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 > 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.