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Abstract
Objectives Early defibrillation in out-of-hospital cardiac arrest (OHCA) is of importance to improve survival. In many countries the number of automated external defibrillators (AEDs) is increasing, but the use is low. Guidelines suggest that AEDs should be installed in densely populated areas and in locations with many visitors. Attempts have been made to identify optimal AED locations based on the incidence of OHCA using geographical information systems (GIS), but often on small datasets and the studies are seldom reproduced. The aim of this paper is to investigate if the distribution of public AEDs follows the incident locations of public OHCAs in urban areas of Stockholm County, Sweden.
Method OHCA data were obtained from the Swedish Register for Cardiopulmonary Resuscitation and AED data were obtained from the Swedish AED Register. Urban areas in Stockholm County were objectively classified according to the pan-European digital mapping tool, Urban Atlas (UA). Furthermore, we reclassified and divided the UA land cover data into three classes (residential, non-residential and other areas). GIS software was used to spatially join and relate public AED and OHCA data and perform computations on relations and distance.
Results Between 1 January 2012 and 31 December 2014 a total of 804 OHCAs occurred in public locations in Stockholm County and by December 2013 there were 1828 AEDs available. The incidence of public OHCAs was similar in residential (47.3%) and non-residential areas (43.4%). Fewer AEDs were present in residential areas than in non-residential areas (29.4% vs 68.8%). In residential areas the median distance between OHCAs and AEDs was significantly greater than in non-residential areas (288 m vs 188 m, p<0.001).
Conclusion The majority of public OHCAs occurred in areas classified in UA as ‘residential areas‘ with limited AED accessibility. These areas need to be targeted for AED installation and international guidelines need to take geographical location into account when suggesting locations for AED installation.
- Out-of-hospital cardiac arrest
- OHCA
- Automated External Defibrillator
- AED
- Urban Atlas
- GIS.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors Study concept and design: DF, MJ, JH, YB, AC, LS.
Acquisition of data: DF, MJ, JH.
Analysis and interpretation of data: DF, MJ, JH.
Drafting of the manuscript: DF, MJ, AC, LS.
Critical revision of the manuscript for important intellectual content: DF, MJ, LS, AC, YB, TD, JH, MR, PN.
Statistical analysis: DF, MJ, JH.
Obtained funding: LS.
Study supervision: AC, LS, YB.
Funding This work was supported by a centre support grant from the Laerdal Foundation and by unrestricted grants from Hjärt-lungfonden (the Swedish Heart and Lung Foundation) and Stockholm County Council. These funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Ethics approval The regional ethics committee in Stockholm County approved the study, (2014/1134-31/2).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Availability of data and material: The OHCA and AED data supporting the findings of this study are available upon reasonable request, but restrictions apply to the availability and sharing of these data, which were used by the authors under license for the current study. Data are available from the following sources: Swedish AED data can be obtained by special permission from the owner of the SAEDREG, the Swedish Resuscitation Council (info@hlr.nu). Data on OHCA incident locations from SRCR can be obtained by special permission from Registercentrum Västra Götaland, Sweden. Urban Atlas shapefiles are freely downloadable from the European Environment Agency .
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.