Search

Purpose To assess the awareness of medical imaging students about cardiopulmonary resuscitation (CPR) and how to perform it correctly. Methods This cross-sectional study assessed CPR knowledge among third- and fourth-year students enrolled in the bachelor of medical imaging program at Fatima College of Health Sciences (FCHS). A survey was adopted from Saquib et al and modified and validated by 2 experts, then piloted with 5 potential participants. The survey included questions about demographics as well as knowledge of and perceptions regarding CPR performance. The awareness and student perception questions were designed in a multiple-choice question format. Results Fifty-seven students completed the survey. Among these, 50% did not know CPR or basic life support (BLS) sequences. However, 84.2% of participants had heard of CPR and BLS, and 89.5% wanted to learn them. Furthermore, 91.2% of respondents agreed with adding a mandatory formal CPR or BLS course to the current medical imaging undergraduate program at FCHS. Students' knowledge of CPR and BLS differed between the Abu Dhabi campus and the Al Ain campus. Discussion These findings agree with previous studies that found medical imaging students and students in other health care education programs have more general knowledge about CPR and BLS but less specific knowledge about performing them. Also aligned with other studies, the findings showed that trained individuals are more likely to perform CPR or BLS and are more confident in their abilities. Conclusion Students in the FCHS bachelor of medical imaging program showed a lack of awareness of how to perform CPR. A formal CPR and patient safety course is recommended as part of the medical imaging curriculum. [ABSTRACT FROM AUTHOR]

Automated external defibrillators (AEDs) are portable emergency medical devices critical for resuscitating individuals experiencing sudden cardiac arrest. The installation of AEDs in public spaces is essential for enhancing society's emergency response capabilities. However, many cities in China currently face issues such as inadequate AEDs deployment and uneven distribution. This study aims to explore a rational layout plan for AEDs through systematic site optimization. Initially, this paper evaluates the current spatial configuration of AEDs in the central urban district of Nanjing using various spatial analysis methods. Subsequently, a coverage model is constructed to simulate the coverage capacity of potential emergency needs for new facilities, and a genetic algorithm is utilized to solve it. Finally, an AED site selection experiment is conducted, and the site selection results are discussed and analyzed in conjunction with practical conditions. The research conclusions are as follows: (1) AED distribution in Nanjing's central urban district is clustered, with some areas lacking facilities, and the coverage rate of AEDs within 100 m and 200 m ranges is relatively low, particularly across different types of venues; and (2) the optimization experiment, with 90 new site selection points, effectively addressed AED distribution gaps, significantly improved coverage, and ameliorated the overall distribution across various public venues. This study provides a scientific basis for the rational placement of AEDs in urban public spaces through systematic analysis and optimization experiments. It enhances the efficiency of current AED deployment in the main urban areas of Nanjing and offers significant insights for the optimization of urban emergency resource allocation. [ABSTRACT FROM AUTHOR]

Abstract Background Sudden cardiac death (SCD) is a leading cause of cardiovascular-related deaths, often occurring outside hospitals in undiagnosed individuals. Our study aims to assess the baseline awareness and skills in performing CPR among the population in Palestine. Methods A cross-sectional study was conducted using an online questionnaire to assess CPR knowledge among residents of the West Bank, Palestine. Convenience sampling targeted 300 participants via social media. Data were analyzed using descriptive statistics and chi-square tests to examine associations. Results The study surveyed 555 participants, revealing that 58.2% lacked CPR training. Awareness of cardiac arrest signs varied, with chest pain being the most recognized 19%. CPR training significantly improved participants’ recognition and response to cardiac emergencies. Conclusion Addressing the fear of legal consequences is crucial to encourage bystander assistance. We recommend increasing first aid awareness through scientific conferences, free training courses, media campaigns, and incentivized competitions.

