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 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 185: Optimization of Public Access Defibrillators Compared to Actual Deployment: An In Silico Trial

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Christopher Sun ◽  
Lena Karlsson ◽  
Christian Thorp-Pedersen ◽  
Fredrik Folke ◽  
Timothy C Chan
Keyword(s):  
Real Time ◽  
Confidence Intervals ◽  
In Silico ◽  
Time Horizon ◽  
Mathematical Optimization ◽  
Public Access ◽  
Optimization Models ◽  
Time Interval ◽  
Automated External Defibrillators ◽  
Risk Areas

Introduction: Unguided placement of automated external defibrillators (AEDs) often leads to placements in low risk areas and locations with limited temporal availability. Mathematical optimization may improve AED placements and increase AED use in out-of-hospital cardiac arrests (OHCAs). Aim: To conduct the first in silico public AED location trial to determine whether optimization models (interventions) trained on historical OHCA data will recommend AED locations that significantly improve OHCA coverage on prospective OHCAs, compared to locations of actually deployed AEDs (control). Methods: We identified all public OHCAs of presumed cardiac cause (1994-2016) and already deployed AEDs (2007-2016) in Copenhagen, Denmark. We computed the number of OHCAs that occurred within 100m of a temporally available AED after it was deployed (“OHCA coverage”). We then divided 2007-2016 into 30-day intervals and determined the number of AEDs deployed in each interval. Using previously validated optimization models, we determined an equal number of optimal AED locations in each time interval, either indoor locations with actual availability (intervention #1) or outdoor locations with 24/7 availability (intervention #2). OHCA coverage was calculated for the interventions similarly to the already deployed AEDs. Finally, we repeated the analysis 25 times to evaluate sensitivity and generate confidence intervals, by randomizing the location and time of the OHCAs. Results: A total of 2,149 public OHCAs (744 between 2007-2016) and 1,573 registered AEDs were identified. OHCA coverage of actually deployed AEDs was 22.3% (166 of 744 OHCAs). For optimally located indoor AEDs, mean OHCA coverage was 32.6% (mean: 242.5 OHCAs; 95% CI: 239.7 - 245.3). For optimally located outdoor AEDs, mean OHCA coverage was 43.9% (mean: 326.6 OHCAs; 95% CI: 324.0 - 329.2). Conclusions: Optimizing AED locations in a real-time deployment approach mimicking the time horizon of actual AED deployment in Copenhagen, Denmark results in significantly higher OHCA coverage compared to the actual AEDs deployed. Between the two interventions, optimal locations that are 24/7 available significantly outperform optimal indoor locations with more limited temporal availability.

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.

Abstract 108: Optimal In-Hospital Defibrillator Placement

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kwan Hon Benjamin Leung ◽  
Matthew Yang ◽  
Christopher Sun ◽  
Katherine S Allan ◽  
Natalie Wong ◽  
...  
Keyword(s):  
Average Distance ◽  
Mathematical Optimization ◽  
Rank Test ◽  
Relative Decrease ◽  
Signed Rank ◽  
Out Of Sample ◽  
Signed Rank Test ◽  
Academic Teaching Hospital ◽  
Mathematical Optimization Model ◽  
The Difference

Introduction: Delays in defibrillation of in-hospital cardiac arrests (IHCAs) can reduce the likelihood of survival. Mathematical optimization has been shown to improve public location defibrillator placement but has not been applied to in-hospital defibrillator placement. Objective: To determine if mathematical optimization of in-hospital defibrillator placements can reduce distances to IHCAs compared to current placements in a large academic teaching hospital. Methods: We identified all treated IHCAs and defibrillator placements in St. Michael’s Hospital in Toronto, Canada from Jan. 2007 to Jun. 2017 and mapped them to a 3-D representation of the hospital that we developed from blueprints. An equal number of optimal defibrillator locations was identified using a mathematical optimization model that minimizes the average distance between IHCAs and the closest defibrillator in a 10-fold cross-validation approach. The optimized and current defibrillator locations were compared in terms of average distance to the out-of-sample IHCAs in each fold. We repeated the analysis excluding IHCAs and defibrillators in intensive care units (ICUs), operating theaters (OTs), and the emergency department (ED). Significance in the difference of average distance was determined using a Wilcoxon signed-rank test. Results: We identified 537 treated IHCAs and 53 defibrillators within the hospital during the study period. Of these, 236 IHCAs and 38 defibrillators were outside of ICUs, OTs, and the ED. Optimal defibrillator placements reduced the average defibrillator-to-IHCA distance from 17.1 m to 3.8 m, a relative decrease of 77.8% (P<0.01) on all IHCAs compared to current defibrillator placements. For non-ICU/OT/ED IHCAs, the average distance was reduced from 18.3 m to 9.8 m, a relative decrease of 46.4% (P<0.01). Conclusion: Optimization-guided placement of in-hospital defibrillators can significantly reduce the distance from an IHCA to the closest defibrillator.

