Cardiac Arrest Emergency Research Articles

Reducing the Likelihood of Opioid Overdose Fatalities on College and University Campuses: An Action Plan and Model.

For more than two decades there has been a continuous rise in opioid overdose related deaths. The majority of the deaths include the age range when, traditionally, individuals are likely to attend college or university. As a result, Vassar College has taken the important initiative and created and implemented a new opioid overdose intervention strategy and action plan called AED+. AED+ expands on the Model of Greater Awareness, Training and Increased Availability of and Accessibility to Life Saving Intervention Devices; a model that was created based on AED devices improving outcomes of out-of-hospital cardiac arrest emergencies. Similar to AED's improving out-of-hospital cardiac arrest outcomes, the + component of the AED+ initiative increases awareness and provides basic, targeted education about naloxone and its use. Furthermore, the education includes information about naloxone's greater availability and its more immediate access across the campus by students, staff, faculty, administrators, and visitors in the event of a suspected opioid overdose. Starting in May 2023, members of the school's Health Service and senior administrative leaders identified it necessary to be proactive and not reactive to managing an opioid overdose in the campus community. Although Vassar College has not recently experienced an opioid overdose, it is confidently projected that these targeted actions will proactively and positively reduce the likelihood of opioid-related fatalities on campus. Furthermore, it is the purpose of this article to share the AED+ model so other colleges and universities can modify it to best fit their unique setting in order to improve opioid overdose outcomes.

The Location Problem of Medical Drone Vertiports for Emergency Cardiac Arrest Needs

The implementation of medical drones can quickly and efficiently expand the coverage range of an area, allowing for a faster response to incidences of out-of-hospital cardiac arrest and improving the subsequent survival rate of such incidences, while promoting sustainable health development goals under the configuration standards for automatic external defibrillators in China. In response to the problem of the selection of locations for medical drone vertiports (for take-off and landing) that are equipped with automatic external defibrillation facilities, a survival function was introduced to establish a model for site selection, with the primary optimization objective of maximizing the average survival rate of patients and taking the operating costs of a system into account. At the same time, considering the constraints of drone phase operation time, energy consumption, coverage range, etc., a medical drone vertiport site selection model was established for emergency cardiac arrest needs. An improved immune algorithm was applied to the model’s calculations and the analysis of the results, using the Jinnan District in Tianjin as an example. The results show that the proposed model and algorithm are feasible and applicable. The Jinnan District in the city of Tianjin requires a total of 24 medical drone vertiports in order to achieve full coverage of an area under the “golden 4-minute” rescue time. When the average survival rate of patients is 0.9, the operation results are deemed optimal, and the average survival rate of patients is 64.06%. Compared to ground ambulances currently used in hospitals, the implementation of medical drones could significantly shorten response time, improve the average survival rate of patients by 41.96%, and effectively improve the existing low survival rate and the accessibility of medical services. The results of this study can provide decision-making support for the planning of automatic external defibrillators in public places and the construction of sustainable and efficient emergency medical service systems.

Action Plan and Model to Reduce Potential Opioid Overdose Deaths on K-12 Campuses.

School communities are not immune to the alarming increase in opioid-related deaths occurring in the United States during the past decade. The purpose of this article is to share how a middle school in New York State, beginning in the late fall of 2022, successfully implemented a program to reduce the likelihood of opioid overdose deaths in their building through expansion of the accessibility of and education and training in use of naloxone, an opioid antagonist. The program is applicable for all K-12 campuses and follows the Model of Greater Awareness, Improved Training, and Increased Availability of and Accessibility to Intervention Devices, based on the steps successfully used for out-of-hospital cardiac arrest emergencies. Because opioid addiction does not discriminate, it is confidently projected that these targeted actions will proactively and positively reduce the likelihood of opioid overdose deaths in our school setting, including for students, faculty, staff, administrators, and visitors, when and should they occur.

