Predicting the Maximal Effect of Public Access Defibrillation: Why Most Public Access Defibrillation Programs Will Not Save Lives

Description
Title: Predicting the Maximal Effect of Public Access Defibrillation: Why Most Public Access Defibrillation Programs Will Not Save Lives
Other Titles: Unpublished Work
Authors: De Maio, Valerie
Coyle, Douglas
Vaillancourt, Christian
Wells, George A.
Spaite, Daniel W.
Nesbitt, Lisa
Stiell, Ian G.
Date: 2016-02-12
Abstract: Context: Many agencies are promoting widespread availability of automated external defibrillators (AED) in public places despite a lack of evidence for the best locations for public access defibrillation (PAD). Objective: To identify high-risk cardiac arrest locations to guide the optimal distribution of AEDs in a wide variety of communities. Design, Setting, and Patients: A prospective cohort study of adult, out-of-hospital cardiac arrests of presumed cardiac etiology within the 20 communities of the Ontario Prehospital Advanced Life Support (OPALS) study from July 1, 1995 to June 30, 2000. The property assessment roll identified the specific property type for each cardiac arrest address and the total number of sites, per location type, within the study boundary. Main Outcome Measures: Measures of the potential utility of PAD for each of 26 location categories, including the number of PAD programs needed to treat one cardiac arrest, and the potential PAD use per site in years. Results: Overall, 7,667 (99.5%) of 7707 cardiac arrests had valid address information. Private residences comprised 85% of the arrest locations and the remaining 15% were public locations. Potential PAD venues include (location-specific cardiac arrest rates per site, the number of PAD programs needed to treat one cardiac arrest during a five-year period and the potential PAD use per site in years): casinos (14, 0.07, 0.4); non-acute hospitals (1, 1, 5); nursing/retirement homes (1, 1, 5); penal institutions (0.3, 4, 18); indoor shopping malls (0.2, 5, 26); and hotels (0.1, 9, 46). All other remaining locations had poor utility scores. Conclusions: Most cardiac arrests occur in private residences. It appears that only a few locations may be amenable to efficient placement of PAD. All communities considering public placement of AEDs should identify high-risk sites to guide the rational deployment of these devices.
URL: http://hdl.handle.net/10393/34276
CollectionIRHO - Publications // OHRI - Publications
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