Automated External Defibrillators Placement Research Articles

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

Bystander-applied Automated External Defibrillators (AED) improve outcomes for out-of-hospital cardiac arrest. AED placement is often driven by private enterprise or non-for-profit agencies, which may result in inequitable access. We sought to compare AED availability between four regions in British Columbia (BC). We identified AEDs (confirmed to be operational) and emergency medical system (EMS)-treated out-of-hospital cardiac arrests (OHCA) from provincial registries. We compared AED availability between BC's four most populous regions. The primary outcome was the total regional weekly accessible AED-hours per 100,000 population. We also examined: AEDs per 100,000 population and per km2, the ratio of AEDs to OHCA, and the distance from each OHCA to the closest AED. From provincial registries, we included 879 AEDs from BC's four most populous regions, where 9333 EMS-treated OHCA occurred over a 5-year period. The most common AED location types were stores, public community centres, and office buildings. Ten percent of AEDs were accessible for all hours. Weekly accessible AED-hours/100,000 population in the four regions were: 3845, 1734, 1594, and 1299. AEDs/100,000 population ranged from 22 to 48, and AEDs/km2 ranged from 0.0048 to 0.20. The number of OHCAs per AED per year ranged from 1.1 to 2.8. The median OHCA-to-closest AED distance ranged from 503 (IQR 244, 947) to 925 (IQR 455, 1501) metres. The regional mean accessibility of individual AEDs ranged between 59 and 79h per week. BC's four most populous regions demonstrate substantial variability in AED accessibility. Further benefit could be derived from AEDs if placed in locations accessible all hours. Our data may encourage community planning efforts to use data-based strategies to systematically place AEDs in optimal locations with strategies to maximize accessibility.

Abstract 421: Automated External Defibrillator Implementation Gaps in Three Non-Urban U.S. Communities

Introduction: Automated external defibrillators (AEDs) represent a crucial component of bystander response to out-of-hospital cardiac arrest (OHCA), yet epidemiologic evidence suggests that AEDs are deployed by laypersons in less than 5% of OHCA events in the US. The reasons for low utilization remain poorly characterized, especially in rural/suburban environments. We hypothesized that in these non-urban environments, layperson AED use is mostly in commercial or public locations despite most arrests occuring in private residences. Methods: We conducted an analysis of EMS-treated atraumatic OHCA events from 3 non-urban US regions (Cumberland County, PA; Jackson, TN; Forsyth County, GA), abstracted from EMS patient care reports. Data included Utstein reporting elements, arrest location type, and response intervals as calculated by dispatch and EMS arrival times. We excluded events in skilled nursing facilities and prisons. CPR and AED delivery by laypersons was measured. Results: Between 12/8/17-12/31/21, we identified 1542 adult OHCA patients with median age 66.5 y (IQR 22.5), 37% female, 18% had initial shockable rhythms, and 75% occurred in private residences. Return of spontaneous circulation was obtained in 19% of cases. Bystander CPR was performed in 23% and AEDs were deployed by laypersons in 3%. Laypersons applied AEDs in 12% of OHCA in commercial locations, 6% of OHCA in public, and 3% of OHCA in private residences. EMS response times were 4% less than 4 min, 48% 4-9 min, and 48% >9 min; prevalence of AED use was indistinguishable between time intervals of EMS response. 16% OHCA victims still had initial shockable rhythms even among the >9 min EMS response cases; of these, 1% received AED use from laypersons. Conclusion: In three non-urban US regions, most arrests occurred in private residences while AED use was much more likely in public or commercial locales, suggesting an important gap in AED deployment. Even in cases with prolonged response times, many patients had shockable rhythms, suggesting an important opportunity for earlier AED deployment. Future work will test whether placement of AEDs in residential areas using trained volunteer responders in these same communities will improve OHCA response and survival outcomes.