An Evaluation of the Quality of CPR Chest Compressions Performed on Football-Equipped and Obese Simulation Manikins

Objective Protective athletic equipment may hamper the delivery of effective chest compressions. Unfortunately, an algorithm for managing cardiac arrest emergencies with equipment-laden athletes has yet to be established by national CPR certifying agencies. Further, athletes classified as being overweight or obese carry adipose in the thoracic region, which has been reported to inhibit the ability of rescuers to provide quality chest compressions. Thus, the purpose of this study was two-fold. The first purpose was to assess the ability of emergency responders to perform CPR chest compressions on an obese manikin. The second purpose was to analyze the effect of American football protective equipment on the performance of chest compressions by emergency responders. Methods Fifty emergency responders completed four 2-minute bouts of compression-only CPR. The scenarios included performing chest compressions on both traditional and obese CPR manikins, and performing chest compressions over a set of shoulder pads/chest protector that is used in the sport of American football on both traditional and obese manikins. Results The most notable outcomes in this study were related to chest compression depth, which fell well below the minimum recommended depth published by the American Heart Association in all conditions. Mean compression depth was significantly lower when performed on the obese manikin (avg over pads = 32.8, SD = 9.2 mm; avg no pads = 38.2, SD = 9.1 mm) compared to the traditional manikin (avg over pads = 40.0, SD = 10.9 mm; avg no pads = 40.8, SD = 14.8 mm), with statistical analyses revealing a significant effect due to both manikin size (p < 0.001) and the presence of equipment (p = 0.003), and a statistically significant interaction effect (p = 0.035). Chest recoil data revealed a statistically significant effect due to both manikin size (p = 0.017) and the presence of chest/shoulder safety pads (p = 0.003). Conclusion Within this sample of emergency responders, chest compressions were adversely affected both by the equipment and obesity. Additionally, the traditional manikin received comparable chest compressions regardless of the presence or absence of football protective equipment, albeit both conditions resulted in poor depth performance.

Sudden cardiac arrest response preparedness in Durham County schools.

Sudden cardiac arrest is an uncommon event with high morbidity and mortality. There are improved outcomes with early access to an automated external defibrillator and cardiopulmonary resuscitation. We assessed the availability of automated external defibrillators and emergency cardiac arrest plans in schools. A cross-sectional electronic survey was conducted to determine the status of emergency cardiac arrest plans and automated external defibrillator presence. Most schools (88%) had access to an automated external defibrillator; however, trained staff and maintenance plans were highly variable. Automated external defibrillator availability did not differ by racial/ethnic or socio-economic composition; however, there was a relationship between number of automated external defibrillators and student population (p = 0.0030). The majority of schools either did not have (28%) or did not know if they had (36%) an emergency cardiac arrest plan. Even without state legislation, automated external defibrillators were largely available in schools. However, there remains a paucity of emergency cardiac arrest plans and automated external defibrillator maintenance plans.

The trajectory of repairs in the defibrillator sequence during emergency cardiac arrest calls – Balancing progressivity and intersubjectivity

Due to the urgent, time-sensitive nature of interactions in emergency ambulance phone calls, dealing with repairs (communication trouble) can be challenging. We investigate a critical medical emergency known as out-of-hospital cardiac arrest (OHCA) and focus on how ambulance call-takers handle repairs during an interactive sequence concerning the retrieval of automatic external defibrillators (AED). Clear communication about AEDs is vital, because the device can deliver a life-saving shock to an OHCA patient’s heart. We examined repair initiations, and their subsequent trajectories, during the defibrillator sequences in 58 OHCA emergency calls. We found evidence of competing influences in resolving such repairs: (1) providing a repair solution (including ensuring caller comprehension of what a defibrillator is) to achieve intersubjectivity that could resolve the question of defibrillator availability; or (2) progressing the call as swiftly as possible to an immediately applicable life-saving intervention such as cardiopulmonary resuscitation. The findings suggest that in certain institutional contexts, such as emergency medical service dispatch, the resolution of repairs in communication can take varying trajectories in order to achieve the most feasible goal in immediate time. We suggest that emergency medical services consider these trajectories in helping ambulance call-takers anticipate repairs in OHCA calls.

