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.

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.

scholarly journals Sudden Cardiac Arrest and Automated External Defibrillators

2003 ◽  
Vol 67 (12) ◽  
pp. 975-982 ◽  
Author(s):  
Mithilesh K. Das ◽  
Douglas P. Zipes
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Automated External Defibrillators

scholarly journals LO19: AED on the fly: A drone delivery feasibility study for rural and remote out-of-hospital cardiac arrest

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S13-S14
Author(s):  
I. Drennan ◽  
S. Cheskes ◽  
P. Snobelen ◽  
M. Nolan ◽  
T. Chan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Phase 1 ◽  
Sudden Cardiac Arrest ◽  
Optimal Strategies ◽  
Second Phase ◽  
Phase 2 ◽  
Rural And Remote ◽  
Automated External Defibrillators ◽  
Lift Off

Introduction: Time-to-treatment plays a pivotal role in survival from sudden cardiac arrest (SCA). Every minute delay in defibrillation results in a 7-10% reduction in survival. This is particularly problematic in rural and remote regions, where bystander and EMS response is often prolonged and automated external defibrillators (AED) are often not available. Our objective was to examine the feasibility of a novel AED drone delivery method for rural and remote SCA. A secondary objective was to compare times between AED drone delivery and ambulance response to various mock SCA resuscitations. Methods: We conducted 6 simulations in two different rural communities in southern Ontario. During phase 1 (4 simulations) a “mock” call was placed to 911 and a single AED drone and an ambulance were simultaneously dispatched from the same location to a pre-determined destination. Once on scene, trained first responders retrieved the AED from the drone and initiated resuscitative efforts on a manikin. The second phase (2 scenarios) were done in a similar manner save for the drone being dispatched from a regionally optimized location for drone response. Results: Phase 1: The distance from dispatch location to scene varied from 6.6 km to 8.8 km. Mean (SD) response time from 911 call to scene arrival was 11.2 (+/- 1.0) minutes for EMS compared to 8.1 (+/- 0.1) for AED drone delivery. In all four simulations, the AED drone arrived before EMS, ranging from 2.1 to 4.4 minutes faster. The mean time for trained responders to retrieve the AED and apply it to the manikin was 35 (+/- 5) sec. No difficulties were encountered in drone activation by dispatch, drone lift off, landing or removal of the AED from the drone by responders. Phase 2: The ambulance response distance was 20km compared to 9km for the drone. Drones were faster to arrival at the scene by 7 minutes and 8 minutes with AED application 6 and 7 minutes prior to ambulance respectively. Conclusion: This implementation study suggests AED drone delivery is feasible with improvements in response time during a simulated SCA scenario. These results suggest the potential for AED drone delivery to decrease time to first defibrillation in rural and remote communities. Further research is required to determine the appropriate distance for drone delivery of an AED in an integrated EMS system as well as optimal strategies to simplify bystander application of a drone delivered AED.

scholarly journals Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest

Heart ◽  
2014 ◽  
Vol 100 (8) ◽  
pp. 619-623 ◽  
Author(s):  
Charles D Deakin ◽  
Elizabeth Shewry ◽  
Huon H Gray
Keyword(s):  
Cardiac Arrest ◽  
Weak Link ◽  
Public Awareness ◽  
Sudden Cardiac Arrest ◽  
Public Access ◽  
Public Access Defibrillation ◽  
South Central ◽  
Public Areas ◽  
Chain Of Survival ◽  
The Uk

