Mobile Versus Fixed Deployment of Automated External Defibrillators in Rural EMS

2015 ◽  
Vol 30 (2) ◽  
pp. 152-154 ◽  
Author(s):  
R. Darrell Nelson ◽  
William Bozeman ◽  
Greg Collins ◽  
Brian Booe ◽  
Todd Baker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Public Schools ◽  
Rural Communities ◽  
Rural Community ◽  
Heart Rhythm ◽  
Public Access ◽  
Publication Type ◽  
Automated External Defibrillators ◽  
Institutional Review ◽  
Impact On Survival

AbstractIntroductionThere is no consensus on where automated external defibrillators (AEDs) should be placed in rural communities to maximize impact on survival from cardiac arrest. In the community of Stokes County, North Carolina (USA) the Emergency Medical Services (EMS) system promotes cardiopulmonary resuscitation (CPR) public education and AED use with public access defibrillators (PADs) placed mainly in public schools, churches, and government buildings.Hypothesis/ProblemThis study tested the utilization of AEDs assigned to first responders (FRs) in their private-owned-vehicle (POV) compared to AEDs in fixed locations.MethodsThe authors performed a prospective, observational study measuring utilization of AEDs carried by FRs in their POV compared to utilization of AEDs in fixed locations. Automated external defibrillator utilization is activation with pads placed on the patient and analysis of heart rhythm to determine if shock/no-shock is indicated. The Institutional Review Board of Wake Forest University Baptist Health System approved the study and written informed consent was waived. The study began on December 01, 2012 at midnight and ended on December 01, 2013 at midnight.ResultsDuring the 12-month study period, 81 community AEDs were in place, 66 in fixed locations and 15 assigned to FRs in their POVs. No utilizations of the 66 fixed location AEDs were reported (0.0 utilizations/AED/year) while 19 utilizations occurred in the FR POV AED study group (1.27 utilizations/AED/year; P<.0001). Odds ratio of using a FR POV located AED was 172 times more likely than using a community fixed-location AED in this rural community.DiscussionPlacing AEDs in a rural community poses many challenges for optimal utilization in terms of cardiac arrest occurrences. Few studies exist to direct rural community efforts in placing AEDs where they can be most effective, and it has been postulated that placing them directly with FRs may be advantageous.ConclusionsIn this rural community, the authors found that placing AED devices with FRs in their POVs resulted in a statistically significant increase in utilizations over AED fixed locations.NelsonRD, BozemanW, CollinsG, BooeB, BakerT, AlsonR. Mobile versus fixed deployment of automated external defibrillators in rural EMS. Prehosp Disaster Med. 2015;30(2):1-3.

Abstract 18: Analyzing Heart Rhythm During Chest Compressions in Out-of-Hospital Cardiac Arrest Patients Using New Algorithm for Automated External Defibrillators

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Corina de Graaf ◽  
Stefanie G Beesems ◽  
Ronald E Stickney ◽  
Paula Lank ◽  
Fred W Chapman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Negative Impact ◽  
Pulseless Electrical Activity ◽  
Heart Rhythm ◽  
Chest Compressions ◽  
Study Region ◽  
Automated External Defibrillators ◽  
Conventional Analysis ◽  
Hospital Cardiac Arrest ◽  
Conventional Algorithm

Purpose: Automated external defibrillators (AED) prompt the rescuer to stop cardiopulmonary resuscitation (CPR) for ECG analysis. Any interruption of CPR has a negative impact on outcome. We prospectively evaluated a new algorithm (cprINSIGHT) which can analyse the ECG while rescuers continue CPR. Methods: We analysed data from patients with attempted resuscitation from OHCA who were connected to an AED with cprINSIGHT (Stryker Physio-Control LIFEPAK CR2) between June 2017 and June 2018 in the Amsterdam Resuscitation Study region. The first analysis in the CR2 is a conventional analysis; subsequent analyses use the cprINSIGHT algorithm. This algorithm classifies the rhythm as shockable (S), non-shockable (NS), or no decision. If no decision, the AED prompts for a pause in CPR and uses its conventional algorithm. The characteristics of the first 3 cprINSIGHT analyses (analyses 2-4) were analysed. Ventricular fibrillation (VF) cases were both coarse and fine VF with a lower threshold of 0.08 mV. Results: Data from 132 consecutive OHCA cases were analysed. The initial recorded rhythm was VF or pulseless ventricular tachycardia (VT) in 35 cases (27%), pulseless electrical activity in 34 cases (25%) and asystole in 63 cases (48%). In 114 cases (86%), 1 or more cprINSIGHT analyses were done. Analyses 2-4 covered 90% of all cprINSIGHT analyses. The analyzed rhythm was VF/VT in 12-17%, organised QRS rhythm in 29-35% and asystole in 51-56% (see table). cprINSIGHT reached a S or NS decision in 65-74% of cases, with a sensitivity of 90-100% and a specificity of 100%. When it reached no decision, the rhythm was asystole in 65-79% of analyses, VF/VT in 0-9% and QRS rhythm in 18-27%; conventional analysis followed. Chest compression fraction was 85-88%, CPR fraction was 99%. Conclusion: This new algorithm analysed the ECG without need for a pause in chest compressions 65-74% of the time and had 90-100% sensitivity and 100% specificity when it made a shock or a no shock decision.