Abstract 311: Accuracy of Automated External Defibrillator Pad Placement During Out-of-Hospital Cardiac Arrest Resuscitation Simulations

Introduction: Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. Aim: We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR). Methods: We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LR and FR. LR received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer’s recommendations and distance to anatomical landmarks (mid, nipple, and naval lines). Incorrect AP placement was defined as more than 6 cm medial or 10 cm inferior. Incorrect LP placement was defined as more than 6 cm superior, 9 cm inferior, or 10 cm medial. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (< 1 year) with AED application for FR using Chi-square tests. Results: LR correctly placed the AP in 30/38 (79%) and the LP 30/38 (79%) simulations. Application did not differ significantly based on previous CPR training (AP p= .187, LP p=.578). The most common incorrect placement was too low for both AP (5/8, 63%) and LP (4/8, 50%). FRs applied the AP correctly in 31/36 (86%) and the LP in 22/36 (61%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP p=.29, LP p=.563). The most common incorrect placement was too low for both AP (5/5, 100%) and LP (12/14, 86%). Conclusion: Both LRs and FRs may not apply AEDs per manufacturer’s recommendations. Further research is needed to improve instructions and follow-up training to ensure appropriate placement of AEDs, and to understand how improper AED placement impacts the accuracy of rhythm analysis and defibrillation success.

A roadmap to building first responder networks: Lessons learned and best practices from Belgium and Switzerland

Background/AimsLimited bystander assistance and delayed emergency medical service arrival reduce the chances of survival in cardiac arrest victims. Early basic life support through trained first responders (FR) and automatic external defibrillation both improve the outcome. Well-organized FR networks have shown promise, but guidance on effective implementation is lacking. This study evaluates two FR networks, in Belgium and in Switzerland, to identify main advancements in the development of such systems. MethodDirect comparison is made of the barriers and facilitators in the development of both FR systems from 2006 up until December 2022, and summarized within a roadmap. ResultsThe Roadmap comprises four integral steps: exploration, installation, initiation, and implementation. Exploration involves understanding the national legislation, engaging with advisory bodies, and establishing local steering committees. The installation phase focuses on FR recruitment, engaging specific professional groups such as firemen, registering public Automated External Defibrillators (AEDs), and requesting feedback. The initiation step includes implementing improvement cycles and fidelity measures. Finally, implementation expands the network, leading to increased survival rates and the integration of these practices into legislation. A significant focus is placed on FR's psychological wellbeing. Moreover, the roadmap highlights the use of efficient geo-mapping to simplify optimal AED placement and automatically assign FRs to tasks. ConclusionThe importance of FR networks for early resuscitation is increasingly recognized and various systems are being developed. Key developmental strategies of the EVapp and Ticino Cuore app system may serve as a roadmap for other systems and implementations within Europe and beyond.

Racial and ethnic disparities in the treatment and outcomes for witnessed out-of-hospital cardiac arrest in Connecticut

BackgroundRacial and ethnic disparities in the treatment and outcomes for witnessed out-of-hospital cardiac arrest (OHCA) in the United States have been previously described. We sought to characterize disparities in pre-hospital care, overall survival, and survival with favorable neurological outcomes following witnessed OHCA in the state of Connecticut. MethodsWe performed a cross-sectional study to compare pre-hospital treatment and outcomes for White versus Black and Hispanic (Minority) OHCA patients submitted from Connecticut to the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2021. Primary outcomes included bystander CPR use, bystander automated external defibrillator (AED) use with attempted defibrillation, overall survival, and survival with favorable cerebral function. Results2,809 patients with witnessed OHCA were analyzed (924 Black or Hispanic; 1885 White). Minorities had lower rates of bystander CPR (31.4% vs 39.1%, P = 0.002) and bystander AED placement with attempted defibrillation (10.5% vs 14.4%, P = 0.004), with lower rates of survival to hospital discharge (10.3% vs 14.8%, P = 0.001) and survival with favorable cerebral function (65.3% vs 80.2%, P = 0.003). Minorities were less likely to receive bystander CPR in communities with median annual household income >$80, 000 (OR, 0.56; 95% CI, 0.33–0.95; P = 0.030) and in integrated neighborhoods (OR, 0.70; 95% CI, 0.52–0.95; P = 0.020). ConclusionsBlack and Hispanic Connecticut patients with witnessed OHCA have lower rates of bystander CPR, attempted AED defibrillation, overall survival, and survival with favorable neurological outcomes compared to White patients. Minorities were less likely to receive bystander CPR in affluent and integrated communities.