IntroductionPublic access defibrillation (PAD) prior to ambulance arrival is a key determinant of survival from out-of-hospital (OOH) cardiac arrest. Implementation of PAD has been underway in the UK for the past 12 years, and its importance in strengthening the chain of survival has been recognised in the government's recent ‘Cardiovascular Disease Outcomes Strategy’. The extent of use of PAD in OOH cardiac arrests in the UK is unknown. We surveyed all OOH cardiac arrests in Hampshire over a 12-month period to ascertain the availability and effective use of PAD.MethodsA retrospective review of all patients with OOH cardiac arrest attended by South Central Ambulance Service (SCAS) in Hampshire during a 1-year period (1 September 2011 to 31 August 2012) was undertaken. Emergency calls were reviewed to establish the known presence of a PAD. Additionally, a review of all known PAD locations in Hampshire was undertaken, together with a survey of public areas where a PAD may be expected to be located.ResultsThe current population of Hampshire is estimated to be 1.76 million. During the study period, 673 known PADs were located in 278 Hampshire locations. Of all calls confirmed as cardiac arrest (n=1035), the caller reported access to an automated external defibrillator (AED) on 44 occasions (4.25%), successfully retrieving and using the AED before arrival of the ambulance on only 18 occasions (1.74%).ConclusionsDespite several campaigns to raise public awareness and make PADs more available, many public areas have no recorded AED available, and in those where an AED was available it was only used in a minority of cases by members of the public before arrival of the ambulance. Overall, a PAD was only deployed successfully in 1.74% OOH cardiac arrests. This weak link in the chain of survival contributes to the poor survival rate from OOH cardiac arrest and needs strengthening.

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.

Abstract 11560: Systematic Deployment of AEDs in BC Schools: A Utility and Cost-Effectiveness Study of In-School and Nearby OHCAs

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Li (Danny) Liang ◽  
Benjamin Leung ◽  
Timothy Chan ◽  
Jennie Helmer ◽  
Garth Meckler ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Medical System ◽  
Public Access ◽  
Walking Distance ◽  
System Response ◽  
Years Of Life Lost ◽  
Effectiveness Study ◽  
Automated External Defibrillators ◽  
Response Interval ◽  
Cost Effectiveness Study

Background: While pediatric out-of-hospital cardiac arrests (OHCAs) are relatively uncommon, they have a much higher number of potential years of life lost per event. School-located public access automated external defibrillators (AED) may be beneficial to school-aged OHCAs, but also other OHCAs within the school and in the surrounding community. We sought to identify the incidence of OHCAs within and nearby schools in British Columbia (BC), to estimate the number that may benefit from school-located AEDs. Methods: We used prospectively-collected data from the BC OHCA Registry from 2013 to 2018. We examined the addresses of all OHCAs to determine those occurring in public primary and secondary schools. We geo-plotted all OHCAs to identify the number of OHCAs within walking distance of a school. Assuming an average pedestrian speed for AED retrieval of 1.8 m/second, we calculated the number of school-vicinity OHCAs for which a bystander could retrieve an AED prior to a 6.5 minute emergency medical system response interval, assuming that AEDs would be located on the exterior of a school building. Results: There were a total of 401,423 children enrolled at 824 schools annually in the study footprint. Of a total of 12,480 EMS-treated OHCAs (220 aged < 18 years), 20 were in in schools, of which 4 were <18 years of age. Of school located OHCAs, 14 (70%) had initial shockable rhythms, 4 (20%) had an AED applied (of whom 3 survived), and 10 (50%) survived. Of the four school-located pediatric OHCAs, three were witnessed (75%), two had initial shockable rhythms (50%), and two (50%) survived until hospital discharge. A total of 1128/12,480 (9%) OHCAs were within retrieval distance of a school, corresponding to 0.228 per school per year (95% CI 0.201-0.255 year-to-year) , which is above current thresholds for cost-effectiveness. Conclusion: Outcomes of school-located OHCAs are encouraging, especially those with AED application. While the incidence of school-located OHCAs is low, a substantial proportion of OHCAs occur within a retrievable distance to a school, and thus accessible external school-located AEDs may improve overall OHCA outcomes of a community.