HUBUNGAN PENGALAMAN PERAWAT DAN KEBERHASILAN RESUSITASI JANTUNG PARU DI RUANG IGD,ICU DAN ICCU RSUD PROF.W.Z JOHANNES KUPANG

Cardiovascular disease is a global threat and is the number one cause of death worldwide. Until now, CPR is a very vital management in cases of cardiac arrest. The results of the initial survey found that nurses often found patients who had cardiac arrest, which required CPR. Some patients were saved and some died. Based on this, it is necessary to conduct research on the experience of ER, ICU and ICCU nurses in performing cardiopulmonary resuscitation. The aim of the study was to determine the relationship between nurses' experience and the success of cardiopulmonary resuscitation in the ER, ICU and ICCU RSUD Prof. Dr. W. Z. Johannes Kupang. This research is a quantitative research, correlation study design. The sample used is 41 nurses. Quota sampling technique. Analysis using Chi Square. The results showed that most of the respondents had sufficient experience of cardiopulmonary resuscitation, namely 37 people (90.8%). Most of the respondents managed to perform CPR, namely 34 people (82.9%). There is a relationship between experience and the success of cardiopulmonary resuscitation with a p value of 0.0001. Suggestions Training for emergency cardiac arrest needs to be carried out routinely to improve the quality of CPR

The Effectiveness Of The Application Of Nursing Early Warning Score System (NEWSS) In Reducing The Frequency Of Emergency Cardiac Arrest: A Case Study Of Pelamonia Hospital, Makassar

One of the efforts made by nurses to identify deterioration or emergency incidents in patients is through the use of Nursing Early Warning Score System (NEWSS). This study therefore aims to determine the effectiveness of this system in reducing the frequency of cardiac arrest in patients. A quasi-experiment with a post-test only control group design was adopted and a sample of 80 respondents was obtained. Furthermore, the research instrument consists of 7 physiological parameters in the NEWSS assessment, under standard operating procedures. The results from the Mann Whitney test with a P value of 0.000, (P &lt;0.05) indicate that the System is effective in reducing the frequency of emergency cardiac arrests.&#x0D; &#x0D; Keywords: NEWSS, Cardiac Arrest Emergency

The Impact of CPR Position (Kneeling, Footstool and Standing Beside Bed) on Cardiopulmonary Resuscitation Quality: A Literature Review

Background: Cardiopulmonary Resuscitation (CPR) is one of the measures to deal with emergency cardiac arrest (cardiac arrest) where the heart organ loses its function suddenly. Hence it is unable to pump blood throughout the body. CPR consists of aid in circulation (compression) and breathing (ventilation). AHA has determined guidelines for implementing CPR, especially an essential point in CPR, namely chest compression. The standing position is fundamental in the implementation of CPR, but kneeling and footstool positions can be carried out during CPR implementation. This paper aims to show the impact of standing, kneeling, and footstool positions on CPR quality.Method: The method used is by searching journals in Science Direct, PubMed, and Google Scholar. The keywords used are CPR, Kneeling Position, Footstool, standing beside the bed Obtained eight selected journals according to the topic, then analyzed.Results: Based on the search result, eight articles meet the criteria. The literature review results showed three positions that can be chosen when conducting CPR: standing, kneeling, and footstool. Those positions could give impact toward helper: pain level and exhaustion degree, and quality of CPR: compression strength, depth of compression, amount of compression, chest recoil, elbow movement, and movement in the lower back.Conclusion: Three CPR positions can be done, including standing beside the bed, kneeling, and standing on stepstool footing. Each position gives impacts both to helper condition and CPR quality. Researchers recommend standing on stepstool footing due to it provides the best effect on CPR quality.

The effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement

Objective To investigate the effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement. Methods Based on the national database of emergency cardiac arrest treatment, patients treated with advanced airway placement during cardiopulmonary resuscitation (CPR) were enrolled in PUMCH Emergency Department from December 2013 to June 2018. The physiological parameters, such as electrocardiograph waveform, pulse oximetry plethysmographic waveform and capnography, were recorded at least 18 minutes. The demographic data and resuscitation parameters were collected. Waveform capnography was used for calculating ventilation rate (VR) and the VR between 8 to 12 breaths/min was defined as the qualified ventilation rate (QVR). According to the ventilation modes, patients were divided into the bag-mask group (BMG) and mechanical ventilation group (MVG). According to the VR, patients in the mechanical ventilation group were divided into two subgroups, the high-frequency ventilation subgroup (HFV subgroup) with the VR more than 20 breaths/min and the low-frequency VR subgroup (LFV subgroup) with the VR less than 20 breaths/min. VR, the qualified ventilation rate ratio (QVRR), the return of spontaneous circulation (ROSC), and 24-h and 7-day survival were compared between the two groups and subgroups. Result A total of 90 patients were enrolled in the analysis with 22 patients in the bag-mask group and 68 patients in the mechanical ventilation group. The total rate of ROSC was 35.6%, 24-h survival was 1.1% and 7-day survival was 0. The first 18 minutes ventilation data were collected and added up to 1 620 min. The median VR was 16.5 (12.0, 26.0) breaths/min and the QVRR was 30%. Compared with the mechanical ventilation group, the VR in the bag-mask group were lower (10 breaths/min vs 21 breaths/min) and the QVRR was higher (88.9% vs 11.5%). The ROSC, 24-h survival and 7-day survival had no statistical differences between the two groups. In the mechanical ventilation group, the ratio of VR more than 20 breaths/min was 52.6%. Between the two subgroups, there was no statistical difference in ROSC, 24-h survival and 7-day survival. Conclusions Compared with the mechanical ventilation during CPR, the VR is lower with bag-mask ventilation, and the QVRR is higher. But there was no statistical difference on the outcomes. There was no difference on the outcomes between the two mechanical ventilation subgroups. Key words: Cardiac arrest; Cardiopulmonary resuscitation; Mechanical ventilation; Ventilation rate; Bag-mask ventilation

Differences in out-of-hospital cardiac arrest emergency dispatch recognition and dispatcher assisted cpr instructions – a Scandinavian multicentre study

Purpose of the study: Emergency medical dispatchers play a vital role in early recognition of Out-of-Hospital Cardiac Arrest (OHCA). Provision of dispatcher assisted cardiopulmonary resuscitation (DA-CPR) before arrival of the emergency medical services is associated with increased bystander CPR and survival. The purpose of this study was to investigate differences between OHCA emergency calls from emergency medical communication centers in Stockholm (Sweden), Copenhagen (Denmark), and Oslo (Norway). Quality measures were recognition of OHCA, provision of DA-CPR, median time to first chest compression and dispatchers’ assessment of the quality of bystander CPR concerning chest compression depth and rate.

Keeping Bystanders Active: Resuscitating Resuscitation Skills.

Introduction: Sufficient CPR skills in the general population are essential to make them active bystanders and contribute to an effective chain of survival in cardiac arrest emergencies. However, having a large proportion of the population regularly retrained is practically infeasible.Objective: The aim of this study was to assess and retrain cardiopulmonary resuscitation (CPR) skills of individuals who received (limited) CPR training several months to years prior.Method: Ninety-nine German adults in a possession of a driver's license were asked to perform CPR on a Laerdal Resusci Anne® QCPR manikin (Laerdal, Stavanger, Norway). After initial assessment, participants watched an instructional video and completed short, isolated compression, and ventilation practice with live feedback. CPR competency was assessed again after retraining and after a retention interval of 45 min.Results: Our results indicate that only 2% of participants managed to reach the performance criteria set by the European Resuscitation Council Guidelines, with most failing to reach even the lowest levels of performance. This corroborates earlier observations that CPR skills have deteriorated almost completely after a long retention interval, calling into question “one-and-done” certification of this basic life-saving. However, we also demonstrated that performance strikingly increased after watching a 6-min instructional video and a short opportunity for isolated practice. This increase in performance was stable over 45 min with 96% of participants meeting performance levels specified in the Guidelines. Closer inspection of the isolated compression practice data suggests that performance was very high at the start of the practice already, indicating that short refresher videos might suffice to change bystanders that would not have initiated CPR due to lack of knowledge into active first responders.Conclusion: We suggest that short refresher trainings could be an effective and affordable means of improving basic lifesaving skills to increase the effective contribution of bystanders during emergencies.

