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 Center Dept. of cardiology Amsterdam
Some known facts Survival from OHCA 5-15% BLS and defibrillation are two key interventions Time to start BLS and to defibrillation is of key importance
AED implementation Weisfeldt et al Hospital survival
AED implementation Weisfeldt et al Hospital survival
AED implementation: where?
Arrest 7: North Holland+ AMC Study period Jan 1, 2006- April 1, 2009
Survival by AED use in 2843 patients (all rhythms) 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) 9.0 9.2 8.9 Call to first shock (median, min) 4.1 8.5 11.0 Observed survival % 49.6 17.2 14.3 Expected survival without AED use, mean % 27.5 16.1 14.4 Patients AED at home, from all AED (n, %) 11/128 (9) 345/478 (71) n/a Patients AED at home, from all home (n, %) 11/1962 (<<1%) 345/1962 (18%) 1606/1962 (82%)
AED: public and residential use Public use of AED is highly effective Patients at home hardly treated early by AED More attention needed for use in residential areas 29% by AED, many early from on-site AED 18% by AED, most late by dispatched AED
Weisfeldt NEJM 2011 Public vs. Home AED use 1
Weisfeldt NEJM 2011 Public vs. Home AED use 2 Time to shock ± 7.6 ± 7??
In public: AEDs only 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!
AEDs in my own residential area 138.000 inhabitants 40 AED s 1 AED / 3400 inhabitants Available? Public access No public access 24/7 4 14 8-12/5 8 14
Volendam 2003-2005
AED project Volendam
Experience in Volendam 2003-2005 21 600 inhabitants 18 AEDs (1 AED/1200 inhabitants) > 400 trained volunteers Period september 2003 - september 2005 18 x 112 alarm for cardiac arrest 5 x AED on site before ambulance arrival 3 x from GP: shocks 2 x from AED project: no shocks Why no success: no communication!
Modern communication: SMS message Go to Oranjelaan 10 and start CPR. Go to Rossinistraat 2, fetch the AED (Access # 2074). Then go to Oranjelaan 10.
Arrest 16: volunteer rescuers with SMS messages Start study 1 juli 2009
AEDs in residential areas
Rescuer activation by SMS
Simulation example: alarm system AED-Alert 1/5 AED in the community 500 m.
Simulation example: alarm system AED-Alert 2/5 AED in the community 300 m. A A
Simulation example: alarm system AED-Alert 3/5 AED in the community A Receives no sms.
Simulation example: alarm system AED-Alert 4/5 AED in the community A Receives no sms SMS: Go to Oranjelaan 10 and start CPR.
Simulation example: alarm system AED-Alert 5/5 AED 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.
Time 112 call to shock Results last 5 months (1-1-2011 31-5-2011) 266 resuscitations First rhythm from (n) 1st rhythm VF n (%) Median time call to 1st shock in min:sec # of schocks within 6 min. (%) Ambulance (141) 40 (28%) 12:14 1 (2.5%) First Responders (75) 36 (48%) 07:31 10 (28%) On site (19) 9 (47%) 03:28 5 (56%) SMS responder(31) 14 (45%) 06:41 3 (21%) Shock <6 minutes in 19 (19%) of 99 patients with VF
Future of project Principle proven Improve system More AEDs More volunteers Smarter mobile phones (GPS, directions, etc.) Continue scientific evaluation Optimum of AED density? Optimum of volunteer density? Survival benefit
How many AEDs are needed? 23 AEDs+230 rescuers minimal? 50 AEDs+500 rescuers optimal?
conclusion AEDs are implemented well for ¼ of all victims of cardiac arrest: need more of the same Early arrival finds more patients in VF: rhythm of life AEDs are safe and effective, save many lives ¾ of victims are at home and rarely managed with an AED Community rescuers may offer solution, work in progress
AED: public and residential use AED programs need to be intensified Now focus on public use of AEDs More attention for use in residential areas home at work elsewhere
Why an SMS- volunteer system?? On site AED First Responders Ambulance
First responders Police fire fighters
On-site: Dirk van den Broek