Identification of priority areas for public-access automated external defibrillators (AEDs) in metropolitan areas: A case study in Hangzhou, China

Out-of-hospital cardiac arrest (OHCA) is a major health concern in China. The use of automated external defibrillators (AEDs) has received great attention from Chinese public healthcare departments as a useful intervention to address OHCA, and there is a growing need to place AEDs throughout the urban built environment. However, due to the lack of a publicly available, geocoded dataset of historical OHCA cases, there is not a coherent approach for identifying priority areas for AEDs placement in this country. This study attempts to fill this gap by examining the spatial disparity of OHCA risk in Hangzhou, China, and then proposing a Geographic Information Systems(GIS) based model that incorporates the urban land cover, vulnerable groups, and transportation accessibility to identify priority areas at the hexagon level for future AEDs placement. Results show that: (1) the hexagons with the highest level of OHCA risk (ranked Group 1) are accounting for 9.87%–16.71% and are spatially dispersed. (2) A large high-risk cluster was identified in the western region of the Qiantang district. (3) Nearly one-fifth of the new AEDs are recommended to install in Phase I, more than 60% in Phase II, and the remainder in Phase III. (4) Xiaoshan district requires the most AEDs, while Linping district requires the fewest. Ultimately, these results guide future placement of the AED facilities in the cities, particularly those with no geocoded OHCA historical data.

AED applied, not recommending defibrillation – A validation study of the new variable AED in the Danish Cardiac Arrest Registry

AimThis study aimed to design and implement a new variable, the automated external defibrillator (AED) variable, within the Danish Cardiac Arrest Registry. The introduction of the new variable aims to investigate and solve the challenges of reporting out-of-hospital cardiac arrests. MethodsThis validation study examined all patients with out-of-hospital cardiac arrest from 2016 to 2019. Their medical records were reviewed to establish a variable for AED. All patients with an AED applied were included, and comparative analyses were carried out. The primary outcome was 30-day survival, and the secondary outcome was the return of spontaneous circulation (ROSC) at any time. ResultsA total of 1576 cases were included; of those, 747 cases had an AED applied and received a shock, and in 829 cases, an AED was applied without delivering a shock. Most defibrillated patients were witnessed by bystanders n = 541, (72%). They presented a higher number of ROSC (57%) and higher 30-day survival, (35,2%) compared to patients who were not defibrillated. Of this group, only 47% patients were witnessed; 18% survived more than 30 days, p < 0.001. When comparing AED present with no AED present, the AED group were significantly more likely to be witnessed by bystanders and to have cardiopulmonary resuscitation by bystanders. No significant differences were found regarding the initial rhythm between the two groups. 30-day survival rate was 20% in the AED group compared to 14% in the non-AED group, yielding an OR of 1.14 (95% CI 1.20–1.66). ConclusionThis study highlights the differences between OHCA patients receiving defibrillation and those not receiving defibrillation after AED placement. These differences emphasise the need for uniform reporting of out-of-hospital cardiac arrest. This study showed improvement in the completeness of the registration of OHCA by implementing the AED variable. However, a future effort to improve registration completeness is needed.

