The First Use of a Defibrillator on a U.S. Commercial Airline.

Use of onboard commercial airline defibrillators began in 1997. At first, it was met with resistance but is now present on all planes. The first in-flight resuscitation of a passenger occurred in 1998 and is described here.

Evolution of Incidence, Management, and Outcomes Over Time in Sports-Related Sudden Cardiac Arrest.

BACKGROUND: Major efforts have been made to reduce the burden of sports-related sudden cardiac arrest (SrSCA). The extent to which the incidence, management, and outcomes changed over time has not been investigated. OBJECTIVES: The purpose of this study was to assess temporal trends in SrSCA incidence, management, and survival. METHODS: Using data from the French National Institute of Health and Medical Research, we evaluated the evolution of incidence, prehospital management, and survival at hospital discharge of SrSCA among subjects aged 18 to 75 years, over 6 successive 2-year periods between 2005 and 2018. RESULTS: Among the 377 SrSCA, 20 occurred in young competitive athletes (5.3%), whereas 94.7% occurred in middle-aged recreational sports participants. Comparing the last 2-year to the first 2-year period, SrSCA incidence remained stable (6.24 vs 7.00 per million inhabitants/y; P = 0.51), with no significant differences in patients' mean age (46.6 ± 13.8 years vs 51.0 ± 16.4 years; P = 0.42), sex (men 94.7% vs 95.2%; P = 0.99), and history of heart disease (12.5% vs 15.9%; P = 0.85). However, frequency of bystander cardiopulmonary resuscitation and public automated external defibrillator use increased significantly (34.9% vs 94.7%; P < 0.001 and 1.6% vs 28.8%; P = 0.006, respectively). Survival to hospital discharge improved steadily, reaching 66.7% in the last study period compared with 23.8% in the first (P < 0.001). CONCLUSIONS: Incidence of SrSCA remained relatively stable over time, suggesting a need for improvement in screening strategies. However, major improvements in on-field resuscitation led to a 3-fold increase in survival, underlining the value of public education in basic life support that should serve as an example for SCA in general.

The feasibility of medical unmanned aerial systems in suburban areas.

Out-of-Hospital Cardiac Arrests (OHCA) are one of the biggest challenges facing medical systems world-wide. Each year, more than 420,000 Americans experience cardiac arrests with a survival rate of approximately 10%.1 A large challenge to treating OHCA continues to be rapid access to AEDs which can increase survival rates up to 40%.1 While pivotal to an OHCA patient's survival, AEDs are not always readily available. Advances in unmanned aerial systems (UAS) - commonly referred to as drones - can provide a solution since UAS have the ability to rapidly carry an AED payload to an emergency site. This study examined the potential use of UAS delivered AEDs in suburban areas by using the Charlottesville-Albemarle area as an example. This study was carried out by using Geographical Information Systems mapping. Specifications of the Eagle drone model by Flirtey were used to develop a beneficial drone placement plan. Models were created with drones at first responder stations. Coverage area of the drones at first responder stations was compared to coverage area of drone units placed at "ideal" locations in the Charlottesville-Albemarle County area. Population statistics were gathered from the GIS program Social Explorer, using data from the U.S. Census Bureau. The "ideal" location placement plan was then evaluated for an estimate of total population covered by the system. Finally, ideal drone placements were evaluated and compared to response time and distances versus a local EMS ground unit. With the derived ideal placements, 70.08% of the area would have drone coverage that could deliver an AED in less than five minutes and 97.97% of the area would have coverage in less than 10 min. At minimum, 94.72% of the population would be covered by the ideal placements of drones within the area. Drone response time was significantly faster than ground EMS response by a factor of 5× (P value < .05). Drones were able to get to the incident scene of a theoretical OHCA faster without and with vertical response challenges. The results show that UAS delivery of AEDs is not only possible in the Charlottesville-Albemarle County area, but an effective way to decrease response time to improve chances of survival for a person experiencing an OHCA in similar suburban areas.

Increasing the Availability of Automated External Defibrillators at Sporting Events: A Call to Action from the American College of Sports Medicine.

ABSTRACT: Given that most sudden cardiac arrests (SCAs) occur outside of a medical facility, often in association with exercise and sporting events, and given that early cardiopulmonary resuscitation (CPR) plus defibrillation is the strongest predictor of survival from SCA, this Call to Action from the American College of Sports Medicine recommends increasing the availability and effectiveness of early CPR plus defibrillation so that the time from collapse-to-first automated external defibrillator shock is less than 3 min.

