Automated External Defibrillators Placement Research Articles

A brisk walk—Real-life travelling speed of lay responders in out-of-hospital cardiac arrest

BackgroundDefibrillation by public Automated External Defibrillators (AEDs) before EMS arrival is associated with high survival rates. Previous recommendSations suggest that an AED should be placed within a 1–1.5 min “brisk walk” from a cardiac arrest. Current guidelines hold no recommendation. The real-time it takes for a volunteer to retrieve an AED in a public setting has not been studied. MethodsGlobal Positioning System data and Geographical Information Systems methods were used to track the movement of mobile phone dispatched lay responders in two large Swedish areas. The distance and the travelling time were calculated from when the lay responder received the call, until they were within 25 m from the coordinate of the suspected OHCA sent by the dispatch centre. ResultsDuring 7 months, a total of 2176 persons were included in the final analysis. The median travelling speed was 2.3 (IQR = 1.4–4.0) metres per second (m/s) among all cases with a response time of 6.2 min. The corresponding travelling distance was 956 m (IQR = 480–1661). In the most densely populated areas (>8000 inhabitants/km2) the response time was 1.8 m/s compared to 3.1 in the least densely populated areas (0–1500 inhabitants/km2). ConclusionThe median travelling speed of all lay responders dispatched to suspected OHCAs was 2.3 m/s. In densely populated areas the travelling speed was 1.8 m/s. This can be used as support in guidelines for planning placement of AEDs, in simulation studies, as well as in configuration of mobile-based dispatch systems.

Strategic Mapping and Placement of Automated External Defibrillators in Remote Areas. The case of the Region of Western Macedonia Greece

Background: In Europe, sudden cardiac arrest is one of the dominant causes of death. Considering the fact that defibrillation within 3-5 minutes of collapse can cause survival rates as high as 50-70%, programs for public access defibrillation should be actively implemented. So far, the international research is focused on optimised methods for Automated External Defibrillator (AED) placements in cities and densely populated areas but there is not any concrete approach in connection with geographic information systems to covering the remote rural areas which have different dynamics, demographics and of course accessibility to medical care. This gap is what this paper will try to fill. The work of the current study unfolds in the Region of Western Macedonia (RWM) in Greece for a pilot AED placement program for the Governance of RWM. The initial number of the defibrillators (120) that are needed to be distributed is very small and by far it cannot cover the needs for every major town or rural area. This paper focuses only on the rural dimension for the allocation. Methods: All existing Regional Medical facilities, Health centers and Hospitals were identified and mapped. Subsequently, all types of road network were mapped and classified, which differ in conditions and maintenance, in order to do a network analysis. In addition, the type of land uses, demographics, population densities and seasonal dynamics were also taken into consideration in the mapping process in order to do a priority ranking for the allocation of the AEDs. Results: Based on the methodology the optimised sites and allocated AEDs covered the major rural areas that are most in need for immediate relief in the event of a cardiac episode. The results show a promising future for the foundation and expansion of optimised AED placements in rural areas. Conclusions: The progress of this pilot project must be monitored and there are many problems and obstacles that need to be tackled in order to provide a robust allocation of future defibrillators. Further research is needed to deepen our understanding on optimization approaches to enhance the functionality of the medical services as well as create a stable network of engaged and informed citizens ready to act.

Evaluating health facility access using Bayesian spatial models and location analysis methods.