PENGARUH PELATIHAN RESUSITASI JANTUNG PARU TERHADAP KESIAPAN SEKAA TERUNA TERUNI DALAM MEMBERIKAN PERTOLONGAN PADA KASUS KEGAWATDARURATAN HENTI JANTUNG

Emergency may occur anywhere and anytime. Cardiac Arrest is one of the most life-threatening emergency conditions. The CPR action is an important determinant of survival of cardiac arrest survivors. The purpose of this research is to know the effect of CPR training on the readiness to provide STT relief in cardiac emergency cases in Dawan Kaler Village 2018. This research type is pre experimental with pre-post test approach, and using simple random sampling method with 160 respondents. The instrument used is a questionnaire about the readiness to help victims of cardiac arrest. Data analysis used is univariate and bivariate analysis. The result of the research shows that most of the respondents are female (63.8%), most of the respondents are 17-25 years old (95%), most of them are high school (58.1%), most of them are student (80 , 6%), before CPR training for less ready category (32,5%) and category not ready (67,5%), after CPR training, improvement of readiness to help, category ready (63,8%) and ready category ie 36.3%. Statistical test results using Wilcoxan Signed Rank Test obtained p-value 0.000 <alpha (0,05). Conclusion: CPR training can improve the readiness of providing emergency assistance in cases of cardiac arrest. Suggestion: STT works together with related health officers to create a continuous training program so that the future is able to do quick and proper handling to help cases of cardiac arrest emergency ..

Influence factors analysis of mechanical compression and hands-only compression on restoration of spontaneous circulation and prognosis in patients with cardiac arrest