Abstract 9876: Optimizing Public Naloxone Kit Locations Through Mathematical Modeling

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
K.H. Benjamin Leung ◽  
Brian Grunau ◽  
May K Lee ◽  
Jane Buxton ◽  
Jennie Helmer ◽  
...  
Keyword(s):  
British Columbia ◽  
Public Transit ◽  
Mathematical Optimization ◽  
Public Access ◽  
Walking Distance ◽  
Opioid Overdose ◽  
Automated External Defibrillators ◽  
Metro Vancouver ◽  
Out Of Sample ◽  
Bus Stops

Introduction: Use of bystander-administered naloxone may lead to improved likelihood of recovery from opioid overdose. We sought to determine the accessibility of public access naloxone kits on nearby opioid overdose incidents if placed at public transit stops, compared to placing kits outside pharmacies or with existing public access automated external defibrillators (PADs). Methods: We included all incidents in Metro Vancouver, British Columbia responded to by British Columbia Emergency Health Services coded as a drug overdose with naloxone administered on-scene (Dec. 2014 to Aug. 2020). We geo-coded all public transit bus stops and used a mathematical optimization model to select bus stops where publicly accessible naloxone kits could be placed to maximize accessibility (defined as ≤100 m walking distance) to opioid overdoses. We evaluated accessibility on out-of-sample OHCAs using five-fold cross validation and compared against two baseline policies: placing publicly accessible naloxone kits at all pharmacies identified by the College of Pharmacists of British Columbia, and placing kits at all PADs identified by the British Columbia AED Registry. Statistical analysis was conducted using McNemar’s test. Results: We identified 14,318 opioid overdoses, 8,972 bus stops, 736 pharmacies, and 425 PADs. Accessibility of public naloxone kits for opioid overdose locations was 5.1% when placed at all pharmacies and 3.5% when placed with all existing PADs. Optimized naloxone kit placement using bus stops as candidate locations resulted in significantly higher accessibility than both pharmacy and PAD-based placement at 14.8% with 10 optimized locations (P<0.001), increasing to 36.7% with 500 locations (P<0.001). Conclusion: Optimizing placement of public access naloxone kits at select public transit locations can provide significantly higher accessibility to opioid overdose locations compared to placement at pharmacies or at existing PAD locations.

Abstract 147: AED on the Fly: A Drone Delivery Feasibility Study for Rural and Remote Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sheldon Cheskes ◽  
Paul Snobelen ◽  
Shelley McLeod ◽  
Steven Brooks ◽  
Christian Vaillancourt ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Sudden Cardiac Arrest ◽  
Optimal Strategies ◽  
Rural And Remote ◽  
Remote Communities ◽  
Automated External Defibrillators ◽  
Secondary Objective ◽  
Public Setting ◽  
Lift Off

Introduction: Time-to-treatment plays a pivotal role in survival from sudden cardiac arrest (SCA). Every minute of delay in defibrillation results in a 7-10% reduction in survival. Time to defibrillation is particularly problematic in rural and remote regions, where traditional bystander and EMS response is often prolonged and automated external defibrillators (AED) are often not available. The objective of this study was to examine the feasibility of a novel AED drone delivery method for rural and remote SCA. A secondary objective was to compare times between AED drone delivery and ambulance response to various mock SCA resuscitations. Methods: We conducted four simulations to determine the feasibility of AED drone delivery to mock SCA resuscitations in a rural public setting in Ontario, Canada. During each simulation, a “mock” call was placed to 911 and a single AED drone and an ambulance were simultaneously dispatched from the same location to a pre-determined destination for a mock SCA. Once on scene, trained first responders retrieved the AED from the drone and initiated resuscitative efforts on a manikin until paramedics arrived. Results: The distance from dispatch location to scene varied from 6.6 kms to 8.8 kms. Mean (SD) response time from 911 call to arrive at mock code location was 11.2 (1.0) for EMS compared to 8.1 (0.1) minutes for AED drone delivery. In all four simulations, the AED drone arrived before EMS, ranging from 2.1 minutes to 4.4 minutes faster. Mean (SD) time from AED removal from drone to application to manikin by a trained responder was 35(5) sec. No difficulties were encountered in drone activation by dispatch, drone lift off, landing or removal of the AED from the drone by responders. Conclusions: This implementation study suggests AED drone delivery is feasible with improvements in response time during a simulated SCA scenario. These results suggest the potential for AED drone delivery to decrease time to first defibrillation in rural and remote communities. Further research is required to determine the appropriate distance for drone delivery of an AED in an integrated EMS system as well as optimal strategies to simplify bystander application of a drone delivered AED.

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