Abstract 187: Cardiac Arrest Incidence, Bystander Cardiopulmonary Resuscitation Rates, and Community Characteristics Differ by High and Low Risk Areas

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Rebecca Cash ◽  
Madison K Rivard ◽  
Eric Cortez ◽  
David Keseg ◽  
Ashish Panchal
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Cardiopulmonary Resuscitation ◽  
Low Risk ◽  
Poverty Level ◽  
Community Characteristics ◽  
Franklin County ◽  
Census Tracts ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Risk Areas

Introduction: Survival from out-of-hospital cardiac arrest (OHCA) has significant variation which may be due to differing rates of bystander cardiopulmonary resuscitation (BCPR). Defining and understanding the community characteristics of high-risk areas (census tracts with low BCPR rates and high OHCA incidence) can help inform novel interventions to improve outcomes. Our objectives were to identify high and low risk census tracts in Franklin County, Ohio and to compare the OHCA incidence, BCPR rates, and community characteristics. Methods: This was a cross-sectional analysis of OHCA events treated by Columbus Division of Fire in Franklin County, Ohio from the Cardiac Arrest Registry to Enhance Survival between 1/1/2010-12/31/2017. Included cases were 18 and older, with a cardiac etiology OHCA in a non-healthcare setting, with EMS resuscitation attempted. After geocoding to census tracts, Local Moran’s I and quartiles were used to determine clustering in high risk areas based on spatial Empirical Bayes smoothed rates. Community characteristics, from the 2014 American Community Survey, were compared between high and low risk areas. Results: From the 3,841 included OHCA cases, the mean adjusted OHCA incidence per census tract was 0.67 per 1,000 with a mean adjusted BCPR rate of 31% and mean adjusted survival to discharge of 9.4%. In the 25 census tracts identified as high-risk areas, there were significant differences in characteristics compared to low-risk areas, including a higher proportion of African Americans (64% vs. 21%, p<0.001), lower median household income ($30,948 vs. $54,388, p<0.001), and a higher proportion living below the poverty level (36% vs. 20%, p<0.001). There was a 3-fold increase in the adjusted OHCA incidence between high and low risk areas (1.68 vs. 0.57 per 1,000, p<0.001) with BCPR rates of 27% and 31% (p=0.31), respectively. Compared to a previous analysis, 9 (36%) census tracts persisted as high-risk but an additional 16 were newly identified. Conclusions: Neighborhood-level variations in OHCA incidence are dramatic with marked disparities in characteristics between high and low risk areas. It is possible that improving OHCA outcomes requires multifaceted interventions to address social determinants of health.

scholarly journals Multiple cluster analysis for the identification of high-risk census tracts for out-of-hospital cardiac arrest (OHCA) in Denver, Colorado

Resuscitation ◽  
2014 ◽  
Vol 85 (12) ◽  
pp. 1667-1673 ◽  
Author(s):  
Ariann F. Nassel ◽  
Elisabeth D. Root ◽  
Jason S. Haukoos ◽  
Kevin McVaney ◽  
Christopher Colwell ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Cardiac Arrest ◽  
High Risk ◽  
Census Tracts ◽  
Hospital Cardiac Arrest ◽  
Multiple Cluster

scholarly journals Spatial-time Visualization of Cutaneous Leishmaniasis in an Urban Area: Informing Health Policy and Practice

2020 ◽  
Author(s):  
Neda Firouraghi ◽  
Sayyed Mostafa Mostafavi ◽  
Amene Raouf-Rahmati ◽  
Alireza Mohammadi ◽  
Reza Saemi ◽  
...  
Keyword(s):  
High Risk ◽  
Incidence Rate ◽  
Urban Area ◽  
Incidence Rates ◽  
Low Risk ◽  
Health Concern ◽  
Surveillance Systems ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Risk Areas

