Background

The optimal locations and cost-effectiveness of placing automated external defibrillators(AEDs) for out-of-hospital cardiac arrest(OHCAs) in urban residential neighbourhoods are unclear.

Methods

We used prospectively collected data from 2016 to 2018 from the British Columbia OHCA Registry to examine the utilization and cost-effectiveness of hypothetical AED deployment in municipalities with a population of over 100 000. We geo-plotted OHCA events using seven hypothetical deployment models where AEDs were placed at the exteriors of public schools and community centers and fetched by bystanders. We calculated the “radius of effectiveness” around each AED within which it could be retrieved and applied to an individual prior to EMS arrival, comparing automobile and pedestrian-based retrieval modes. For each deployment model, we estimated the number of OHCAs within the “radius of effectiveness”.

Results

We included 4017 OHCAs from ten urban municipalities. The estimated radius of effectiveness around each AED was 625 m for automobile and 240m for pedestrian retrieval. With AEDs placed outside each school and community center, 2567(64%) and 605(15%) of OHCAs fell within the radii of effectiveness for automobile and pedestrian retrieval, respectively. For each AED, there was an average of 1.20-2.66 and 0.25-0.61 in-range OHCAs per year for automobile retrieval and pedestrian retrieval, respectively, depending on the deployment model. All of our proposed surpassed the cost-effectiveness threshold of 0.125 OHCA/AED/year provided >5.3-11.6% in-range AEDs were brought-to-scene.

Conclusions

The systematic deployment of AEDs at schools and community centers in urban neighbourhoods may result in increased application and be a cost-effective public health intervention.

中文翻译：

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加拿大城市学校和社区中心 AED 部署模式的利用率和成本效益

背景

在城市居民区放置用于院外心脏骤停 (OHCA) 的自动体外除颤器 (AED) 的最佳位置和成本效益尚不清楚。

方法

我们使用从不列颠哥伦比亚省 OHCA 登记处前瞻性收集的 2016 年至 2018 年的数据来检查在人口超过 10 万的城市中假设 AED 部署的利用率和成本效益。我们使用七个假设部署模型对 OHCA 事件进行地理绘图，其中 AED被放置在公立学校和社区中心的外部，由旁观者取走。我们计算了每个 AED 周围的“有效半径”，在 EMS 到达之前，可以在其中检索并应用于个人，比较汽车和基于行人的检索模式。对于每个部署模型，我们估计了“有效性半径”内的 OHCA 数量。

结果

我们纳入了来自 10 个城市的 4017 个 OHCA。每个 AED 周围的估计有效半径对于汽车为 625 m，对于行人检索为 240 m。在每所学校和社区中心外放置 AED 的情况下，分别有 2567（64%）和 605（15%）个 OHCA 在汽车和行人检索的有效范围内。对于每个 AED，每年平均有 1.20-2.66 和 0.25-0.61 个范围内 OHCA 用于汽车检索和行人检索，具体取决于部署模型。我们提出的所有建议都超过了 0.125 OHCA/AED/年的成本效益阈值，前提是 > 5.3-11.6% 的范围内 AED 被带到现场。

结论

在城市社区的学校和社区中心系统地部署 AED 可能会增加应用并成为具有成本效益的公共卫生干预措施。