Background: Sudden cardiac death (SCD) is a leading cause of cardiovascular-related deaths, often occurring outside hospitals in undiagnosed individuals. Our study aims to assess the baseline awareness and skills in performing CPR among the population in Palestine. Methods: A cross-sectional study was conducted using an online questionnaire to assess CPR knowledge among residents of the West Bank, Palestine. Convenience sampling targeted 300 participants via social media. Data were analyzed using descriptive statistics and chi-square tests to examine associations. Results: The study surveyed 555 participants, revealing that 58.2% lacked CPR training. Awareness of cardiac arrest signs varied, with chest pain being the most recognized 19%. CPR training significantly improved participants' recognition and response to cardiac emergencies. Conclusion: Addressing the fear of legal consequences is crucial to encourage bystander assistance. We recommend increasing first aid awareness through scientific conferences, free training courses, media campaigns, and incentivized competitions. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Nursing Journal is the property of University of Applied Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Volunteer responder systems (VRS) alert and guide nearby lay rescuers towards the location of an emergency. An application of such a system is to out-of-hospital cardiac arrests, where early cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED) are crucial for improving survival rates. However, many AEDs remain underutilized due to poor location choices, while other areas lack adequate AED coverage. In this paper, we present a comprehensive data-driven algorithmic approach to optimize deployment of (additional) public-access AEDs to be used in a VRS. Alongside a binary integer programming (BIP) formulation, we consider two heuristic methods, namely Greedy and Greedy Randomized Adaptive Search Procedure (GRASP), to solve the gradual Maximal Covering Location (MCLP) problem with partial coverage for AED deployment. We develop realistic gradually decreasing coverage functions for volunteers going on foot, by bike, or by car. A spatial probability distribution of cardiac arrest is estimated using kernel density estimation to be used as input for the models and to evaluate the solutions. We apply our approach to 29 real-world instances (municipalities) in the Netherlands. We show that GRASP can obtain near-optimal solutions for large problem instances in significantly less time than the exact method. The results indicate that relocating existing AEDs improves the weighted average coverage from 36% to 49% across all municipalities, with relative improvements ranging from 1% to 175%. For most municipalities, strategically placing 5 to 10 additional AEDs can already provide substantial improvements. [ABSTRACT FROM AUTHOR]

The survivability of out-of-hospital cardiac arrest patients in China is notably low, at less than 1%, primarily due to difficulties in accessing nearby Automated External Defibrillator (AED) devices during emergencies. Therefore, the strategic deployment of AEDs is crucial for improving patient survival. This study adopts a novel hybrid methodology that integrates the Fuzzy Analytic Network Process (FANP) and Grey Relational Analysis (GRA) to assess and prioritize the critical factors for optimizing AED deployment in China. In the FANP model, the rate of cardiopulmonary resuscitation training among individuals in the area, the rate of AED training among individuals in the area, and records of AED device usage within the area are key factors for improving the effectiveness of AED deployment. Furthermore, in the GRA model, the factors with higher gray relational degrees are Visibility, Social Environment, and Accessibility. This analysis sheds light on which secondary indicators can have the most significant impact on improving specific primary indicators. The insights from this study can guide the optimization of AED deployment strategies in China and offer practical solutions for enhancing the deployment of relevant public medical facilities. [ABSTRACT FROM AUTHOR]

Intervention by members of the public during an out of hospital cardiac arrest (OHAC) including resuscitation attempts and accessible automated external defibrillator (AED) has been shown to improve survival. This study aimed to investigate the OHCA and AED knowledge and confidence, and barriers to intervention, of the public of North East England, UK. This study used a face-to-face cross-sectional survey on a public high street in Newcastle, UK. Participants were asked unprompted to explain what they would do when faced with an OHCA collapse. Chi-Square analysis was used to test the association of the independent variables sex and first aid trained on the participants' responses. Of the 421 participants recruited to our study, 82.9% (n = 349) reported that they would know what to do during an OHCA collapse. The most frequent OHCA action mentioned was call 999 (64.1%, n = 270/421) and 58.2% (n = 245/421) of participants reported that they would commence CPR. However, only 14.3% (n = 60/421) of participants spontaneously mentioned that they would locate an AED, while only 4.5% (n = 19/421) recounted that they would apply the AED. Just over half of participants (50.8%, n = 214/421) were first aid trained, with statistically more females (57.3%, n = 126/220) than males (43.9%, n = 87/198) being first aiders (p = 0.01 χ2 = 7.41). Most participants (80.3%, n = 338/421) knew what an AED was, and 34.7% (n = 326/421) reported that they knew how to use one, however, only 11.9% (n = 50/421) mentioned that they would actually shock a patient. Being first aid trained increased the likelihood of freely recounting actions for OHCA and AED intervention. The most common barrier to helping during an OHCA was lack of knowledge (29.9%, n = 126/421). Although most participants reported they would know what to do during an OHCA and had knowledge of an AED, low numbers of participants spontaneously mentioned specific OHCA and AED actions. Improving public knowledge would help improve the public's confidence of intervening during an OHCA and may improve OHCA survival. [ABSTRACT FROM AUTHOR]

