Number Of Automated External Defibrillators Research Articles

Observed Equity and Driving Factors of Automated External Defibrillators: A Case Study Using WeChat Applet Data

Out-of-hospital cardiac arrest (OHCA) causes a high mortality rate each year, which is a threat to human well-being and health. An automated external defibrillator (AED) is an effective device for heart attack-related diseases and is a panacea to save OHCA. Most relevant literature focuses on the spatial distribution, accessibility, and configuration optimization of AED devices, which all belong to the characteristics of the spatial distribution of AED devices. Still, there is a lack of discussion on related potential influencing factors. In addition, analysis of AED facilities involving multiple city comparisons is less considered. In this study, data on AED facilities in two major cities in China were obtained through the WeChat applet. Then, the AED equity at the city and block scales and its socioeconomic factors were analyzed using the Gini coefficient, Lorenz curve, and optimal parameters-based geo-graphical detector (OPGD) model. Results show that the number of AEDs in Shenzhen was about eight-times that of in Guangzhou. The distribution of AEDs in Shenzhen was more equitable with a global Gini of 0.347, higher than that in Guangzhou with a global Gini of 0.504. As for the determinants of AED equity, residential density was the most significant determinant in both Guangzhou and Shenzhen from the perspective of individual effects on AED equity. Differently, due to the aging population in Guangzhou, the proportion of the elderly in blocks was influential to local AED equity. The local economic development level was crucial to local AED equity in Shenzhen. The results of the interaction detector model illustrate that relatively equitable AED distributions were found in the high-density residential areas with a balance of employment and housing, high-aging residential areas, and high-mobility residential areas in Guangzhou. The area with a high level of local economic development, dense population, and large mobility was the area with a relatively equitable distribution of AEDs in Shenzhen. The results of this paper are conducive to understanding the equity of AEDs and its socio-economic determinants, providing scientific reference for the optimization and management of AEDs.

Trends in maintenance status and usability of public automated external defibrillators during a 5-year on-site inspection

This study aimed to assess the trend of the maintenance status and usability of public automated external defibrillators (AEDs). Public AEDs installed in Seoul from 2013 to 2017 were included. An inspector checked the maintenance status and usability of the AEDs annually using a checklist. During the study period, 23,619 AEDs were inspected. Access to the AEDs was improved, including the absence of obstacles near the AEDs (from 90.2% in 2013 to 99.1% in 2017, p < 0.0001) and increased AED signs (from 34.3% in 2013 to 91.3% in 2017, p < 0.0001). The rate of AEDs in normal operation (from 94.0% in 2013 to 97.6% in 2017, p < 0.0001), good battery status (from 95.6% in 2013 to 96.8% in 2017, p = 0.0016), and electrode availability increased (from 97.1% in 2013 to 99.0% in 2017, p < 0.0001); the rate of electrode validity decreased (from 90.0% in 2013 to 87.2% in 2017, p < 0.0001). The overall rate of the non-ready-to-use AEDs and AEDs with less than 24-h usability accounted for 15.4% and 44.1% of the total number of AEDs, respectively. Although most AEDs had a relatively good maintenance status, a significant proportion of public AEDs were not available for 24-h use. Invalid electrodes and less than 24-h accessibility were the main reasons that limited the 24-h usability of public AEDs.

Discussion on automated external defibrillator configuration optimization strategy of rapidly developing city: a case study of Bao'an, Shenzhen