Maximum expected survival rate model for public access defibrillator placement

AimMathematical optimization of automated external defibrillator (AED) placement has demonstrated potential to improve survival of out-of-hospital cardiac arrest (OHCA). Existing models mostly aim to improve accessibility based on coverage radius and do not account for detailed impact of delayed defibrillation on survival. We aimed to predict OHCA survival based on time to defibrillation and developed an AED placement model to directly maximize the expected survival rate. MethodsWe stratified OHCAs occurring in Singapore (2010–2017) based on time to defibrillation and developed a regression model to predict the Utstein survival rate. We then developed a novel AED placement model, the maximum expected survival rate (MESR) model. We compared the performance of MESR with a maximum coverage model developed for Canada that was shown to be generalizable to other settings (Denmark). The survival gain of MESR was assessed through 10-fold cross-validation for placement of 20 to 1000 new AEDs in Singapore. Statistical analysis was performed using χ2 and McNemar’s tests. ResultsDuring the study period, 15,345 OHCAs occurred. The power-law approximation with R2 of 91.33% performed best among investigated models. It predicted a survival of 54.9% with defibrillation within the first two minutes after collapse that was reduced by more than 60% without defibrillation within the first 4 minutes. MESR outperformed the maximum coverage model with P-value < 0.05 (<0.0001 in 22 of 30 experiments). ConclusionWe developed a novel AED placement model based on the impact of time to defibrillation on OHCA outcomes. Mathematical optimization can improve OHCA survival.

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

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

Socioeconomically equitable public defibrillator placement using mathematical optimization

BackgroundMathematical optimization can be used to place automated external defibrillators (AEDs) in locations that maximize coverage of out-of-hospital cardiac arrests (OHCAs). We sought to determine whether optimization can improve alignment between AED locations and OHCA counts across levels of socioeconomic deprivation. MethodsAll suspected OHCAs and registered AEDs in Scotland between Jan. 2011 and Sept. 2017 were included and mapped to a corresponding socioeconomic deprivation level using the Scottish Index of Multiple Deprivation (SIMD). We used mathematical optimization to determine optimal locations for placing 10%, 25%, 50%, and 100% additional AEDs, as well as locations for relocating existing AEDs. For each AED placement policy, we examined the impact on AED distribution and OHCA “coverage” (suspected OHCA occurring within 100 m of AED) with respect to SIMD quintiles. ResultsWe identified 49,432 suspected OHCAs and 1532 AEDs. The distribution of existing AED locations across SIMD quintiles significantly differed from the distribution of suspected OHCAs (P < 0.001). Optimization-guided AED placement increased coverage of suspected OHCAs compared to existing AED locations (all P < 0.001). Optimization resulted in more AED placements and increased OHCA coverage in areas of greater socioeconomic deprivation, such that resulting distributions across SIMD quintiles matched the shape of the OHCA count distribution. Optimally relocating existing AEDs achieved similar OHCA coverage levels to that of doubling the number of total AEDs. ConclusionsMathematical optimization results in AED locations and suspected OHCA coverage that more closely resembles the suspected OHCA distribution and results in more equitable coverage across levels of socioeconomic deprivation.

Design and analysis of automated external defibrillator (AED) using new service development

Coronary heart disease has become the major health issue that causes sudden heart attacks. In Indonesia, the number of death due to heart attack has been increased significantly. The purpose of this study is to design a new service development for Automated External Defibrillator Services in the public. The method used is conjoint analysis, cluster analysis, quality function deployment, process flow diagram and quality control plan. The results provided include user preferences regarding AED services, AED user segmentation, designing technical responses, designing operational procedures and designing quality control plans. In aggregate, users choose the website as a platform to guide the direction to the AED location and AED socialization, AED placement in or near the medical room and emergency telephone is equipment that must be placed with AED.