In-flight Medical Emergencies.

In 2018, approximately 2.8 million passengers flew in and out of U.S. airports per day. Twenty-four to 130 in-flight medical emergencies are estimated to occur per 1 million passengers; however, there is no internationally agreed-upon recording or classification system. Up to 70% of in-flight emergencies are managed by the cabin crew without additional assistance. If a health care volunteer is requested, medical professionals should consider if they are in an appropriate condition to render aid, and then identify themselves to cabin crew, perform a history and physical examination, and inform the cabin crew of clinical impressions and recommendations. An aircraft in flight is a physically constrained and resource-limited environment. When needed, an emergency medical kit and automated external defibrillator are available on all U.S. aircraft with at least one flight attendant and a capacity for 30 or more passengers. Coordinated communication with the pilot, any available ground-based medical resources, and flight dispatch is needed if aircraft diversion is recommended. In the United States, medical volunteers are generally protected by the Aviation Medical Assistance Act of 1998. There is no equivalent law governing international travel, and legal jurisdiction depends on the patient's and medical professional's countries of citizenship and the country in which the aircraft is registered.

Strategies on locations of public access defibrillator: A systematic review.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a critical condition with poor outcomes. Although the survival rate increases in those who undergo defibrillation, the utility of on-time defibrillation among bystanders remained low. An evaluation of the deployment strategy for public access defibrillators (PADs) is necessary to increase their use and accessibility. This study was to conduct a systematic review for deployment strategies of PADs. METHODS: Two authors independently searched for articles published before October 2019 from PubMed, Embase, Web of Science, and Cochrane Library. An independent librarian provided the search strategy and assisted the literature research. We included articles that were focused on the main topic, but excluded those which were missing results or that used an unclear definition. The qualitative outcomes were the utility and OHCA coverage of PADs. We performed a qualitative analysis across the studies, but a quantitative analysis was not available due to the studies' heterogeneity in design and variety of outcomes. RESULTS: We eventually included 15 studies. Three strategies were presented: guidelines-based, grid-based, and landmark-based. The guidelines-based deployment was common fit for OHCA events. The grid-based method increased the use of bystander defibrillation 3-fold, and 30-day survival doubled. The top 3 landmarks in the landmark-based strategy were offices (18.6%), schools (13.3%), and sports facilities (12.9%). Utility of PADs might increase if we optimize PAD location by mathematical modeling and evaluation feedback. CONCLUSION: Three deployment strategies were presented. Although the optimal method could not be fully identified, a more efficient PAD deployment could benefit the population in terms of OHCA coverage and survival among patients with OHCA.

Effect of Optimized Versus Guidelines-Based Automated External Defibrillator Placement on Out-of-Hospital Cardiac Arrest Coverage: An In Silico Trial.

Background Mathematical optimization of automated external defibrillator (AED) placement may improve AED accessibility and out-of-hospital cardiac arrest (OHCA) outcomes compared with American Heart Association (AHA) and European Resuscitation Council (ERC) placement guidelines. We conducted an in silico trial (simulated prospective cohort study) comparing mathematically optimized placements with placements derived from current AHA and ERC guidelines, which recommend placement in locations where OHCAs are usually witnessed. Methods and Results We identified all public OHCAs of presumed cardiac cause from 2008 to 2016 in Copenhagen, Denmark. For the control, we computationally simulated placing 24/7-accessible AEDs at every unique, public, witnessed OHCA location at monthly intervals over the study period. The intervention consisted of an equal number of simulated AEDs placements, deployed monthly, at mathematically optimized locations, using a model that analyzed historical OHCAs before that month. For each approach, we calculated the number of OHCAs in the study period that occurred within a 100-m route distance based on Copenhagen's road network of an available AED after it was placed ("OHCA coverage"). Estimated impact on bystander defibrillation and 30-day survival was calculated by multivariate logistic regression. The control scenario involved 393 AEDs at historical, public, witnessed OHCA locations, covering 15.8% of the 653 public OHCAs from 2008 to 2016. The optimized locations provided significantly higher coverage (24.2%; P<0.001). Estimated bystander defibrillation and 30-day survival rates increased from 15.6% to 18.2% (P<0.05) and from 32.6% to 34.0% (P<0.05), respectively. As a baseline, the 1573 real AEDs in Copenhagen covered 14.4% of the OHCAs. Conclusions Mathematical optimization can significantly improve OHCA coverage and estimated clinical outcomes compared with a guidelines-based approach to AED placement.