BackgroundFloating catchment methods have recently been applied to identify priority regions for Automated External Defibrillator (AED) deployment, to aid in improving Out of Hospital Cardiac Arrest (OHCA) survival. This approach models access as a supply-to-demand ratio for each area, targeting areas with high demand and low supply for AED placement. These methods incorporate spatial covariates on OHCA occurrence, but do not provide precise AED locations, which are critical to the initial intent of such location analysis research. Exact AED locations can be determined using optimisation methods, but they do not incorporate known spatial risk factors for OHCA, such as income and demographics. Combining these two approaches would evaluate AED placement impact, describe drivers of OHCA occurrence, and identify areas that may not be appropriately covered by AED placement strategies. There are two aims in this paper. First, to develop geospatial models of OHCA that account for and display uncertainty. Second, to evaluate the AED placement methods using geospatial models of accessibility. We first identify communities with the greatest gap between demand and supply for allocating AEDs. We then use this information to evaluate models for precise AED location deployment.MethodsCase study data set consisted of 2802 OHCA events and 719 AEDs. Spatial OHCA occurrence was described using a geospatial model, with possible spatial correlation accommodated by introducing a conditional autoregressive (CAR) prior on the municipality-level spatial random effect. This model was fit with Integrated Nested Laplacian Approximation (INLA), using covariates for population density, proportion male, proportion over 65 years, financial strength, and the proportion of land used for transport, commercial, buildings, recreation, and urban areas. Optimisation methods for AED locations were applied to find the top 100 AED placement locations. AED access was calculated for current access and 100 AED placements. Priority rankings were then given for each area based on their access score and predicted number of OHCA events.ResultsOf the 2802 OHCA events, 64.28% occurred in rural areas, and 35.72% in urban areas. Additionally, over 70% of individuals were aged over 65. Supply of AEDs was less than demand in most areas. Priority regions for AED placement were identified, and access scores were evaluated for AED placement methodology by ranking the access scores and the predicted OHCA count. AED placement methodology placed AEDs in areas with the highest priority, but placed more AEDs in areas with more predicted OHCA events in each grid cell.ConclusionThe methods in this paper incorporate OHCA spatial risk factors and OHCA coverage to identify spatial regions most in need of resources. These methods can be used to help understand how AED allocation methods affect OHCA accessibility, which is of significant practical value for communities when deciding AED placements.

In-building automated external defibrillator location planning and assessment through building information models

Abstract The morality rate of patients with out-of-hospital cardiac arrest (OHCA) is 92%. Public Access Defibrillation before the arrival of emergency medical services is critical in increasing the survival rate of patients with OHCA. The American Heart Association recommends to install automated external defibrillators (AEDs) in areas that are crowded regularly or during specific times and events, including airports, stations, stadiums, schools, offices, and shopping malls. While the importance of deploying AEDs in public areas is widely accepted, the impact of the specific locations and quantities of these AEDs, in terms of efficiency, remains largely un-evaluated. We propose to evaluate the in-building travels through a network, particularly to avoid penetrating the structural obstacles (walls, corners, floors and ceilings), with the aid of Building Information Modeling (BIM) models. The constructed network enables four main decision models in this work: 1) efficient routing to access an AED, 2) optimal location planning of AEDs, 3) a coverage targeting model that finds suitable numbers of AEDs and their corresponding locations, and 4) an AED placement evaluation model. A case study is presented for an actual building, and the coverage rate is increased from 28.33% to 50% given the same amount of AED through the proposed approach.

Abstract 197: What Limits the Use of AEDs by Bystanders?