To explore the automated external defibrillator (AED) configuration optimization strategy in line with the characteristics of the rapidly developing cities by analyzing the actual coverage of AED in Bao'an District based on the real world data of out-of-hospital cardiac arrest (OHCA) in Bao'an District, Shenzhen City. The data of cardiac arrest database registered in Bao'an District of Shenzhen City from March 1, 2019 to February 29, 2020 were included in a retrospective observational study. The AED coverage of public and non-public areas was analyzed by calculating the minimum distance between the occurrence place of each OHCA event and the nearest AED. The minimum distance ≤ 100 m was set as AED coverage, and the minimum distance > 100 m was set as non-AED coverage. It was assumed that one AED was configured for each OHCA hotspot area, then the AED coverage changes were analyzed. Based on the actual situation that the AED in schools, governments, sports venues, subways, tourist attractions and parks of public areas in Bao'an District could not be obtained at any time within 24 hours, it was assumed that all AED in the public areas could be obtained at any time within 24 hours, the impact of AED available at any time on AED coverage was analyzed. A total of 525 cases of OHCA were enrolled. The highest incidence of OHCA was found in residential and industrial areas [54.5% (286/525) and 14.3% (75/525), respectively]. There were 252 AED in Bao'an District, Shenzhen, and 115 OHCA events occurred within the coverage area of AED. Even if all AED met the ideal state that could be obtained at any time within 24 hours, the coverage rate was only 21.9% (115/525). The AED coverage rate of the public areas and non-public areas was 31.6% (37/117) and 19.1% (78/408) respectively, with uneven distribution, and the AED coverage rate of non-public areas was low. Assuming that the residential community and industrial zone with more than 2 OHCA cases were respectively equipped with one AED, the coverage rate of AED in the non-public areas increased from 19.1% (78/408) to 28.2% (115/408), basically meeting the requirement that AED could be obtained at any time when OHCA events occurred. Some AED in the public areas of Bao'an District were not available at any time within 24 hours. If the ideal state that all AED in the public area could be obtained at any time within 24 hours could be achieved, the AED coverage rate of all regions increased from 16.8% (88/525) to 21.9% (115/525), the AED coverage rate of the public areas increased from 29.1% (34/117) to 31.6% (37/117), the AED coverage rate of the non-public areas increased from 13.2% (54/408) to 19.1% (78/408). AED configuration in Bao'an District was unevenly distributed, and the coverage rate of AED in non-public areas was low. The allocation strategy for AED in fast-growing cities like Shenzhen should be as follows: on the premise of ensuring AED availability for 24 hours, priority should be given to covering the number of AED in the non-public areas including residential communities and industrial zones; AED is available in the public areas for 24 hours.

Mismatches Between the Number of Installed Automated External Defibrillators and the Annual Rate of Automated External Defibrillator Use Among Places.

In South Korea, the law concerning automated external defibrillators (AEDs) states that they should be installed in specific places including apartment complexes. This study was conducted to investigate the current status and effectiveness of installation and usage of AEDs in South Korea. Installation and usage of AEDs in South Korea is registered in the National Emergency Medical Center (NEMC) database. Compared were the installed number, usage, and annual rate of AED use according to places of installation. All data were obtained from the NEMC database. After excluding AEDs installed in ambulances or fire engines (n = 2,003), 36,498 AEDs were registered in South Korea from 1998 through 2018. A higher number of AEDs were installed in places required by the law compared with those not required by the law (20,678 [56.7%] vs. 15,820 [43.3%]; P <.001). Among them, 11,318 (31.0%) AEDs were installed in apartment complexes. The overall annual rate of AED use was 0.38% (95% CI, 0.33-0.44). The annual rate of AED use was significantly higher in places not required by the law (0.62% [95% CI, 0.52-0.72] versus 0.21% [95% CI, 0.16-0.25]; P <.001). The annual rate of AED use in apartment complexes was 0.13% (95% CI, 0.08-0.17). There were significant mismatches between the number of installed AEDs and the annual rate of AED use among places. To optimize the benefit of AEDs in South Korea, changes in the policy for selecting AED placement are needed.

Assessment of Canadian Public Automated External Defibrillator Registries

BackgroundPublic automated external defibrillator (AED) registries aim to increase layperson defibrillation for victims of out-of-hospital cardiac arrest. This study aims to characterize Canadian AED registries and the process by which these databases are updated and used. MethodsA survey was administered to representatives from each eligible AED registry. Collected data included information on registry management, AED validation process, linkage to emergency medical dispatch (EMD), and number of AEDs per registry. Three unregistered AEDs in each region were then located and registered into their respective registry. The primary endpoint was the proportion of AEDs that became visible in the registry within 1 month. ResultsOf the 9 Canadian provinces that have registries, 7 are provincial, whereas 2 contain smaller independent registries. The survey was completed by 90% of contacted registries. The number of AEDs per registry ranged from 21 to 443 per 100,000 persons. Six registries are managed by a provincial government, 6 use a standardized validation process, and 8 are linked to EMD. Of the 21 AEDs registered by our study personnel in 7/10 registries, 9 (43%) were made available to the public within 1 month of registration. Only 1 registry employed an AED validation process that included direct contact with AED managers. ConclusionsCanadian public AED registries demonstrate significant differences in their governance and administrative processes. A majority of registries are integrated with EMD for out-of-hospital cardiac arrest, but not all registries use a standardized validation process to ensure accuracy of AED information submitted by the public.