Assessment on CPR Knowledge and AED Availability in Saudi Malls by Security Personnel: Public Safety Perspective.

Security personnel are the first ones who attend the scene in the case of out-of-hospital cardiac arrest (OHCA) at malls. Cardiopulmonary resuscitation (CPR) is not enough for those patients; they need an automated external defibrillator (AED) to bring the heart to function normally. This study aimed to assess the current status of CPR and AED knowledge and availability in Saudi malls by security personnel. Using a descriptive design, a study was conducted at seven malls located in the Eastern Province of Saudi Arabia. Two hundred and fifty participants were surveyed using the American Heart Association (AHA) 2015 guidelines to assess CPR and AED knowledge and availability in Saudi malls. The sample mean age was 32.60 years (SD = 10.02), and 87% of participants were working as security personnel. The majority of the participants had not received training about CPR and AED (75.8% and 95.2%, respectively). Common misconceptions are fallen into all categories of CPR and AED knowledge. Correctly answered statements ranged from 7.2% in the compression rate to 24.2% in hand placement. The study results indicated a poor training knowledge of CPR and AED in public settings. Integrating high-quality CPR and AED knowledge within the school and college curricula is a vital need. However, in order to maximize the survival rate, it is important to set laws and legislation adopted by stakeholders and decision makers to advocate the people who try to help, mandate AED installation in crowded places, and mandate teaching hands-only CPR and AED together as a package.

Sudden cardiac arrest survival in HEARTSafe communities.

BACKGROUND: The HEARTSafe Communities program promotes community efforts to improve systems for treating sudden cardiac arrest (SCA). The study hypothesis was that the rates of SCA survival to admission, discharge, and discharge with CPC score 1 or 2 are higher in HEARTSafe-designated communities than non-designated communities in Connecticut, USA. Secondary outcomes included bystander CPR and AED application. METHODS: The state Office of EMS supplied a list of towns that are HEARTSafe-designated, and dates of designation. The Cardiac Arrest Registry to Enhance Survival provided data for all SCA from 2013 to 2017 in the 70 participating towns. For each SCA, it was determined whether the town was HEARTSafe-designated at the time. RESULTS: Of 2922 SCA cases, 1569 (54%) occurred in towns that were HEARTSafe-designated. Patients in designated towns were 1.15 times more likely to have AEDs applied by bystanders, and 1.15 times more likely to have CPR started by bystanders, than were patients in non-designated towns, but these differences were not significance (p = 0.66 and 0.28). The likelihood of surviving to admission was 1.33 times higher (p = 0.02) in designated towns. The likelihood of surviving to discharge was 1.33 times higher, and of surviving to discharge with CPC 1 or 2 was 1.4 times higher, but these differences were not significant (p = 0.17 and 0.13). CONCLUSION: SCA survival rates do not differ between HEARTSafe and non-HEARTSafe communities in Connecticut. SCA patients in HEARTSafe communities are no more likely to receive bystander AED application or bystander CPR.

Effectiveness of a community based out-of-hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study.

BACKGROUND: 70% of Out-of-hospital cardiac arrests (OHCA) in Singapore occur in residential areas, and are associated with poorer outcomes. We hypothesized that an interventional bundle consisting of Save-A-life (SAL) initiative (cardiopulmonary resuscitation (CPR)/automated external defibrillator (AED) training and public-housing AED installation), dispatcher-assisted CPR (DA-CPR) program and myResponder (mobile application) will improve OHCA survival. METHODS: This is pilot data from initial implementation of a stepped-wedge, before-after, real-world interventional bundle in six selected regions. Under the SAL initiative, 30,000 individuals were CPR/AED trained, with 360 AEDs installed. Data was obtained from Singapore's national OHCA Registry. We included all adult patients who experienced OHCA in Singapore from 2011 to 2016 within study regions, excluding EMS-witnessed cases and cases due to trauma/drowning/ electrocution. Cases occurring before and after intervention were allocated as control and intervention groups respectively. Survival was assessed via multivariable logistic regression. RESULTS: 1241 patients were included for analysis (Intervention: 361; Control: 880). The intervention group had higher mean age (70 vs 67 years), survival (3.3% [12/361] vs. 2.2% [19/880]), pre-hospital return of spontaneous circulation (ROSC) (9.1% [33/361] vs 5.1% [45/880]), bystander CPR (63.7% [230/361] vs 44.8% [394/880]) and bystander AED application (2.8% [10/361] vs 1.1% [10/880]). After adjusting for age, gender, race and significant covariates, the intervention was associated with increased odds ratio (OR) for survival (OR 2.39 [1.02-5.62]), pre-hospital ROSC (OR 1.94 [1.15-3.25]) and bystander CPR (OR 2.29 [1.77-2.96]). CONCLUSION: The OHCA interventional bundle (SAL initiative, DA-CPR, myResponder) significantly improved survival and is being scaled up as a national program.