Introduction: In Japan, the number of automated external defibrillators (AEDs) placed in public areas has climbed up to the estimated 530,000. We reported previously that a half of out-of-hospital cardiac arrests occurred within 100 m from a public AED in urban areas. However, shocks for defibrillation were given to less than 15% of those patients. The objectives of this study was to identify the limiting factors against the use of AEDs by bystanders. Methods: A prospective survey on out-of-hospital cardiac arrest was conducted in the city of Osaka (Dec 2016 through Mar 2017) and the city of Nagoya (Dec 2016 through Nov 2017) searching for patient demographics and AED settings including; absence/presence of a public AED on the scene, attachment of AED pads, delivery of shocks before the time of EMS arrival. Results: Of 558 cases of cardiac arrest registered during the survey period, an AED had already been delivered at the patient side by the time of EMS arrival in 92 case (16.5%). Of those, pads had been attached in 89 cased (96.7%). Shocks had been advised in 35 cases (39.3%) and to all but one of those cases at least 1 shock had been given by the bystanders. There were no statistically significant differences between the groups of cases with and without AEDs at the patient side regarding the patient age (65 years [IQR: 48-74] vs 63 years [IQR49-75], p=0.84), gender (p=0.68) and the time from call to EMS arrival (7 min [IQR: 6-9] vs 7 min [IQR: 6-9], p=0.74). Cases occurring indoors had more chances of AEDs being delivered on the patient side than cases occurring outdoors (24.0% vs 7.8%, p<0.001). Conclusions: Our study indicates that once an AED is delivered at the patient side, pads are successfully attached and shocks are given if indicated in almost all cases. This suggests that finding and delivering an AED onto the patient side are the limiting factors against the use of AEDs by bystanders. In order to popularize the use of AEDs by bystanders, informing people with AED placement and clear direction to the AED location seem to be the key steps.

Spatiotemporal AED optimization is generalizable

AimsMathematical optimization of automated external defibrillator (AED) placements has the potential to improve out-of-hospital cardiac arrest (OHCA) coverage and reverse the negative effects of limited AED accessibility. However, the generalizability of optimization approaches has not yet been investigated. Our goal is to examine the performance and generalizability of a spatiotemporal AED placement optimization methodology, initially developed for Toronto, Canada, to the new study setting of Copenhagen, Denmark. MethodsWe identified all public OHCAs (1994–2016) and all registered AEDs (2016) in Copenhagen, Denmark. We calculated the coverage loss associated with limited temporal accessibility of registered AEDs, and used a spatiotemporal optimization model to quantify the potential coverage gain of optimized AED deployment. Coverage gain of spatiotemporal deployment over a spatial-only solution was quantified through 10-fold cross-validation. Statistical testing was performed using χ2 and McNemar’s tests. ResultsWe found 2149 public OHCAs and 1573 registered AED locations. Coverage loss was found to be 24.4% (1104 OHCAs covered under assumed 24/7 coverage, and 835 OHCAs under actual coverage). The coverage gain from using the spatiotemporal model over a spatial-only approach was 15.3%. Temporal and geographical trends in coverage gain were similar to Toronto. ConclusionsWithout modification, a previously developed spatiotemporal AED optimization approach was applied to Copenhagen, resulting in similar OHCA coverage findings as Toronto, despite large geographic and cultural differences between the two cities. In addition to reinforcing the importance of temporal accessibility of AEDs, these similarities demonstrate the generalizability of optimization approaches to improve AED placement and accessibility.

Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care?

Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care. To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care). Cross-sectional study. Public and private secondary schools in northwest Ohio and southeast Michigan. Thirty schools (24 public, 6 private) volunteered. Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care. Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED ( F1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle. Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.

The challenges and possibilities of public access defibrillation.

Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.

Robust Defibrillator Deployment Under Cardiac Arrest Location Uncertainty via Row-and-Column Generation

Sudden cardiac arrest is a significant public health concern. Successful treatment of cardiac arrest is extremely time sensitive, and use of an automated external defibrillator (AED) where possible significantly increases the probability of survival. Placement of AEDs in public locations can improve survival by enabling bystanders to treat victims of cardiac arrest prior to the arrival of emergency medical responders, thus shortening the time between collapse and treatment. However, since the exact locations of future cardiac arrests cannot be known a priori, AEDs must be placed strategically in public locations to ensure their accessibility in the event of an out-of-hospital cardiac arrest emergency. In this paper, we propose a data-driven optimization model for deploying AEDs in public spaces while accounting for uncertainty in future cardiac arrest locations. Our approach involves discretizing a continuous service area into a large set of scenarios, where the probability of cardiac arrest at each location is itself uncertain. We model uncertainty in the spatial risk of cardiac arrest using a polyhedral uncertainty set that we calibrate using historical cardiac arrest data. We propose a solution technique based on row-and-column generation that exploits the structure of the uncertainty set, allowing the algorithm to scale gracefully with the total number of scenarios. Using real cardiac arrest data from the City of Toronto, we conduct an extensive numerical study on AED deployment public locations. We find that hedging against cardiac arrest location uncertainty can produce AED deployments that outperform an intuitive sample average approximation by 9%–15% and cuts the performance gap with respect to an ex post model by half. Our findings suggest that accounting for cardiac arrest location uncertainty can lead to improved accessibility of AEDs during cardiac arrest emergencies and the potential for improved survival outcomes.The electronic companion is available at https://doi.org/10.1287/opre.2017.1660 .

