AED strategies in the community

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Monica Byrd
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1 AED strategies in the community R.W. Koster Dept. of cardiology Academic Medical Center Amsterdam

2 Conflicts of interest Arrest studies supported by Netherlands Heart Foundation Netherlands Ministry of Health Device companies Physio Control Zoll Medical Cardiac Science Defibtech

3 Why do we need AEDs?

4 Ambulances are fast.

5 ... but not fast enough Ambulance

6 Weisfeldt NEJM 2011 Public vs. Home AED use 2 77% 23% 2% 16% Time to shock ± 7.6 ± 7??

7 AEDs only in public? In public: Younger, more healthy, more witnessed arrest, more bystander CPR, more VF In the home: Older, more comorbidity, less witnessed, less bystander CPR, later arrival of rescuers, less VF BUT.. There are 3-4 times as many at home!

Survival by AED use in 2833 patients (all rhythms) Period January 2006 to April 2009 Treatment with Onsite AED Circulation 2011;124:2225-2232 Dispatched AED No AED # of patients in group N=128 N=478

8 Survival by AED use in 2833 patients (all rhythms) Period January 2006 to April 2009 Treatment with Onsite AED Circulation 2011;124: Dispatched AED No AED # of patients in group N=128 N=478 N=2227 Call to arrival of ambulance (median, min) Call to first shock (median, min) % patients in VF (%) Overall survival (all rhythms) % AED use from all home <<1% 18% 0%

9 Ambulances are not fast enough Ambulance

10 Who is the best first responder? First Responders Ambulance

11 Public Access Defibrillation (PAD) On site AED First Responders Ambulance

12 AED: public or residential use? Public use of AED is very effective: survival 49% Patients at home are seldom treated with AED: survival 17% More focus on residential AEDs! 40% with AED, mostly on-site home at work elsewhere 18% by AED, dispatched AED

13 What options can be considered for AED locations? Emergency Medical Services Dispatched by first responders (police, firefighters) AED at home Public Access Defibrillation Schools municipalities

14 N Engl J Med 2008;358:

15 Schools: 2 studies USA: use of each AED once in 343 years Japan: use of each AED once in 5826 years

16 1: years

17 The 6 minutes zone Target: A region in which a first defibrillation is given <6 minutes after call in >25% of OHCA

18 Local rescuer activated by SMS from dispatch center

19 567 AED s 4503 civic lay rescuers AED strategies in the community 4. Resultaten

20 Communication with local rescuer: SMS message Go to Oranjelaan 10 and start CPR. Go to Rossinistraat 2, fetch the AED (Access # 2074). Then go to Oranjelaan 10.

21 AEDs in residential areas

22 Simulation example: alarm system AED-Alert 1/5 AED strategies in the community 500 m.

23 Simulation example: alarm system AED-Alert 2/5 AED strategies in the community 300 m. A A

24 Simulation example: alarm system AED-Alert 3/5 AED strategies in the community A Receives no sms.

25 Simulation example: alarm system AED-Alert 4/5 AED strategies in the community A Receives no sms SMS: Go to Oranjelaan 10 and start CPR.

26 Simulation example: alarm system AED-Alert 5/5 AED strategies in the community A Go to Oranjelaan 10 and start CPR. Go to Rossinistraat 2, fetch the AED (Access # 2074). Then go to Oranjelaan 10 Receives no sms.

27 Smart smartphone

28 Arrest 16: volunteer rescuers with SMS messages Noord Holland Start study Juli 1, 2009 Twente November 2012: Inhabitants: Rescuers: AEDs: 1344

29 Questions How many AEDs are needed? How many volunteer rescuers are needed? Does it improve survival?

30 AED-density /km 2 populated AED strategies in the community Density of civic lay rescuers 4. Resultaten

31 3 lay rescuers 15 lay rescuers

32 Of 3 lay rescuers 1 responds If 1 out of 3 is responding: Of 15 lay rescuers 5 respond

33 AmsteRdam REsuscitation STudies AED strategies in the community Results AEDs(1) 31 months

34 AmsteRdam REsuscitation STudies AED strategies in the community Results AEDs(2) 31 months

35 AmsteRdam REsuscitation STudies AED strategies in the community Results lay rescuers(1) 31 months

36 AmsteRdam REsuscitation STudies AED strategies in the community Results lay rescuers(2) 31 months

37 Expect outcome data in 2014

38 Conclusion AEDs are needed to improve outcome Without AEDs survival will hardly improve AEDs in public increase survival dramatically, especially on-site Effectiveness in public dependent on numbers AEDs in residential areas underdeveloped are in need of better logistics Collect and publish data!