Strategic Mapping and Optimised Allocation of Automated External Defibrillators in Urban Areas

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death and is regarded as a significant public health issue. Immediate treatment with an automated external defibrillator (AED) increases OHCA patient survival potential. For AEDs to be used and fulfil their lifesaving potential, they need to be in close proximity to the victim and accessible at the time of a cardiac arrest. The current paper sheds light upon an optimized location-allocation method achieving full coverage with immediate accessibility in an urban context given a limited number of available AEDs for deployment using GIS. The case study is the Region of Western Macedonia (RWM) in Greece for a pilot AED placement program for the Governance of RWM. The focus of the current study is the capital city of RWM, Kozani. The initial number of the defibrillators (120) that are needed to be distributed is very small and cannot cover the needs for every major city or rural area in the region. Out of the 120 AEDs, the challenge is to find the minimum required number of AEDs to allocate in the city providing full coverage and accessibility. This paper focuses only on one city, however, the same methodology was applied to allocate AEDs in the other selected cities of the region. The rural dimension and methodology are not in the scope of this paper. &lt;br&gt; &lt;strong&gt;Methods&lt;/strong&gt;: Road network data, spatio-temporal analysis of accessibility network, digital elevation model, land uses, population density, seasonal fluctuations and socio-demographic variables were used. GIS algorithms such as spatial analysis, kernel density, hot spot analysis, maximal covering location problem (MCLP) tests, proximity algorithms, buffer zoning, were a few of the tests made in order to find the most efficient positions and maximize coverage keeping in mind that access to an AED until defibrillation time must not exceed the time range of five minutes. &lt;br&gt; &lt;strong&gt;Results&lt;/strong&gt;: optimised sites and allocated AEDs in urban areas we managed to achieve full city coverage with 17 AEDs. In every part of the city, people can have access to a nearby AED with its critical radius of less than or equal to 250m achieving defibrillation in the critical period of 5 minutes. The results are promising for the establishment and expansion of optimised AED deployment in cities. &lt;br&gt; &lt;strong&gt;Conclusions&lt;/strong&gt;: The progress of the project must be monitored and there are still unresolved problems that need to be tackled to provide a robust allocation of future defibrillators. Further research to enhance our understanding on public access defibrillation and optimize the accessibility and functionality of the medical health care services is needed. A network of engaged and informed citizens ready to act is required for a successful public access defibrillation program.&lt;/p&gt;

Abstract 286: Chance of Bystander Defibrillation According to Number of Nearby Automated External Defibrillators in Out-Of-Hospital Cardiac Arrests