Automated External Defibrillators and Survival After Nonresidential Out of Hospital Cardiac Arrest in a Small North American City

Most studies demonstrate that the use of automated external defibrillators (AEDs) during out of hospital cardiac arrest is associated with survival, but the majority of these studies were performed in large cities. With this in mind, the aims of our study were to examine AED placement and variables associated with survival after nonresidential out of hospital cardiac arrest (NROHCA) in a small North American city. Cases of NROHCA and locations with AEDs, in Regina, between January 2010 and December 2014 were reviewed. Common locations for NROHCA were identified, the frequency of AED availability was determined, and the relations between survival and AED presence, bystander initiated cardiopulmonary resuscitation (CPR), or shockable rhythms were determined. Only 20% of cases of NROHCA had an AED present on the premise. The presence of an AED (p= 0.94) was not associated with survival to the emergency department, whereas bystander initiated CPR (p <0.01) and shockable rhythm (p <0.01) were associated with survival to the emergency department. The presence of an AED (p= 0.86) and bystander initiated CPR (p= 0.06) were not associated with survival to discharge from the hospital, whereas the presence of a shockable rhythm was (p <0.01). Multivariable logistic regression analysis demonstrated that the presence of a shockable rhythm was independently associated with survival to the emergency department (OR 11.78, p <0.01) and discharge from the hospital (OR 6.08, p <0.01). The optimal locations for AED placement in cities of similar size and density may need to be reexamined, as the findings may have implications for public policies surrounding AED placement.

Abstract 22: Geographic Proximity of Automated External Defibrillators to Out-of-hospital Sudden Deaths in Wake County, North Carolina

Introduction: Survival rates for out-of-hospital sudden cardiac arrest are substantially improved by access to automated external defibrillators (AEDs) prior to Emergency Medical Services (EMS) arrival. However, AED use may be inhibited if their locations are unknown or far from the bystander. Objectives: We sought to classify out-of-hospital sudden death (OHSD) event locations, ascertain if bystanders utilized AEDs prior to EMS arrival, and calculate the distance to the nearest AED. Methods: From 2013 to 2015, we screened all EMS-reported out-of-hospital deaths aged 18-64 within Wake County, North Carolina to identify OHSDs. We geocoded event locations from EMS records and classified them as residential, commercial, public, or unknown using US Postal Service Residential Delivery Indicator, EMS narratives, and web searches. AED locations and installation dates, registered by law, were obtained from North Carolina Department of Health and Human Services. We used EMS narratives to determine AED use prior to EMS arrival. Walking distance between coordinates of an OHSD location and every AED installed prior to the death date was estimated using the Great-Circle distance. Results: Of 434 adjudicated OHSDs, 390 (90%) were residential, 31 (7%) were commercial, and 11 (2.5%) were public. Of commercial locations, 12 (39%) occurred in hotels. Of public locations, 6(46%) occurred in parking lots or parks. Wake County had 168 registered AEDs during the study period. The mean distance from OHSD to closest AED was 3.2 km (95% CI: 3.0-3.5 km). Only 20 (4.6%) of OHSDs were within 500 meters of an AED; the closest AED was 77 meters from an OHSD. Bystanders used AEDs prior to EMS arrival twice. Conclusions: While potentially lifesaving, AEDs are not placed optimally with respect to OHSD locations and are rarely utilized by bystanders, even in non-residential spaces. Public health strategies should be considered that incentivize optimal AED placement to witnessed cardiac arrest locations.