To evaluate the influence factors of different compression modes on restoration of spontaneous circulation (ROSC) and outcomes in patients with cardiac arrest. Based on the national database of emergency cardiac arrest treatment, the clinical data of 517 patients with cardiac arrest admitted to 14 teaching hospitals in 7 provinces from July 2015 to July 2017 were enrolled. According to the way of compression, the patients were divided into mechanical compression group and hands-only compression group. The demographic data, resuscitation parameters [compression frequency, monitored ventilation frequency, duration of resuscitation, drug usage] and physiological parameters [end-expiratory partial pressure of carbon dioxide (PETCO2), pulse oxygen saturation (SpO2)] were collected. The ROSC rates and 24-hour, 7-day, 28-day survival rates were compared between the two groups. Multivariate Logistic regression model was used to analyze the influencing factors of ROSC according to whether the duration of resuscitation was longer than 60 minutes. Of 517 patients, 24 were excluded because of incomplete data. A total of 493 patients were enrolled in the analysis with 214 patients in the mechanical compression group, and 279 in the hands-only compression group. Compared with hands-only compression group, the patients in mechanical compression group had higher age, proportion of chronic obstructive pulmonary disease (COPD) and PETCO2, fewer un-shockable rhythm, less compression rate, more epinephrine and sodium bicarbonate usage, and longer duration of cardiopulmonary resuscitation (CPR). Although the rate of ROSC in the mechanical compression group was higher than that in the hands-only compression group [36.9% (79/214) vs. 30.5% (85/279)], there was no significant difference in the rate of ROSC between the two groups [odds ratio (OR) = 1.10, 95% confidence interval (95%CI) = 0.68-1.76, P = 0.693], even after adjusted for con-variables by multivariate Logistic regression (OR = 1.21, 95%CI = 0.54-1.88, P = 0.054). Furthermore, 24-hour, 7-day, and 28-day survival rate also showed no significant difference in both univariate model and multivariate model. Comparisons of resuscitation parameters and physiological parameters between the two groups showed that when the duration of CPR < 60 minutes, the pressing frequency of the mechanical compression group was lower, ventilation frequency and adrenaline dosage were higher; and when the duration of CPR ≥ 60 minutes, the adrenaline dosage and PETCO2 of the mechanical compression group were higher. Multivariate Logistic regression analysis showed that among patients with a duration of CPR < 60 minutes, un-shockable rhythm (OR = 0.29, 95%CI = 0.05-0.75, P = 0.015), compression rate > 120 times/min (OR = 0.39, 95%CI = 0.24-0.64, P < 0.001), ventilation frequency > 40 times/min (OR = 0.50, 95%CI = 0.31-0.84, P = 0.034) were independent risk factors for ROSC; while PETCO2 ≥ 20 mmHg (1 mmHg = 0.133 kPa) was protective factor for ROSC (OR = 2.79, 95%CI = 1.88-4.49, P < 0.001). However, for patients with CPR duration ≥ 60 minutes, ≥ 65 years old (OR = 0.33, 95%CI = 0.15-0.67, P = 0.018), admission at night (OR = 0.74, 95%CI = 0.59-0.94, P = 0.035), un-shockable rhythm (OR = 0.38, 95%CI = 0.25-0.65, P = 0.001), non-cardiogenic cardiac arrest (OR = 0.35, 95%CI = 0.25-0.48, P = 0.013), previous history of diabetes mellitus (OR = 0.46, 95%CI = 0.27-0.82, P = 0.015) were independent risk factors for ROSC, and cardiac arrest occurred in emergency room (OR = 2.02, 95%CI = 1.02-2.92, P = 0.023), mechanical compression (OR = 1.41, 95%CI = 1.12-1.75, P = 0.043), PETCO2 ≥ 20 mmHg (OR = 2.94, 95%CI = 1.34-4.54, P = 0.012), previous history of acute coronary syndrome (ACS; OR = 2.47, 95%CI = 1.15-3.78, P = 0.043) were protective factors for ROSC. Mechanical compression CPR had no significant differences in the rate of ROSC and 24-hour, 7-day, 28-day survival rates for cardiac arrest patients in the emergency departments compared with hands-only compression CPR. For those who undergone CPR duration more than 60 minutes, mechanical compression was associated with a higher rate of ROSC.

Mapping the potential of community first responders to increase cardiac arrest survival

ObjectiveResuscitation from out-of-hospital cardiac arrest (OHCA) is largely determined by the availability of cardiopulmonary resuscitation (CPR) and defibrillation within 5–10 min of collapse. The potential contribution of organised groups of...

The use of unmanned aerial vehicles for health purposes: a systematic review of experimental studies.

Unmanned aircraft vehicles (UAVs) have had a rapid escalation in manageability and affordability, which can be exploited in healthcare. We conducted a systematic review examining the use of drones for health-related purposes. A search was conducted in Medline, Embase, Global Health, Scopus, CINAHL and SciELO. Experimental studies were selected if the population included human subjects, the intervention was the use of UAVs and there was a health-related outcome. Of 500 results, five met inclusion criteria during an initial search. An updated search yielded four additional studies. Nine studies, all in high-income countries, were included for systematic syntheses: four studies addressed out-of-hospital cardiac arrest emergencies, three assessed drones for identification of people after accidents, one used drones to transport blood samples and one used drones to improve surgical procedures in war zones. Research on the use of drones in healthcare is limited to simulation scenarios, and this review did not retrieve any studies from low- and middle-income countries.