Introduction: Use of automated external defibrillators (AEDs) for early defibrillation in out-of-hospital cardiac arrest (OHCA) substantially increases chance of survival. Aim: To examine the relationship between number of nearby accessible AEDs and chance of bystander defibrillation. Methods: All OHCAs (2008-2016), and all publicly available AEDs (2007-2016) in Copenhagen were identified. The route distances between OHCAs and AEDs were calculated to determine the number of accessible AEDs ≤100m of an OHCA (OHCA coverage). Multiple logistic regression was performed to identify the adjusted Odds Ratios (ORs) of OHCA characteristics, including the number of AEDs covering an OHCA, on bystander defibrillation. The regression model was evaluated using receiver operator characteristics (ROC). Multiple logistic regression was also used to determine the predicted probability (through a 2000 iteration bootstrap approach) of bystander defibrillation for public vs. residential OHCAs, according to the number of accessible AEDs covering the OHCA, defined as covered by 0, 1 or &gt;1 AED. Results: There were 1830 AEDs registered in Copenhagen. Of 2500 OHCAs, 75.2% (n=1879) occurred in residential locations of which 98.1% were not covered by an AED, 1.7% were covered by 1 AED only, and 0.2% were covered by &gt;1 AED. The corresponding figures for public OHCAs (n=621, 24.8%) were 87.5%, 9.0%, and 3.5%, respectively. Overall, the number of accessible AEDs covering the OHCA, public location, bystander witnessed arrest and bystander CPR were significantly associated with bystander defibrillation (OR (95%CI): 1.75 (1.24-2.46); 4.25 (2.75-6.57); 3.12 (1.84-5.27); 2.33 (1.44-3.75), respectively. (ROC=82%)). The predicted probability of bystander defibrillation for public OHCAs was 12.2% (95%CI: 9.5-14.9) with no AED covering the OHCA, 24.7% (95%CI: 18.2-31.3) with 1 AED, and 39.8% (95%CI: 23.4-56.7) with &gt;1 AED. The corresponding figures for residential OHCAs were 2.1% (95%CI: 1.5-2.8), 4.3% (95%CI: 2.5-6.8), and 4.0% (95%CI: 0.9-10.8), respectively. Conclusions: Rates of bystander defibrillation significantly improved with increasing number of accessible AEDs covering the OHCA, especially for public OHCAs.

Abstract 185: Optimization of Public Access Defibrillators Compared to Actual Deployment: An In Silico Trial

Introduction: Unguided placement of automated external defibrillators (AEDs) often leads to placements in low risk areas and locations with limited temporal availability. Mathematical optimization may improve AED placements and increase AED use in out-of-hospital cardiac arrests (OHCAs). Aim: To conduct the first in silico public AED location trial to determine whether optimization models (interventions) trained on historical OHCA data will recommend AED locations that significantly improve OHCA coverage on prospective OHCAs, compared to locations of actually deployed AEDs (control). Methods: We identified all public OHCAs of presumed cardiac cause (1994-2016) and already deployed AEDs (2007-2016) in Copenhagen, Denmark. We computed the number of OHCAs that occurred within 100m of a temporally available AED after it was deployed (“OHCA coverage”). We then divided 2007-2016 into 30-day intervals and determined the number of AEDs deployed in each interval. Using previously validated optimization models, we determined an equal number of optimal AED locations in each time interval, either indoor locations with actual availability (intervention #1) or outdoor locations with 24/7 availability (intervention #2). OHCA coverage was calculated for the interventions similarly to the already deployed AEDs. Finally, we repeated the analysis 25 times to evaluate sensitivity and generate confidence intervals, by randomizing the location and time of the OHCAs. Results: A total of 2,149 public OHCAs (744 between 2007-2016) and 1,573 registered AEDs were identified. OHCA coverage of actually deployed AEDs was 22.3% (166 of 744 OHCAs). For optimally located indoor AEDs, mean OHCA coverage was 32.6% (mean: 242.5 OHCAs; 95% CI: 239.7 - 245.3). For optimally located outdoor AEDs, mean OHCA coverage was 43.9% (mean: 326.6 OHCAs; 95% CI: 324.0 - 329.2). Conclusions: Optimizing AED locations in a real-time deployment approach mimicking the time horizon of actual AED deployment in Copenhagen, Denmark results in significantly higher OHCA coverage compared to the actual AEDs deployed. Between the two interventions, optimal locations that are 24/7 available significantly outperform optimal indoor locations with more limited temporal availability.

Experiences and outcome from the implementation of a national Swedish automated external defibrillator registry