Abstract 024: Public Access Defibrillation State Law Assessment: Do Current Laws Align With Best Available Evidence?

I. Introduction: Cardiac arrest (CA) is a leading cause of death in the U.S. An estimated 70-90% of people experiencing out-of-hospital CA die before reaching the hospital. Applying cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED) within minutes of CA can dramatically raise survival rates. Public Access Defibrillation (PAD) laws can facilitate rapid AED application by lay bystanders. This study assesses whether existing state laws align with best available evidence for PAD implementation to assist decision makers in strengthening existing PAD policies. II. Methods: Two analysts applied CDC’s Quality and Impact of Component (QuIC) Evidence Assessment to appraise the strength of evidence bases for 9 PAD program “policy components,” defined as discrete requirements, provisions, or other elements within a public health policy. Analysts utilized subject matter experts (SME), PubMed, and grey literature to collect evidence and identify 9 policy components. Analysts independently coded evidence across 8 dimensions of evidence quality and public health impact. Resulting scores were used to rank the policy component evidence bases into 3 categories; best, promising or emerging. To identify policy components found in state law, two legal researchers reviewed PAD peer-reviewed and grey literature and analyzed 10 states’ laws using Westlaw. The results were used to construct variables for a legal dataset. Researchers coded and categorized the components in statutes and regulations for all 50 states and Washington, D.C, in effect as of December 31, 2015. Researchers conducted descriptive analysis of the legal dataset and examined correlations with the QuIC policy component results. III. Results: Fifty jurisdictions had PAD laws in effect as of December 31, 2015, authorizing at least one of the 9 evidence-informed PAD policy components (maximum: 8; median: 6). The QuIC assessment categorized 3 components “best”, 4 “promising” and 2 “emerging.” The most common components found in law were PAD use training (best), EMS coordination (best) and lay bystander limited liability (emerging). No state authorized all 9 components. However, 3 states authorized 8 components and 12 states authorized all 3 best components. Two states authorized only lay bystander limited liability (emerging). IV. Implications: There is strong evidence of potential public health impact for targeted AED placement, user training, and EMS PAD coordination, yet two thirds of states have not enacted all three policy components. The Institute of Medicine recommends developing policy strategies and addressing legal barriers to bystander CPR and defibrillation to improve CA outcomes. Studies directly evaluating the role of PAD law in cardiac arrest response and associated health outcomes are needed to determine the best policy approaches to meet state needs and contexts.

Locating Automated External Defibrillators in a Complicated Urban Environment Considering a Pedestrian-Accessible Network that Focuses on Out-of-Hospital Cardiac Arrests

Automated external defibrillators (AEDs) are portable devices that defibrillate and diagnose sudden-cardiac-arrest patients. Therefore, AEDs are widely installed in public places such as airports, schools, sport complexes, etc., and the installation of AEDs is required by law in these places. However, despite their usefulness, AEDs are mostly installed indoors with limited coverage outdoors. Hence, this study conducts research in the placement of AEDs in outdoor locations. This study considers a complicated urban environment using a pedestrian network dataset and network barriers. We draw on the Teitz and Bart’s (1968) heuristic method that was built in the location-allocation solver in ArcMap. The results of this study found that a total of 455 AEDs, including 227 pre-installed AEDs, could be placed in the study area, thus providing an additional 228 devices. Compared with 10 different installation methods that were set as experimental groups, our test results found that additional installations were able to cover 10% to 30% more actual out-of-hospital cardiac-arrest cases. The main contribution of this study is the proposal of a new method in locating AEDs in optimal areas while considering complicated urban environments. We predict that the cardiac-arrest-related mortality rate would be reduced through implementing the findings of this study.