Effect of simulation-based emergency cardiac arrest education on nursing students' self-efficacy and critical thinking skills: Roleplay versus lecture

BackgroundSimulation education is a learning method for improving self-efficacy and critical thinking skills. However, not much study has been done on how to use it for education on emergency cardiac arrest situations, for which a multidisciplinary team approach is required. ObjectivesThis study investigated the effects of simulation education on nursing students' self-efficacy and critical thinking skills in emergency cardiac arrest situations. DesignA quasi-experimental research approach with a crossover design was used to compare two types of simulation instruction methods. Participants and SettingThis study was conducted with 76 nursing students divided into two groups by order of instruction methods, in November and December 2016. MethodsBoth groups of participants experienced a simulation lesson based on the same emergency scenario. Group A first completed a roleplay of an emergency cardiac arrest situation in a clinical setting, while Group B first listened to a lecture on the procedure. After ten days, Group A repeated the simulation exercise after listening to the lecture, while Group B completed the simulation exercise after the roleplay. The students' self-efficacy and critical thinking skills were measured using a questionnaire before and after each session. ResultsIn the first session, self-efficacy and critical thinking skills scores increased greatly from pretest to posttest for Group A in comparison to Group B; no statistically significant difference was found between the two groups. In the second session, Group B showed a significant increase between pretest and posttest, while Group A showed no significant difference. ConclusionsConducting the simulation exercise after the roleplay was a more effective teaching method than conducting it after the lecture. Moreover, having the nursing students assume various roles in realistic roleplay situations combined with simulation exercises led to a deeper understanding of clinical situations and improved their self-efficacy and critical thinking skills.

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 .

The effect of an electronic cognitive aid on the management of ST-elevation myocardial infarction during caesarean section: a prospective randomised simulation study

BackgroundCognitive aids have come to be viewed as promising tools in the management of perioperative critical events. The majority of published simulation studies have focussed on perioperative crises that are characterised by time pressure, rare occurrence, or complex management steps (e.g., cardiac arrest emergencies, management of the difficult airway). At present, there is limited information on the usefulness of cognitive aids in critical situations with moderate time pressure and complexity. Intraoperative myocardial infarction may be an emergency to which these limitations apply.MethodsAnaesthetic teams were allocated to control (no cognitive aid; n = 10) or intervention (cognitive aid provided; n = 10) groups. The primary aim of this study was to compare cognitive aid versus memory for intraoperative ST-elevation myocardial infarction (STEMI) management in a simulation of caesarean delivery under spinal anaesthesia. We identified nine evidence-based metrics of essential care from current guidelines and subdivided them into mandatory (high level of evidence; no interference with surgery) and optional (lower class of recommendation; possible impact on surgery) tasks. Six clinically relevant tasks were added by consensus. Implementation of these steps was measured by scoring task items in a binary fashion (yes/no). The interval between the diagnosis of STEMI and the first contact with the cardiac catheterisation lab was measured. To determine whether or not the cognitive aid had prompted an action, participants from the cognitive aid group were interviewed during debriefing on every single treatment step. At the end of the simulation, session participants were asked to complete a survey.ResultsThe presence of the cognitive aid did not shorten the time interval until the cardiac catheterisation lab was contacted. The availability of the cognitive aid improved task performance in the tasks identified from the guidelines (93% vs. 69%; p < 0.001) as well as overall task performance (87.5% vs. 59%; p < 0.001). The observed difference in performance can be attributed to the use of the cognitive aid, as performance from memory alone would have been comparable across both groups. Trainees appeared to derive greater benefit from the cognitive aid than did consultants and nurses.ConclusionsThe management of intraoperative ST-elevation myocardial infarction can be improved if teams use a cognitive aid. Trainees appeared to derive greater benefit from the cognitive aid than did consultants and nurses.

Effect of Team Debriefing in Simulation-based Cardiac Arrest Emergency Nursing Education

Purpose: The aim of this study was to verify the effect of simulation and examine the effect of within-team debriefing for cardiac arrest emergency nursing education. Methods: A non-equivalent control group quasi-experimental design was used. The participants in this study were 199 senior nursing st...