scholarly journals Measuring Accessibility to Various ASFs from Public Transit using Spatial Distance Measures in Indian Cities

2020 ◽  
Vol 9 (7) ◽  
pp. 446 ◽  
Author(s):  
Pavan Yenisetty ◽  
Pankaj Bahadure
Keyword(s):  
Public Transit ◽  
Network Connectivity ◽  
Distance Measures ◽  
Spatial Distance ◽  
Walking Distance ◽  
Area Network ◽  
Network Access ◽  
Distance Method ◽  
Unique Approach ◽  
Indian Cities

Nowadays, accessibility to facilities is one of the most discussed issues in sustainable urban planning. In the current research, two spatial distance accessibility measures were applied to evaluate the accessibility to amenities, services, and facilities (ASFs) from public transit (PT) by walking distance in six Indian cities. The first stage accounts for distance measures using the Euclidean distance with a new methodical approach derived from the built-up area with a spatial resolution of 30 m from Landsat data, and for the network distance method, the actual road distances using OpenStreetMap (OSM) for different threshold ranges of distances were derived. Meanwhile, in the second stage, indicators such as built-up area, network connectivity, and network density with the percentage of ASFs are evaluated and combined for normalization process for ranking the city. The present study assesses the accessibility to various ASFs from PT at city level and explores whether the actual road network access (by measuring distance) in Indian cities is contributing to a high level of accessibility. It adopts a unique approach using statistical tools while assessing both Euclidean and network distances. It models a framework for overall benchmarking in all six cities by ranking them for their accessibility. The results show various scenarios in terms of the rank of cities, which had been strongly affected by distance metrics (Euclidean vs. network) and thus emphasize the careful use of these measures as supporting tools for planning. This facilitates the identification of the local barriers and problems with network access that affect the actual distance. This unique approach can help policymakers to identify the gaps in PT coverage for reaching ASFs. Furthermore, it helps in crucial implementation by strategic planning that can be achieved using these distance criteria.

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 How do passenger and trip attributes affect walking distances to bus public transport stops? Evidence from university students in Greece

Spatium ◽  
2020 ◽  
pp. 12-21
Author(s):  
Christos Tsioulianos ◽  
Socrates Basbas ◽  
Georgios Georgiadis
Keyword(s):  
Public Transport ◽  
Spatial Arrangement ◽  
Walking Distance ◽  
Transport Systems ◽  
University Campuses ◽  
Spatial Design ◽  
Transport Services ◽  
User Expectations ◽  
Bus Stops ◽  
Inference Methods

The spatial arrangement of public transport systems seriously affects their ridership and thus the fulfillment of sustainable transport goals. This paper examines the case of students at Aristotle University of Thessaloniki and investigates their perceptions regarding a critical spatial attribute of public transport, that is, the walking distance they have to cover to/from bus stops when they commute by bus to their campus. A questionnaire survey was conducted to collect relevant data from 300 students and a set of statistical inference methods was employed to explore whether student-specific attributes relate to the walking distances they consider to be acceptable. Empirical findings highlighted weak relationships between user/trip specific attributes with regard to students, and their walking distance preferences for the bus public transport services they use. The majority of students consider that the maximum acceptable walking distance can be higher than the standard value of 400 meters. Moreover, they would be willing to walk more than they currently do in order to reach a bus stop with higher service frequencies to their campus. The study concept and findings could assist in delivering a more successful spatial design of bus public transport systems which serve university campuses. A more sparsely positioned network of bus stops would provide better opportunities for personal physical activity but should not yield increased total travel times; and they should incorporate local user expectations. Public transport agencies could also benefit from achieving higher service speeds which, in turn, would reduce energy consumption and operating costs.

scholarly journals Eating and learning about food at school and on campus:

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Estevan Leopoldo de Freitas Coca
Keyword(s):  
British Columbia ◽  
Qualitative Analysis ◽  
Public Procurement ◽  
Learning Processes ◽  
Structured Interviews ◽  
Metro Vancouver ◽  
Educational Spaces ◽  
Practical Development ◽  
Teaching Learning ◽  
The Relationship

Food is an interdisciplinary topic that transverses different areas of knowledge, allowing it to be used as a pedagogical resource in numerous teaching-learning processes and environments. This paper seeks to contribute to early debates on the relationship between public procurement and food pedagogies in schools and universities, a topic that is still little addressed in the literature. I explore the Farm to Cafeteria Canada (F2CC) network in Metro Vancouver, British Columbia, which beyond institutional procurement recognises food as a pedagogical resource at schools and on campus. My research is based on 18 site visits and qualitative analysis of documents and 9 semi-structured interviews conducted with institutional administrators associated with F2CC in Metro Vancouver. This paper demonstrates how the F2CC network activities in Metro Vancouver contribute not only to food procurement, but also to the practical development of pedagogical activities from different areas of knowledge and in different educational spaces.

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