Mismatch between Sites of Incidence of Out-of-Hospital Cardiac Arrest and Locations of Installed Automated External Defibrillator in the Tokyo Metropolitan Area

Background: Since 2004, the number of installed Automated External Defibrillator (AED) has been increased in Japan annually, the cumulative number of sold AED more than 600,000 units by 2016. Despite there have been about 130,000 out of hospital cardiac arrest annually, there have only 1302 cases delivered defibrillation by bystanders at the scene. Therefore, we investigate that number of AED installation and usage rate for Out of Hospital Cardiac Arrest (OHCA) patients. Methods: Retrospective metropolitan wide cohort study. Subject: Total 13,364 OHCA patients in the Tokyo Metropolitan area from Jan. 1 through Dec. 31 in 2012 were eligible for theses analyses. Also, OHCA occurrence place and AED usage rate were studied. Results: 82.8% of OHCA occurred at residences, 10% at outdoors, 6.4% at indoors, only 0.7% at schools. In the other hand, highest bystander’s CPR rates were found in sports facilities and schools (71.4%). The installation rate of AEDs in residences was 9.6%, instead of highest incidence for OHCA patients, school and sports institute made up 21.4% of AED installations, but only 1.0% of the incidences of cardiac arrest. We found that there is a mismatch between incidence sites of cardiac arrest and locations of installed AED. Discussion: It is essential to increase the number of AED installations. Furthermore, it is desirable to install AEDs in locations where cardiac arrest is liable to occur following guidelines for the proper placement of AEDs, and important to further spread BLS education among the general citizens.

Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk

AimApproximately 424,000 out-of-hospital cardiac arrests (OHCA) occur in the US annually. As automated external defibrillators (AED) are an important part of the community response to OHCA, we investigated how well the spatial demand (likelihood of OHCA) was met by the spatial supply (AEDs) in a dense urban environment. MethodsUsing geographic information system (GIS) software, we applied kernel density and optimized hot spot procedures with two differently-sized radii to model OHCA incidence rates from existing studies, providing an estimate of OHCA likelihood at a given location. We compared these density maps to existing AED coverage in the study area. Descriptive statistics summarized coverage by land use. ResultsWith a 420-ft buffer, we found that 56.0% (79.9%, 840-ft buffer) of the land area in the city center was covered by existing AEDs at, though 70.1 (91.5)% of the OHCA risk was covered using kernel density and 79.8% (98.1) was covered using hot spot analysis. ConclusionsThe difference in coverage by area and risk seems to indicate efficient placement of existing AEDs. Our findings also highlight the possible benefits to expanding the influence of AEDs by lowering search times, and identify opportunities to improve AED coverage in the study area. This article offers one method by which local officials can use spatial data to prioritize attention for AED placement and coverage.

Public access defibrillation: improving accessibility and outcomes.

Worldwide, out-of-hospital cardiac arrest (OHCA) remains a serious problem. Public access defibrillation (PAD) has been shown to be effective in improving survival in OHCA with good neurological outcome. Original articles, reviews and national/international guidelines. Limitations to how much we can improve ambulance response times mean that the public have an essential role to play in OHCA survival. Training of laypersons in the use of automated external defibrillators (AEDs) has been shown to improve outcomes. Placement of AEDs should be related to underlying population demographics. Placements of AEDs face cost constraints. PAD programs also face challenges in the upkeep of AEDs. Concerns about legal liability for lay rescuers to act remain. Systematic programs should be in place to train the public in PAD. All AEDs should be listed in national registries and available for usage in an emergency. 'Smart' technology is being developed to improve accessibility of AEDs.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 12: Emergency Action Plans, Resuscitation, Cardiopulmonary Resuscitation, and Automated External Defibrillators: A Scientific Statement From the American Heart Association and American College of Cardiology.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 12: Emergency Action Plans, Resuscitation, Cardiopulmonary Resuscitation, and Automated External Defibrillators: A Scientific Statement From the American Heart Association and American College of Cardiology.