Simulating Public Buses as a Mobile Platform for Deployment of Publicly Accessible Automated External Defibrillators.

Introduction: Public access defibrillation (PAD) programs seek to optimize locations of automated external defibrillators (AEDs) to minimize the time from out-of-hospital cardiac arrest (OHCA) recognition to defibrillation. Most PAD programs have focused on static AED (S-AED) locations in high traffic areas; pervasive electronic data infrastructure incorporating real-time geospatial data opens the possibility for AED deployment on mobile infrastructure for retrieval by nearby non-passengers. Performance characteristics of such systems are not known. Hypothesis: We hypothesized that publicly accessible AEDs located on buses would increase publicly accessible AED coverage and reduce AED retrieval time relative to statically located AEDs. Methods: S-AED sites in Pittsburgh, PA were identified and consolidated to 1 AED per building for analysis (n = 582). Public bus routes and schedules were obtained from the Port Authority of Allegheny County. OHCA locations and times were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium. Two simulations were conducted to assess the characteristics and impact of AEDs located on buses. In Simulation #1, geographic coverage area of AEDs located on buses (B-AEDs) was estimated using a 1/8th mile (201 m) retrieval radius during weekday, Saturday and Sunday periods. Cumulative geographic coverage across each period of the week was compared to S-AED coverage and the added coverage provided by B-AEDs was calculated. In Simulation #2, spatiotemporal event coverage was estimated for historical OHCA events, assuming constraints designed to reflect real world AED retrieval scenarios. Event coverage and AED retrieval time were compared between B-AEDs and S-AEDs across periods of the week and residential/nonresidential spatial areas. Results: Cumulative geographic coverage by S-AEDs was 23% across all periods, assuming uniform access hours. B-AEDs alone versus B-AEDs + S-AEDs covered 20% vs. 34% (weekday), 14% + 30% (Saturday), and 10% + 28% (Sunday). There was no statistically significant difference in 3-minute historical AED accessibility between only B-AEDs and only S-AEDs in standalone deployments (12% vs. 14%). However, when allowing for retrieval of either type of AED in the same scenario, event coverage was improved to 22% (p < 0.001). Conclusion: Deployment of B-AEDs may improve AED coverage but not as a standalone deployment strategy.

Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics.

BACKGROUND: Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA. METHODS: Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes. RESULTS: Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics. CONCLUSIONS: Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.

A Comparison of Emergency Preparedness Between High School Coaches and Club Sport Coaches.

CONTEXT: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown. OBJECTIVE: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams. DESIGN: Cross-sectional survey. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training. MAIN OUTCOME MEASURE(S): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid). RESULTS: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training (P < .001). CONCLUSIONS: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.

Availability of automated external defibrillators in Hamilton, New Zealand.

BACKGROUND: Last year, there were 2,000 out-of-hospital cardiac arrests (OHCA) in New Zealand, 74% received CPR but only 5.1% accessed an automated external defibrillator (AED). The average survival rate of OHCA is 13%. The aim of this study was to visit all 50 AED locations shown on www.hamiltoncentral.co.nz to assess their true availability and visibility to the public in the event of an OHCA. METHOD: All premises were visited and the first staff member encountered was asked if they were aware an AED was onsite, its location, hours of availability, if restricted access applied and whether it had been used. RESULTS: Of the 50 locations, three sites no longer exist and two AEDs were listed twice. Therefore, only 45 AEDs exist. Two sites had grossly inaccurate locations. Three AEDs (7%) were continuously available. Nine AEDs were accessible after 6pm at least one day of the week. Thirteen AEDs were available on weekends; however, five required swipe card access. None of the AEDs were located outdoors. CONCLUSION: Far fewer than 50 listed AEDs are freely available to the public, especially after 6pm and on weekends. Lack of signposting and restrictions to access would lead to delayed defibrillation. This important health issue needs addressing.