scholarly journals The Role of Automated External Defibrillators in Athletics

2009 ◽  
Vol 1 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Justin D. Rothmier ◽  
Jonathan A. Drezner
Keyword(s):  
Cardiac Arrest ◽  
Action Plan ◽  
Sudden Cardiac Arrest ◽  
Public Access ◽  
Time Interval ◽  
Athletic Programs ◽  
Early Defibrillation ◽  
Automated External Defibrillators ◽  
External Defibrillator

Context: Sudden cardiac arrest is the leading cause of death in young athletes. The purpose of this review is to summarize the role of automated external defibrillators and emergency planning for sudden cardiac arrest in the athletic setting. Evidence Acquisition: Relevant studies on automated external defibrillators, early defibrillation, and public-access defibrillation programs were reviewed. Recommendations from consensus guidelines and position statements applicable to automated external defibrillators in athletics were also considered. Results: Early defibrillation programs involving access to automated external defibrillators by targeted local responders have demonstrated a survival benefit for sudden cardiac arrest in many public and athletic settings. Conclusion: Schools and organizations sponsoring athletic programs should implement automated external defibrillators as part of a comprehensive emergency action plan for sudden cardiac arrest. In a collapsed and unresponsive athlete, sudden cardiac arrest should be suspected and an automated external defibrillator applied as soon as possible, as decreasing the time interval to defibrillation is the most important priority to improve survival in sudden cardiac arrest.

Out-of-Hospital Cardiac Arrest Locations in a Rural Community: Where Should We Place AEDs?

2004 ◽  
Vol 19 (04) ◽  
pp. 352-355 ◽  
Author(s):  
Marc E. Portner ◽  
Marc L. Pollack ◽  
Steven K. Schirk ◽  
Melissa K. Schlenker
Keyword(s):  
Cardiac Arrest ◽  
Rural Community ◽  
Residential Areas ◽  
Study Objective ◽  
Automated External Defibrillators ◽  
The Past ◽  
Extended Care ◽  
High Incidence ◽  
Care Facilities ◽  
Hospital Cardiac Arrest

AbstractEarly defibrillation improves survival for patients suffering cardiac arrest from ventricular fibrillation (VF) or ventricular tachycardia (VT). Automated external defibrillators (AEDs) should be placed in locations in which there is a high incidence of out-of-hospital cardiac arrest (OOHCA). The study objective was to identify high-risk, rural locations that might benefit from AED placement. A retrospective review of OOHCA in a rural community during the past 5.5 years was conducted. The OOHCAs that occurred in non-residential areas were categorized based on location. Nine hundred, forty OOHCAs occurred during the study period of which 265 (28.2%) happened in non-residential areas. Of these, 127 (47.9%) occurred in healthcare-related locations, including 104 (39.2%) in extended care facilities. No location used in this study had more than two OOHCAs. Most (52.1%) non-residential OOHCAs occurred as isolated events in 146 different locations. Almost half of the OOHCAs that occurred in non-residential areas took place in healthcare-related facilities suggesting that patients at these locations may benefit from AED placement. First responders with AEDs are likely to have the greatest impact in a rural community.

scholarly journals MP55: Reducing barriers to successful cardiac resuscitation: intervention in elementary schools

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S62-S63
Author(s):  
P. Blanchard ◽  
V. Gauvin ◽  
L. Marie-Pier ◽  
F. Péloquin ◽  
I. Bertrand ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Elementary Schools ◽  
Public School ◽  
Local Community ◽  
Training Session ◽  
Public Access ◽  
School Systems ◽  
Automated External Defibrillators ◽  
Public School Systems ◽  
Cardiac Resuscitation