Abstract Background:Cutaneous leishmaniasis (CL) is an important public health concern worldwide. Iran is among the most CL-affected countries, being listed as one of the first six endemic countries in the world. In order to develop targeted interventions, we performed a spatial-time visualization of CL cases in an urban area to identify high-risk and low-risk areas during 2016-2019.Methods:This cross-sectional study was conducted in the city of Mashhad. Patient data were gathered from Mashhad health centers. All cases (n=2425) were diagnosed in two stages; the initial diagnosis was based on clinical findings. Subsequently, clinical manifestation was confirmed by parasitological tests. The data were aggregated at the neighborhood and district levels and smoothed CL incidence rates per 100,000 individuals were calculated using the spatial empirical Bayesian approach. Furthermore, we used the Anselin Local Moran’s I statistic to identify clusters and outliers of CL distribution during 2016-2019 in Mashhad. Results:The overall incidence rates decreased from 34.6 per 100,000 in 2016 to 19.9 per 100,000 individuals in 2019. Both cluster analyses by crude incidence rate and smoothed incidence rate identified high-risk areas in southwestern Mashhad over the study period. Furthermore, the analyses revealed low-risk areas in northeastern Mashhad over the same 3-year period.Conclusions:The southwestern area of Mashhad had the highest CL incidence rates. This piece of information might be of value to design tailored interventions such as running effective resource allocation models, informed control plans and implementation of efficient surveillance systems. Furthermore, this study generates new hypotheses to test potential relationships between socio-economic and environmental risk factors and incidence of CL in areas with higher associated risks.

scholarly journals Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

2021 ◽  
Author(s):  
Richard Chocron ◽  
Julia Jobe ◽  
Sally Guan ◽  
Madeleine Kim ◽  
Mia Shigemura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Performance Metrics ◽  
Medical System ◽  
Emergency Medical System ◽  
Compression Rate ◽  
Emergency Medical ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

scholarly journals Landslide Hazard Knowledge, Risk Perception and Preparedness in Southeast Bangladesh

2020 ◽  
Vol 12 (16) ◽  
pp. 6305 ◽  
Author(s):  
Edris Alam
Keyword(s):  
Risk Perception ◽  
High Risk ◽  
Economic Status ◽  
Informal Settlements ◽  
Landslide Hazard ◽  
Low Risk ◽  
Community Members ◽  
Landslide Occurrence ◽  
Hilly Region ◽  
Risk Areas

Over the last thirty years, Bangladesh has been experiencing hill cutting problems and subsequent landslide occurrence in its southeastern hilly region. Since 2000, landslides have caused over 500 deaths, mostly in informal settlements in southeast Bangladesh. The most significant single event was the 2007 landslide causing 127 deaths in Chittagong’s informal settlements. The landslide events took over 110 people in Rangamati on 12 June 2017. In the scenario of rising deaths by landslides in the southeastern region, this research aimed to understand communities’ landslide hazard knowledge, reasons for living in at-risk areas, risk perception and preparedness. This research applied both quantitative (i.e., structural questionnaire) and qualitative (i.e., semi-structured and open-ended questionnaire and informal interviews) data collection techniques to assess hill-top and hill-side dwellers knowledge, risk perception and preparedness to landslides in southeast Bangladesh. The investigation conducted face-to-face interviews with 208 community members, 15 key informant interviews, three Focus Group Discussions (FGDs) and field observations and visits in southeast Bangladesh. The findings suggest that unplanned development activities, overpopulation, settlement along hill slopes and ineffective disaster risk reduction efforts are the anthropogenic contributories accompanying climate-change induced increased torrential rainfall are the main reasons for the increase of landslide occurrence. The results suggest that community members perceive a low-risk for landslides, despite the community’s location in high-risk areas. The community’s perception of low risk results in a lack of preparedness and an unwillingness to relocate a comparatively safer place. It was noted that landslide disaster preparation depends on the communities’ development maturity, house ownership, ethnicity, gender and economic status of the residents. It is suggested that the place of relocation for residents living in the high-risk areas should be selected with full consideration of psychosocial aspects of the community, particularly providing acceptable livelihood options.

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