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

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

Use and coverage of automated external defibrillators according to location in out-of-hospital cardiac arrest

AimsTo evaluate 1) the relative use of automated external defibrillators (AEDs) at different types of AED locations 2) the percentage of AEDs crossing location types during OHCA before use 3) the AED coverage distance at different types of AED locations, and 4) the 30-day-survival in different subgroups. MethodsFrom 2014–2018, AEDs used by bystanders during out-of-hospital cardiac arrest (OHCA) in the Region of Southern Denmark were collected. Data regarding registered AEDs was retrieved from the national AED-network. The OHCA site and AED placement was categorized into; 1) Residential; 2) Public; 3) Nursing home, 4) Company/workplace; 5) Institution; 6) Health clinic and 7) Sports facility/recreational. To evaluate 30-day-survival, groups 4–7 were pooled into one Mixed group. ResultsIn total 509 OHCAs were included. There was high relative usage of AEDs from public places, nursing homes, health clinics and sports facilities, and low relative usage from companies/workplaces, residential areas and institutions. Of AEDs used during residential OHCAs 39% were collected from public places. AEDs placed in residential areas and public places had a coverage of 575 m (IQR 130–1300) and 270 m (IQR5-550), respectively. Thirty-day- survival in public, residential and mixed groups were 49%, 14% and 67%, respectively. ConclusionThe relative use of AEDs from public places, nursing homes, sports facilities and health clinics was high, and AEDs used during OHCA in residential areas were most frequently collected from public places. AEDs placed in both residential areas and public places may have a wider coverage area than proposed in current literature.

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.

Use, Outcomes and Policy on the Placement of Automated External Defibrillators on Commercial Aircraft for the Management of In-flight Cardiac Arrest; A Scoping Review

&lt;p&gt;&lt;strong&gt;ABSTRACT&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Some commercial aircraft carry an AED, but little is known about international policies and requirements. The aim is to review policy regarding AED placement on commercial aircraft, summarising reported incidence and outcomes of AED utilisation for individuals experiencing an in-flight cardiac arrest (IFCA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;A scoping review was undertaken. Online databases (Medline and CINAHL) were searched using prespecified terms to identify reports evidencing use, outcome and policy of AEDS for IFCA on commercial aircraft. Reports were screened and data extracted following scoping review extraction methods. Data were analysed to describe incidence of AED use and outcomes following IFCA, and policies regarding AED placement on commercial aircraft.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt; &lt;/p&gt;&lt;p&gt;9 observational studies were identified. 8 reported instances of successful shock delivery using AED. No published reports of safety incidents involving in-flight AED use were found. 7 studies reported survival following AED use: of these, 6 reported administration of a shock for IFCA survivors, whilst 1 study reported deployment of an AED without shock delivery. Overall, survival following in-flight AED use was 9%, with 37% survival reported where patients presented with shockable rhythm. Only one policy mandating AED placement on commercial aircraft was identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Despite the small, retrospective and observational nature of the reports identified, findings suggest in-flight AED use is feasible and associated with improved outcomes from IFCA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords:&lt;/strong&gt; cardiac arrest; defibrillators; AED; aircraft; flight &lt;/p&gt;

Abstract 138: Socioeconomically Equitable Public Defibrillator Placement Using Mathematical Optimization

Introduction: Mathematical optimization can be used to place automated external defibrillators (AEDs) in locations that maximize coverage of out-of-hospital cardiac arrests (OHCAs). However, the extent to which optimization strategies affect socioeconomically equitable distribution of AEDs is unknown. Methods: All suspected OHCAs and registered AEDs in Scotland between Jan. 2011 - Sept. 2017 with a recorded location were included and mapped across the quintiles of the Scottish Index of Multiple Deprivation (SIMD), a national measure of socioeconomic status. First, we maintained AEDs at current locations and modeled placing an equal number of additional AEDs to maximize “coverage” (i.e., AED located within 100 m) of suspected OHCAs. A second analysis determined optimal sites for relocating all existing AEDs to optimize coverage without additional AEDs. We computed the proportion of OHCAs covered in each SIMD quintile under each AED placement strategy. A Wilcoxon signed-rank test was used to test difference in coverage levels across all regions of Scotland. Results: We identified 49,692 suspected OHCAs and 1,532 AEDs. Existing AEDs covered 1,384 OHCAs (2.8%), with OHCA coverage peaking in quintile 3 (moderate deprivation), indicating a mismatch with the distribution of suspected OHCA. Adding an equal number of new AEDs in optimal locations covered 10,465 OHCAs (21.1%; P&lt;0.001). Optimal relocation of existing AEDs with no additional units covered 9,464 OHCAs (19.0%; P&lt;0.001). OHCA coverage under either optimization strategy peaked in quintile 1 (highest deprivation), aligning to the OHCA incidence distribution. Conclusion: Optimizing AED placement significantly increases OHCA coverage and better aligns coverage with OHCA incidence across SIMD quintiles, improving socioeconomic equity of OHCA coverage. Relocating existing AEDs could achieve similar coverage to doubling the number of devices.