Introduction: The incidence of out-of-hospital cardiac arrest (OHCA) in school is approximately 2.1 for 100,000 per year. Although rare, it is a devastating event for the local community. Schools with public access to automated external defibrillators (AED) and an emergency response plan have demonstrated increased survival rates of up to 70% for students who suffer cardiac arrest. Previous studies identified numerous barriers to successful cardiac resuscitation in public school systems. The main objectives of this study were to identify those barriers in the Quebec region elementary school system and to assess the impacts of an AED focused training session. Methods: A previously validated survey focused on the potential barriers to successful defibrillation in OHCA and on demographic variables was sent to 139 elementary schools. Later, 92 employees within three elementary schools who responded to the survey were evaluated before and after receiving training on the use of AED in a mock cardiac arrest scenario. The primary outcome was the time to first shock and the secondary outcomes included correct AED pad placement and safety of the procedure. Results: Survey response rate was 53%, which is comparable to previous studies assaying barriers to cardiac resuscitation in public school systems. 95% of school respondents reported the presence of an AED on the school premises but 46% stated that no formal AED training course was provided to employees. Out of the four schools who reported a previous OHCA, only one had access to an AED at the time of the event. Following focused AED training, 92% of school workers successfully completed a defibrillation sequence in a mock scenario, from 53% before (p < 0.001, McNemar test). The time to first shock went from 66 seconds (95% CI 63-70) to 47 seconds (95% CI 45-49; -29%, p < 0.001). Proper pad placement was the most problematic step for participants and personnel who reported previous training had better performance (OR 3.15, 95% CI 1.33-7.42, p = 0.009). Conclusion: Most elementary schools in the Quebec region have access to AEDs. However, inadequate AED training represents a significant barrier to successful defibrillation in the event of an OHCA. Our results showed that a simple focused AED training could improve the performance of school workers and optimize the chain of survival.

scholarly journals Is Distance to the Nearest Registered Public Automated Defibrillator Associated with the Probability of Bystander Shock for Victims of Out-of-Hospital Cardiac Arrest?

2018 ◽  
Vol 33 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Joel Neves Briard ◽  
Luc de Montigny ◽  
Dave Ross ◽  
François de Champlain ◽  
Eli Segal
Keyword(s):  
Cardiac Arrest ◽  
Urban Areas ◽  
Prehospital Care ◽  
Time Of Day ◽  
Publication Type ◽  
Cross Sectional ◽  
Automated External Defibrillators ◽  
Life Saving ◽  
Sectional Analysis ◽  
Hospital Cardiac Arrest

AbstractIntroductionRapid access to defibrillation is a key element in the management of out-of-hospital cardiac arrests (OHCAs). Public automated external defibrillators (PAEDs) are becoming increasingly available, but little information exists regarding the relation between the proximity to the arrest and their usage in urban areas.MethodsThis study is a retrospective, observational, cross-sectional analysis of non-traumatic OHCA during a 24-month period in the greater Montreal area (Quebec, Canada). Using logistic regression, bystander shock odds are described with regards to distance from the OHCA scene to the nearest PAED, adjusted for prehospital care arrival delay and time of day, and stratifying for type of location.ResultsOut of a total of 2,443 OHCA victims identified, 77 (3%) received bystander PAED shock, 622 (26%) occurred out-of-home, and 743 (30%) occurred during business hours. When controlling for time (business hours versus other hours) and minimum response delay for prehospital care arrival, a marginal negative association was found between bystander shock and distance to the nearest PAED in logged meters (aOR=0.80; CI, 0.64-0.99) for out-of-home cardiac arrests. No significant association was found between distance and bystander shock for at-home arrests. Out-of-home victims had significantly higher odds of receiving bystander shock up to 175 meters of distance to a PAED inclusively (aOR=2.52; CI, 1.07-5.89).ConclusionFor out-of-home cardiac arrests, proximity to a PAED was associated with bystander shock in the greater Montreal area. Strategies aiming to increase accessibility and use of these life-saving devices could further expand this advantage by assisting bystanders in rapidly locating nearby PAEDs.Neves BriardJ, de MontignyL, RossD, de ChamplainF, SegalE. Is distance to the nearest registered public automated defibrillator associated with the probability of bystander shock for victims of out-of-hospital cardiac arrest?Prehosp Disaster Med. 2018;33(2):153–159.

