Abstract 12132: Diurnal Variation in Citizen Responder and Automated External Defibrillation Coverage of Out-of-Hospital Cardiac Arrest in Denmark According to Area Types

Introduction: Following the implementation of the Danish AED network and a nationwide citizen responder (CR) program for out-of-hospital cardiac arrest (OHCA), CR and AED coverage for OHCAs according to area types has not been investigated. We aimed to assess AED and CR coverage of historical OHCAs according to area types in daytime (12pm) and nighttime (12am). Methods: We included non-EMS witnessed OHCAs from the Danish Cardiac Arrest Registry (2016-2019) and AEDs registered with the Danish AED network (November 2020) available at 12am (n=22,418) and 12pm (n=14,734). Exact locations of CRs who were registered with the national CR program by December 2020 were identified on a normal working day (Wednesday, December 2, 2020) at 12am and 12pm (representing day- and nighttime location). OHCAs, AEDs, and CRs were identified and geocoded using a geographical information system. Urban Atlas was used to categorize areas into subgroups using satellite images; high density residential areas, low density residential areas, public and industrial sites, nature, sport and leisure facilities, transportation (e.g. airport and railway stations), and fast transit roads. Results: A total of 10,126 OHCAs (63.0% male, median age 73 years). We mapped 14,119 AEDs (12 pm) and 24,372 CR (12 pm) in Urban Atlas. Most OHCAs in all area types were covered by >= 1 AED. A greater variation was observed in CR coverage when compared to AED coverage, according to area type. Little difference in coverage of both AED and CR according to time of day was observed. (Figure 1) Conclusion: The highest CR and AED coverage were observed in high density residential areas, transportation sites, public and industrial areas, and sport and leisure facilities, which is where most OHCAs occurred. These findings indicate a high coverage of citizen responders and AEDs in Denmark.

Singapore Basic Cardiac Life Support and Automated External Defibrillation Guidelines 2021

Basic Cardiac Life Support and Automated External Defibrillation (BCLS+AED) refers to the skills required in resuscitating cardiac arrest casualties. On recognising cardiac arrest, the rescuer should call for ‘995’ for Emergency Ambulance and immediately initiate chest compressions. Good-quality chest compressions are performed with arms extended, elbows locked, shoulders directly perpendicular over the casualty’s chest, and the heel of the palm placed on the lower half of the sternum. The rescuer compresses hard and fast at 4–6 cm depth for adults at a compression rate of 100–120 per minute, with complete chest recoil after each compression. Two quick ventilations of 400–600 mL each can be delivered via a bag-valve-mask after every 30 chest compressions. Alternatively, a trained, able and willing rescuer can provide mouth-to-mouth ventilation. Cardiopulmonary resuscitation should be stopped only when the casualty wakes up, the emergency team takes over care, or when an automated external defibrillator prompts for heart rhythm analysis or delivery of a shock.

Development controller and feedback of Chiang Mai automated external defibrillation trainer and manikin for basic life support training

Objectives Basic Life Support (BLS) should be taught to everyone; however, there is a lack of Automated External Defibrillation (AED) trainers in Thailand due to the cost of the imported equipment. An AED trainer, manikin, and manikin controller system was locally developed which can display training results to help reduce the cost. Methods This is a descriptive study of a locally developed controller and feedback system, the Chiang Mai AED trainer and manikin. The controller was examined by 5 BLS instructors using a 10-point scale questionnaire consisting of 3 questions to evaluate the efficacy of the device. Correlation among BLS instructors was also calculated. Results The controller and feedback system for the Chiang Mai AED trainer and manikin worked appropriately as intended. The instructor set up either a ‘shock advised’ or a ‘no shock advised’ scenario for 2 two-minute chest compressions. The AED trainer responded promptly when the electrode pads were attached to the manikin. The controller was also able to display compression depth, compression speed, chest recoils, rescue breaths, and time to first defibrillation. Evaluation of the controller using a 10-point scale resulted in a median of 27 (interquartile range 26-29) out of 30. Intraclass correlation was 0.97 (95% confidence interval 0.90-0.99, p < 0.001). Conclusions The controller for the Chiang Mai AED trainer and manikin is effective for use in BLS training. Chiang Mai Medical Journal 2021;60(1):87-98. doi 10.12982/CMUMEDJ.2021.08

Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016

Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% ( P =0.006). Overall survival rates improved from 3.6% to 6.5% ( P <0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.

First aid and emergencies

This chapter covers first aid, including adult basic life support, automated external defibrillation, the recovery position for babies, children, and adults, adult choking, child basic life support, and the management of the choking child. How to manage emergencies such as anaphylaxis, external bleeding, burns and scalds, eye trauma, hypothermia, poisoning and overdoses, sprains, strains and fractures in the context of primary and community care are all included. Sepsis in infants, children, young people and adults, pregnancy, and postpartum women is also discussed. Finally, the identification and management of stroke is explained.