Abstract 233: Characterizing Impact of State Legislation on Cardiac Arrest Outcomes at K-12 Schools

Background: Cardiac arrests that occur in schools are infrequent, but high-profile events. Many states have enacted school specific legislation regarding automated external defibrillators (AEDs) placement, CPR training and emergency response plans (EAP). Objective/Aim: To characterize out-of-hospital cardiac arrests (OHCA) that occur in K-12 schools; and, assess the relationship of U.S. state AED and CPR laws to outcomes of in school cardiac arrests. Methods: A retrospective review of in school OHCA was completed with data from the National EMS Information System (NEMSIS) 3.4 database, calendar years 2017-2018. Study subjects were non-traumatic OHCA occurring prior to EMS arrival on K-12 school grounds. Additionally, we conducted a search of Westlaw (Thomson Reuters) to identify current school specific AED, CPR and EAP laws for all 50 states, and created a structured taxonomy for these laws. Datasets were linked by an honest broker and the K-12 school CPR and AED provisions were compared to state legislation. Results: During the study period, there were 454 cases of in school cardiac arrest out of the 25.3 million incidents submitted to NEMSIS. We excluded 140, thus leaving 314 arrests for analysis. The average age was 46.7 (SD=24.1), most were over 18 years old (79.4%), and male 221 (70.4%). Bystander CPR (BCPR) was performed in 240 (76.4%) of cases, bystander AEDs were used in 160 (51.0%) cases, and 107 (34.1%) patients received an AED shock. State AED and CPR laws required student CPR training in 78%, school AED placement in 46%, teacher CPR certification in 14%, and school specific cardiac emergency response plans in 32%. We found no increase in BCPR or AED placement in states with school CPR, AED or EAP legislation. These findings persisted regardless of patient age, school type, or legislative mandate (all P &gt; 0.05). Conclusion: Despite the perceived benefit of legislation supporting CPR and AED use in schools, we identified no improved provision of BCPR or AED use in schools in states with such legislation. Given the high proportions of BCPR and AED in states with and without statutes, we believe this data suggests that non-legislative initiatives, which exist in many states, may be an important driver of emergency cardiac care in K-12 schools.

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;

An accessibility spatial search algorithm to optimize defibrillator deployment in indoor space

ABSTRACT Indoor space, where humans spend 80% of their lives, is subject to frequent out-of-hospital cardiac arrest (OHCA). Optimizing the spatial deployment of automated external defibrillators (AEDs) has the potential to improve OHCA survival rate. Complex indoor space is typically divided by hard barriers into multiple discrete subspaces across floors. Commonly used distance measurements, such as Euclidean distance and network distance, are unsuitable for indoor AED deployment. Instead, we propose an accessibility spatial search algorithm (ASSA) to generate accessible areas of candidate facilities, i.e. AEDs, based on an indoor space model, and optimizes the facility deployment subject to three objectives: maximizing the survival rate, maximizing total spatial coverage and maximizing backup coverage. Additionally, improved artificial bee colony (ABC) algorithm is used to solve the optimization problem. We design experiments with simulated and real-world scenarios for AED placements and evaluate the ASSA results. The experiments show that the ASSA can provide helpful guidance in optimizing AED placement in indoor space.

Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study

IntroductionA voluntary State Government-led programme in Victoria, Australia ‘Defibrillators for Sporting Clubs and Facilities Program’ ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs),...