation/Results: PulsePoint was found to be an effective, free, publicly accessible resource to log AEDs within the Niagara region. The initial round of 4 PDSA cycles added a total of 56 new AEDs within the region, which were logged into PulsePoint app and the Excel spreadsheet. Through the fourth PDSA cycle, 136 businesses were contacted and made aware of the project and the AED application. In addition,138 health-related colleagues and medical students were contacted to raise awareness. PDSA cycles five through eight are currently ongoing or in the planning stages. Discussion/Impact: Raising awareness among emergency services and sharing information about the registry to local CPR training providers will be paramount. Creating awareness of PulsePoint and installing AEDs in locations that currently lack such devices could ultimately improve cardiac arrest survival rates within Niagara Region.