BackgroundEarly cardiopulmonary resuscitation (CPR) and defibrillation with an Automated External Defibrillator (AED) increase survival from out-of-hospital cardiac arrest (OHCA). Although international guidelines recommend the use of AED registries to increase AED use, little is known about implementation. The aim of this paper is to describe the development of a national AED registry, to analyse the coverage and barriers to register AEDs. MethodsThe Swedish AED Registry (SAEDREG) was initiated in 2009 with the purpose of gathering the data of all public AEDs in Sweden. Data on all AEDs between 2013 and 2016 were included in the study. Additionally, data of non-registered AEDs was collected in one region using a survey to AED owners focusing on AED functionality. ResultsThe number of AEDs doubled between 2013–2016. A total of 6703 AEDs (30%) were removed due to unavailability of validation. At the end of 2016, AEDs were most frequently registered in offices and workplaces, 45% (n = 7241) followed by shops, 7% (n = 1200). In the Gotland region, 218 AEDs, 57% (n = 124) were registered in the SAEDREG. Of n = 94 Non-registered AED functionality was high, the main reason not to register was unawareness of the SAEDREG, 74.5%. Of those aware of the register but not having registered, 25% stated “hard to register” as cause. ConclusionsA national AED registry may gather information of AEDs on a national level. Although numbers have doubled between 2013–2016 in Sweden, a large proportion is still non-registered. More awareness of the registry and easier registration process is needed. General AED functionality seems high regardless of registered or non-registered AEDs. A key area for future research may be to use AED-registers to ascertain effectiveness of AED programs in terms of actual patient outcome.

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 Current Status of Development and Implementation of Medical Emergency Response Plan in Schools.

Automated external defibrillators (AEDs) have been widely distributed at schools in Japan. We have demonstrated that ventricular fibrillation accounted for 68% of nontraumatic sudden cardiac arrest (SCA) in schools, suggesting that a well-prepared medical emergency response plan (MERP) for schools would improve the outcomes of SCA patients. However, it is uncertain if the MERP has been well developed or implemented in Japanese schools. We conducted a cross-sectional study of schools in Osaka using a postal questionnaire. Survey items included type of school, number of students, school staff and teaching staff, number of AEDs used and the place of installation, cardiopulmonary resuscitation (CPR) training to school staff, MERP development and implementation, and the number of SCA cases they experienced. The response rate to this survey was 44% (764 of 1728 schools). Every school except for 4 have installed at least 1 AED. Thirty-six percent of schools, however, have not yet developed and implemented a MERP for SCA. Moreover, 49% of schools surveyed have not conducted a rehearsal training session for SCA in the previous 3 years, although 95% of schools provided CPR training courses to school staff. A total of 15 schools have experienced 16 presumed or actual SCA cases in the study period. Of the 15 schools, 6 schools reported that bystanders experienced psychological stress. A MERP for SCA has not yet been fully developed and implemented in the schools surveyed in our study despite widely distributed AEDs and CPR training.

Simulation of the Effects of Co-Locating Naloxone with Automated External Defibrillators

Introduction: Opioid-related overdoses have been steadily increasing over the past decade in the United States. Naloxone is used by first responders to revive overdose victims, but results may be improved by increasing access to and usage of naloxone by bystanders. Automated External Defibrillators (AEDs) are pervasive, recognizable, and publicly accessible. Co-locating naloxone kits with AEDs could increase public naloxone access and usage. However, the impact of co-locating naloxone kits with AEDs is not known. Objectives: We sought to evaluate the impact of co-locating naloxone kits with AEDs in a simulation study centered on Allegheny County, Pennsylvania. Methods: Naloxone administration frequency (N = 3,650) at the zip-code level from March 2016 to March 2017 was provided by the Allegheny County Health Department. AED point locations (N = 1,653) were obtained from the University of Pittsburgh's Resuscitation Logistics and Informatics Venture. Zip-code level geospatial analyses were conducted using QGIS and STATA to determine the correlation between AED count and naloxone administrations. AED naloxone kit (N-AED) coverage, based on a maximum “walking-distance” radius of 200 m, was estimated at a zip-code level using the QGIS buffer tool and a custom MATLAB script. Potential impact of N-AEDs was estimated assuming uniform spatial distribution of naloxone administrations. Results: The median (IQR) AED coverage based on a 200 m access radius per zip code was 4% (0–7). The median (IQR) number of naloxone administrations per zip code was 27(7-55). A total of 82 zip codes had data for both AED locations and naloxone administrations. The correlation between number of AEDs and naloxone administrations per zip code was 0.20. Overall, 16% of naloxone administrations were estimated to be covered by an N-AED. Conclusion: Using these limited methods, co-locating naloxone with AEDs is not likely to have a standalone impact on preventing overdose fatalities.