Abstract 5: CPR Fraction Prior to Defibrillation Determines Survival in Prehospital Cardiac Arrest in the Resuscitation Outcomes Consortium (ROC) Epistry

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
James Christenson ◽  
Douglas Andrusiek ◽  
Siobhan P Everson-Stewart ◽  
Peter J Kudenchuk ◽  
David Hostler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Case Series ◽  
Heart Association ◽  
Preliminary Evidence ◽  
Public Access ◽  
Public Access Defibrillation ◽  
Impact On Survival ◽  
Initial Rhythm ◽  
Prehospital Cardiac Arrest

Introduction : In 2005, the American Heart Association recommended increased “hands-on time” during cardiopulmonary resuscitation (CPR) based on animal research and small case series. This study estimated the effect of increasing CPR fraction (proportion of resuscitation time with active CPR) on survival in a cohort of patients with out-of hospital ventricular fibrillation or ventricular tachycardia (VF/VT). Methods: Patients were selected from the ROC Epistry who had a confirmed VF/VT cardiac arrest that was not witnessed by Emergency Medical Services (EMS), received no public access defibrillation shock prior to EMS arrival, and had impedance recordings of CPR before the first shock. The proportion of each minute with active CPR, from defibrillator pad application until the first shock, was measured from the electronic resuscitation record by skilled readers who were blinded to hospital discharge outcome. The effect of increasing CPR fraction on survival to hospital discharge was adjusted for age, sex, bystander CPR, public location, interval from 911 call to defibrillator activation, chest compression rate, and ROC community. Results: Of 7963 EMS-treated cases of cardiac arrest without public access defibrillation, 1893 had an initial rhythm of VF/VT and 283 of those had electronic tracings and confirmed outcome. Mean age was 63 years and 81% were male. Bystanders performed CPR on 51% and 41% arrested in a public location. Outcomes and odds ratios (OR) with 95% confidence intervals (CI) of survival are shown from lowest to highest category of CPR fraction. Conclusions: This study provides preliminary evidence that increasing CPR fraction is associated with increased survival from VF/VT cardiac arrest. Though the study was observational, relatively small, and able only to measure CPR fraction after pad application, these findings suggest that provision of minimally interrupted CPR has direct clinical impact on survival after VF cardiac arrest.

Abstract 287: Simulating the Effects of Sudden Cardiac Arrest Responders Embedded in a Marathon Cohort

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jessica E Salerno ◽  
Connor J Willson ◽  
Leonard S Weiss ◽  
David D Salcido
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Public Access ◽  
Walking Distance ◽  
Marathon Runners ◽  
Automated External Defibrillators ◽  
Weighted Distribution ◽  
Practical Utility ◽  
Pure Chance ◽  
Baseline Coverage

Introduction: Risk of sudden cardiac arrest may increase during distance running. In marathons, this risk is typically mitigated by deployment of medical resources, e.g. automated external defibrillators (AED), at fixed locations, potentially leaving racers vulnerable for periods of the race. We investigated utilization of marathon runners themselves as mobile emergency resources (R-AEDs). We hypothesized that systematic R-AED deployment would increase AED coverage of a race cohort over baseline coverage from static public AEDs. Methods: A simulation was constructed in MATLAB (vR2018a) incorporating the route of the 2018 Pittsburgh Marathon, detailed publicly available runner performance data from a nearby local marathon (N=1536), and known locations of S-AEDs with 1/8 th mile of any part of the Pittsburgh Marathon course (N = 47). During each simulation run, participants were randomly selected based on several distribution schemes (including age, pace category and pure chance) to carry an R-AED. R-AED coverage was assessed per minute by determining the proportion of racers up to 3 minutes ahead of each R-AED. S-AED coverage was calculated similarly based on whether runners were within 3-minutes of a public AED. All simulation variants were repeated 100 times and aggregated. Results: At baseline, 44% of the Pittsburgh Marathon course was within 3-minute walking distance of a public AED. Full coverage could be achieved with an additional 54 S-AEDs. Of the schemes we tested, when R-AEDs were deployed to random participants, optimal overall coverage was achieved with 1 R-AED per 25 runners (61 total for 57%), with 10% of race time achieving over 95% coverage. Weighted distribution of R-AEDs within age categories or pace categories achieved 72% coverage (155 AEDs) and 71% coverage, and over 95% coverage for 33% and 32% of the race duration, respectively. Conclusion: R-AEDs provided varying levels of additional coverage over baseline public access AED coverage during a simulated marathon. More work is necessary to fully determine the practical utility of this approach.

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