39 Greetings from Holland

41 AED

42 Circulation 2011;124:

43 AED strategies in Lay the community rescuers with AED Alert via SMS message is feasible Faster response than ambulance Helps reduce time to defibrillation Next step: proof of increased survival

45 Circulation 2011;124: Survival by AED use in 2833 patients (all rhythms) Period January 2006 to April 2009 Treatment with Onsite AED Dispatched AED No AED # of patients in group N=128 N=478 N=2227 Call to arrival of ambulance (median, min) Call to first shock (median, min) Survival % AED use at home, from all AEDs 9% 71% n/a AED use from all home <<1% 18% 0%

46 AED strategies in Arrest the community infrastructure 7/

47 Arrest studies: out of hospital cardiac arrest Noord Holland Start 1995 July 2011: Inhabitants: Rescuers: AEDs: 1070

48 Arrest 7: infrastructure Dispatch center Info from ambulancepersonnel Datacenter in AMC Data from AED Data from hospital admission Data transmission from ambulance defibrillator

49 AmsteRdam REsuscitation STudy Where is the best place for an AED? AED strategies in the community Stepwise introduction: Onsite AED Dispatched first responders Public access: on site First Responders Ambulance

50 60 Arrest studies AEDs, shocks and survival 50 % connected AED's

51 60 Arrest studies AEDs, shocks and survival % connected AED's % first shock <6 minutes

52 60 % connected AED's 50 % survival Arrest studies AEDs, shocks and survival 40 % first shock <6 minutes

53 AmsteRdam REsuscitation STudy AED strategies in the community Background Time from emergency call to 1 st shock is too long Onsite AED First Responders Ambulanc e

54 AED strategies Percentage in the community of population in SMS region Februari 2010 Juni 2010 % inwoners binnen het ROS-gebied in NHN % inwoners binnen het ROS-gebied in Twente Oktober 2010 Februari 2011 Juni 2011 Oktober 2011 Februari 2012 Juni 2012 Oktober 2012 Februari 2013

55 AED Cumulative strategies in the community number of resuscitations in SMS region Cumulative number resuscitations in Twente Cumulative number resuscitations in NHN Februari 2010 Juni 2010 Oktober 2010 Februari 2011 Juni 2011 Oktober 2011 Februari 2012 Juni 2012 Oktober 2012 Februari 2013

56 Number of resuscitations/100,000 inh # reanimaties per in Twente # reanimaties per in NHN Februari Juni 2010 Oktober Februari Juni 2011 Oktober Februari Juni 2012 Oktober Februari

57 Survival witnessed/unwitnessed; all rhythms; bystander BLS/no bystander BLS AED 30:2 TH - PCI x!

58 Survival witnessed/unwitnessed; all rhythms; bystander BLS/no bystander BLS % of patients with CPR started AED 30:2 TH - PCI /1000 inh/yr 2.6 x!

59 Who first connects the AED or defibrillator? Results to resuscitations ROS area Total in regions First rhythm from (n) Ambulance 700 (48.8%) 864 (49.9%) First Responders 408 (28.5%) 518 (29.9%) On site 147 (10.3%) 170 (9.8%) SMS responder 178 (12.4%) 178 (10.3%)

60 Delay between 112-call and connection/defibrillation First rhythm from N= 711 Delay 112- connect (min:sec) Delay 112- shock (min:sec) Time gain from ambulance Ambulance :15 11:48 - First Responders 267 7:42 7:57 4:45 On site 36 4:13 5:01 8:07 SMS responder 54 7:31 8:45 5:32 missing 54

DECLARATION OF CONFLICT OF INTEREST

DECLARATION OF CONFLICT OF INTEREST Data collection supported by unconditional grant of Physio- Control Place and use of the Automated External Defibrillator in the community R.W. Koster Academic Medical