Quality of basic life support education and automated external defibrillator setting in schools in Ishikawa, Japan.

Automated external defibrillators (AED) have been installed in schools in Japan since 2004, and the government strongly recommends teaching basic life support (BLS). We therefore examined the quality of BLS education and AED installation in schools. We conducted a prefecture-wide questionnaire survey of all primary and junior high schools in 2016, to assess BLS education and AED installation against the recommendations of the Japan Circulation Society. The results were analyzed using descriptive statistics and chi-squared test. In total, 195 schools out of 315 (62%) responded, of which 38% have introduced BLS education for children. BLS training was held in a smaller proportion of primary schools (18%) than junior high schools (86%). More than 90% of primary school staff had undergone BLS training in the previous 2 years. The most common locations of AED were the gymnasium (32%) followed by entrance hall (28%), staffroom (25%), and infirmary (12%). The reasons given for location were that it was obvious (34%), convenient for staff (32%), could be used out of hours (17%), and the most likely location for a heart attack (15%). Approximately 18% of schools reported that it takes >5 min to reach the AED from the furthest point. BLS training, AED location, and understanding of both are not sufficient to save children's lives efficiently. Authorities should make recommendations about the correct number of AED, and their location, and provide more information to improve the quality of BLS training in schools.

Survival after Public Access Defibrillation in Stockholm, Sweden – A striking success

BackgroundIn Stockholm, a first responder system and a Public Access Defibrillation (PAD) program has been implemented. Additionally, the number of “unregulated” public Automated External Defibrillators (AEDs) sold “over-the-counter” has increased. The aim of this study was to evaluate the impact on survival from different defibrillation strategies in cases of out-of-hospital cardiac arrest (OHCA) available for PAD. Methods and ResultsDesign: Retrospective study of all OHCAs in Stockholm, 2006–2012. Witnessed OHCAs occurring outside home with cardiac origin and ventricular fibrillation were considered subjects for PAD. The sites within the PAD program increased from 60 to 135 while the number of unregulated AEDs outside the PAD program increased from 178 to 5016.Of 6532 OHCAs, 7% (n=474) were defined as subjects for PAD. Of these, 69% (n=326) were defibrillated by the EMS, 11% (n=53) by first responders and 16% (n=74) by public AEDs. Survival to one month was 31% (n=101) for cases defibrillated by the EMS, 42% (n=22) when defibrillated by first responders and 70% (n=52) when defibrillated by a public AED. The AEDs within the PAD program constituted 2.6% of all public AEDs and were used in 28% (n=21) of cases when a public AED was used. ConclusionsIn OHCAs available for PAD, 70% of patients survived if a public AED was used. Both the structured AED program as well as the spread of unregulated AEDs was associated with very high survival rates, but the structured approach was more efficient in relation to the number of AEDs used.

Temporal trends in coverage of historical cardiac arrests using a volunteer-based network of automated external defibrillators accessible to laypersons and emergency dispatch centers.

Although increased dissemination of automated external defibrillators (AEDs) has been associated with more frequent AED use, the trade-off between the number of deployed AEDs and coverage of cardiac arrests remains unclear. We investigated how volunteer-based AED dissemination affected public cardiac arrest coverage in high- and low-risk areas. All public cardiac arrests (1994-2011) and all registered AEDs (2007-2011) in Copenhagen, Denmark, were identified and geocoded. AED coverage of cardiac arrests was defined as historical arrests ≤100 m from an AED. High-risk areas were defined as those with ≥1 arrest every 2 years and accounted for 1.0% of the total city area. Of 1864 cardiac arrests, 18.0% (n=335) occurred in high-risk areas throughout the study period. From 2007 to 2011, the number of AEDs and the corresponding coverage of cardiac arrests increased from 36 to 552 and from 2.7% to 32.6%, respectively. The corresponding increase for high-risk areas was from 1 to 30 AEDs and coverage from 5.7% to 51.3%, respectively. Since the establishment of the AED network (2007-2011), few arrests (n=55) have occurred ≤100 m from an AED with only 14.5% (n=8) being defibrillated before the arrival of emergency medical services. Despite the lack of a coordinated public access defibrillation program, the number of AEDs increased 15-fold with a corresponding increase in cardiac arrest coverage from 2.7% to 32.6% over a 5-year period. The highest increase in coverage was observed in high-risk areas (from 5.7% to 51.3%). AED networks can be used as useful tools to optimize AED placement in community settings.

Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?

Out-of-hospital sudden cardiac arrest (OHCA) is a leading cause of death all over the world. Although the outcome of OHCA resulting from 'nonshockable' rhythms (asystole and pulseless electrical activity) is poor regardless of resuscitation efforts, 'shockable' rhythms such as ventricular tachycardia or fibrillation may carry a good prognosis if early defibrillation is performed. At present, simplified cardiopulmonary resuscitation techniques (hands-only cardiopulmonary resuscitation) and automated external defibrillators (AEDs) offer lay people the possibility to provide lifesaving treatment to OHCA victims in the critical minutes before the arrival of the emergency medical system. Programs aimed at increasing provision of cardiopulmonary resuscitation and use of AEDs by lay people have been set up in different countries, including Italy, and have contributed to improve survival rates. However, success of these programs critically depends on appropriate planning and design, and on cultural predisposition of witnesses to undertake immediate measures of resuscitation in the case of OHCA. Placement of a large number of AEDs may carry high costs and little benefits if it is uncoordinated and not preceded by educational campaigns to spread widely the 'culture of resuscitation' in the population.

Abstract 19536: Primary and Secondary Prevention of Athletic Sudden Cardiac Death in Suffolk County Public High Schools, New York

Optimal strategies to prevent and treat SCD (Sudden Cardiac Death) in student athletes remain debatable. To identify students at risk of SCD, American Heart Association (AHA) has recommended a 12-point pre-participation evaluation (PPE) tool. NY State laws require the presence of Automated External Defibrillators (AEDs) during high school sports activities. Aim: To examine (1) adherence to AHA’s 12 element PPE (2) presence, training and implementation of AEDs in Suffolk County public schools. Methods: In 2010, voluntary surveys were sent out to 53 public school districts in Suffolk County. Each district’s PPE forms were requested to evaluate adherence to AHA recommendations. AED survey included its presence, training and use. Results: A total of 52 districts responded to PPE request (response rate 98.1%). No districts used all 12 elements in their forms; 11 districts (21.5%) used no elements; majority (35 districts, 67.31%) used ≤ 4 elements. Maximum number of elements used was 8 in 19 districts (15.38%). Most frequently used element was syncope (57.9%). Each elements frequency is tabulated. 27 districts completed AED survey (response rate 50.9%). Each school had at least 2 AEDs (range 2-34, mean 19.2); students per AED was 70.9. Coaches (92.6%) were mostly to be trained in AED formally followed by 85.2% of school nurses, 51.9% of security staff, 32.14% of teachers, and 17.85% of students. A total 25 districts (89.29%) had emergency response plan, 26 (92.85%) had access to early defibrillation, 21 (75%) had practiced emergency response plan. There was no significant correlation between number of AEDs in a school and number of AHA elements used in PPE forms (ρ = -0.3251, P &lt; 0.2567). CONCLUSION: In the absence of legislation mandating implementation of the AHA PPE tool, suboptimal adherence persists. In contrast, implementation of AEDs appears more promising. Future management guidelines should focus on broader AED training of students and teachers.

Where are Automated External Defibrillators located in the community areas in Bahrain? And are there any barriers to purchasing AEDs?

Introduction Currently to date no study has explored whether Automated External Defibrillators (AED) are readily available in the community setting in Bahrain. Deaths in the pre-hospital setting are high in Bahrain, due to an increase in Heart disease & diabetes in the Gulf. Objectives The aim of the study was to find out where are AEDs located in the community areas of Bahrain & to assess the knowledge in these community areas on AEDs. Methods A phone survey was conducted of 84 locations in Bahrain. The questionnaire assessed primarily if the community location had an AED and secondly assessed knowledge and awareness of AED. Results Indicated that only 22% (n = 19) of areas surveyed currently had an AED. Also 68% of locations reported that people had collapsed at these locations & 32% (n = 27) of the areas reported deaths at these locations. Of the 22% (n = 19) locations with an AED in place, four of these locations have used the AED in an emergency. Conclusion In conclusion the study indicated that there is an inadequate number of AEDs available in the community in Bahrain. No barriers to purchase AEDs were indicated. Public education and awareness of AEDs is fundamental to increase the number of AEDs in the community in Bahrain.