Employment and residential characteristics in relation to automated external defibrillator locations

Survival from out-of-hospital cardiac arrest (OHCA) is generally poor and varies by geography. Variability in automated external defibrillator (AED) locations may be a contributing factor. To inform optimal placement of AEDs, we investigated AED access in a major US city relative to demographic and employment characteristics. This was a retrospective analysis of a Philadelphia AED registry (2,559 total AEDs). The 2010 US Census and the Local Employment Dynamics database by ZIP code was used. Automated external defibrillator access was calculated as the weighted areal percentage of each ZIP code covered by a 400-m radius around each AED. Of 47 ZIP codes, only 9% (4) were high-AED-service areas. In 26% (12) of ZIP codes, less than 35% of the area was covered by AED service areas. Higher-AED-access ZIP codes were more likely to have a moderately populated residential area (P = .032), higher median household income (P = .006), and higher paying jobs (P =. 008). The locations of AEDs vary across specific ZIP codes; select residential and employment characteristics explain some variation. Further work on evaluating OHCA locations, AED use and availability, and OHCA outcomes could inform AED placement policies. Optimizing the placement of AEDs through this work may help to increase survival.

Preventing Sudden Cardiac Death: Automated External Defibrillators in Ohio High Schools.

Ohio passed legislation in 2004 for optional public funding of automated external defibrillators (AEDs) in all Ohio high schools. To report occurrences of sudden cardiac arrest in which AEDs were used in Ohio high schools and to evaluate the adherence of Ohio high schools with AEDs to state law and published guidelines on AEDs and emergency action plans (EAPs) in schools. Cross-sectional survey. Web-based survey. A total of 264 of 827 schools that were members of the Ohio High School Athletic Association. We surveyed schools on AED use, AED maintenance, and EAPs. Twenty-five episodes of AED deployment at 22 schools over an 11-year period were reported; 8 (32%) involved students and 17 (68%) involved adults. The reported survival rate was 60% (n = 15). Most events (n = 20, 80%) in both students and adults occurred at or near athletic facilities. The annual use rate of AEDs was 0.7%. Fifty-three percent (n = 140) of schools reported having an EAP in place for episodes of cardiac arrest. Of the schools with EAPs, 57% (n = 80) reported having rehearsed them. Our data supported the placement of AEDs in high schools given the frequency of use for sudden cardiac arrest and the survival rate reported. They also suggested the need for increased awareness of recommendations for EAPs and the need to formulate and practice EAPs. School EAPs should emphasize planning for events in the vicinity of athletic facilities.

Automated external defibrillators in schools

Objective: Automated external defibrillators (AEDs) placed in public locations can save lives of cardiac arrest victims. In this paper, we try to estimate the cost-effectiveness of AED placement in Belgian schools. This would allow school policy makers to make an evidence-based decision about an on-site AED project. Methods and results: We developed a simple mathematical model containing literature data on the incidence of cardiac arrest with a shockable rhythm, the feasibility and effectiveness of defibrillation by on-site AEDs and the survival benefit. This was coupled to a rough estimation of the minimal costs to initiate an AED project. According to the model described above, AED projects in all Belgian schools may save 5 patients annually. A rough estimate of the minimal costs to initiate an AED project is 660 EUR per year. As there are about 6000 schools in Belgium, a national AED project in all schools would imply an annual cost of at least 3 960 000 EUR, resulting in 5 lives saved. Conclusions: As our literature survey shows that AED use in schools is feasible and effective, the placement of these devices in all Belgian schools is undoubtedly to be considered. The major counter-arguments are the very low incidence and the high costs to set up a school-based AED programme. Our review may fuel the discussion about whether or not school-based AED projects represent good value for money and should be preferred above other health care interventions.