Public Access Defibrillation

Sudden cardiac arrest (SCA) is recognized as a serious public health problem, accounting for 250 000 to 300 000 deaths per year; it is now the third-leading cause of death behind cancer and nonsudden cardiovascular deaths.1,2 Immediate, well-performed cardiopulmonary resuscitation (CPR) and early defibrillation are the only out-of-hospital interventions that improve outcomes.3 The chain of survival relies on lay responders and emergency medical services (EMS) to initiate the potentially life-saving procedures of CPR and defibrillation. Articles see pp 510 and 518 In 1994, the American Heart Association (AHA) convened the first conference on public access defibrillation (PAD) to introduce the strategy of placing easy-to-use defibrillators in public places to decrease the death rate from SCA.4 Specific recommendations encouraged the stakeholders (the AHA, the US Food and Drug Administration, the National Institutes of Health, industry, and communities) to facilitate PAD by developing user-friendly, less-expensive automated external defibrillators (AEDs); testing the concept within large clinical trials; and organizing communities to promote and support effective PAD programs. Widespread CPR and AED training of the public was emphasized. In the ensuing 15 years, many of these recommendations have been heeded, and PAD programs are now commonplace. The National Institutes of Health–sponsored PAD trial demonstrated that survival doubled when events occurred in communities equipped and trained with CPR and AEDs compared with CPR alone.5 Within the Resuscitations Outcomes Consortium (ROC), out-of-hospital cardiac arrest victims had a markedly increased chance of survival if the first shock was delivered by a bystander using an AED rather than by EMS.6 PAD programs in airports, airlines, and casinos have also validated the effectiveness of the concept. Out-of hospital cardiac arrest is treatable, and outcomes can be improved with currently available approaches. Multiple locations have been recognized as having a higher incidence of cardiac arrest …

Recalls and Safety Alerts Affecting Automated External Defibrillators

Automated external defibrillators (AEDs) play a key role in the community resuscitation of persons with cardiac arrest and are of proven clinical benefit. Although AEDs are complex medical devices designed to function during life-threatening emergencies, little is known about their reliability. To determine the number and rate of AED recalls and safety alerts, to identify trends in these rates, and to identify the types of malfunctions prompting AED and AED accessory advisories. Analysis of weekly US Food and Drug Administration (FDA) Enforcement Reports between January 1996 and December 2005 was performed to identify all recalls and safety alerts (collectively referred to as "advisories") involving AEDs and AED accessories. Confirmed AED device malfunctions were identified by reviewing AED-related adverse events reported to the FDA. Number of AEDs and AED accessories subject to FDA recall or safety alert between January 1996 and December 2005; annual AED advisory rates; and number of confirmed fatal AED-related device malfunctions reported to the FDA. During 2.78 million AED device-years of observation, 52 advisories (median [25th and 75th percentiles], 4.5 [3.0 and 5.0] per year) affecting 385,922 AEDs and AED accessories were issued. The mean (SE) annual number of AEDs affected by advisories was 5.1 (1.5) devices per 100 AED device-years. Overall, 21.2% of AEDs distributed during the study period were recalled, most often because of electrical or software problems. The AED advisory rate did not significantly increase during the study period, although the annual number of AED advisories (P for trend =.02) and AED advisory devices (P for trend = .01) did increase. Confirmed fatal AED-related device malfunctions occurred in 370 patients. Automated external defibrillators and AED accessory advisories occur frequently and affect many devices. Actual AED malfunctions do occur occasionally, although the number of observed malfunctions is small compared with the number of lives saved by these important devices. As the prevalence of AEDs continues to increase, the number of devices affected by advisories can also be expected to increase. Efforts should be directed at developing a reliable system to locate and repair potentially defective devices in a timely fashion.