The increased use of the Automated External Defibrillator (AED) and the creation of cardio protected areas in the world and in Mexico contribute to increased survival rates after Out of Hospital Cardiac Arrest (OHCA). When used, the AED records not only the heart rhythm, but also information about Cardiopulmonary Resuscitation (CPR) in the unconscious victim. This data could be important and useful for further diagnosis and treatment. However, there are also some legal questions regarding the use of this information and how it should be managed. To this purpose we suggest the creation of a National Registry of Out-of-Hospital Cardiac Arrest (RENAPACE, for its acronym in Spanish) to handle the AED data. That information could serve for several purposes: 1. Guarantee the availability of data in Mexico for the care of patients who survive an episode of OHCA. 2. To monitor the quality in the use of the AED. 3. Scientific research. 4. To help create a more concise registry of the cause of death and push to include the term «sudden cardiac death» in death certificates. Creating a national AED registry requires, medical and political will and could confront economical, political, legal and organizational problems to address. There are some cities in Mexico developing this program. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background The rate of survival after out‐of‐hospital cardiac arrest varies depending on the timeliness and effectiveness of prehospital interventions. This study was conducted to compare out‐of‐hospital cardiac arrest outcomes between intravenous and intraosseous routes and between upper and lower extremity routes for drug administration. Methods and Results We retrospectively analyzed data (collected using the Utstein template) from 1220 patients who had experienced out‐of‐hospital cardiac arrest in Taiwan's Taoyuan City between January 2021 and August 2023. The patients were stratified into intravenous and intraosseous groups by treatment approach and upper and lower extremity access groups by access site. The study outcomes were survival to discharge, favorable neurologic outcomes (Cerebral Performance Category score 1 or 2), and survival for >2 hours. The study groups were statistically compared before and after propensity score matching. Significant pre–propensity score matching differences were observed between intravenous and intraosseous groups, and the aforementioned study outcomes were better in the intravenous group than in the intraosseous group. However, the between‐group differences became nonsignificant after propensity score matching. Furthermore, lower extremity access and delayed epinephrine administration were associated with worse outcomes. Survival rates fell below 12.6% when time to treatment exceeded 15 minutes, particularly in the cases of intraosseous access and lower extremity access. Conclusions This study highlights the benefits of early intervention and upper extremity access for drug administration in patients with out‐of‐hospital cardiac arrest. Intraosseous access may serve as a viable alternative to intravenous access. Timely administration of essential drugs during resuscitation can improve clinical outcomes and thus has implications for emergency medical service training.

Automated external defibrillators (AEDs) are portable emergency medical devices critical for resuscitating individuals experiencing sudden cardiac arrest. The installation of AEDs in public spaces is essential for enhancing society’s emergency response capabilities. However, many cities in China currently face issues such as inadequate AEDs deployment and uneven distribution. This study aims to explore a rational layout plan for AEDs through systematic site optimization. Initially, this paper evaluates the current spatial configuration of AEDs in the central urban district of Nanjing using various spatial analysis methods. Subsequently, a coverage model is constructed to simulate the coverage capacity of potential emergency needs for new facilities, and a genetic algorithm is utilized to solve it. Finally, an AED site selection experiment is conducted, and the site selection results are discussed and analyzed in conjunction with practical conditions. The research conclusions are as follows: (1) AED distribution in Nanjing’s central urban district is clustered, with some areas lacking facilities, and the coverage rate of AEDs within 100 m and 200 m ranges is relatively low, particularly across different types of venues; and (2) the optimization experiment, with 90 new site selection points, effectively addressed AED distribution gaps, significantly improved coverage, and ameliorated the overall distribution across various public venues. This study provides a scientific basis for the rational placement of AEDs in urban public spaces through systematic analysis and optimization experiments. It enhances the efficiency of current AED deployment in the main urban areas of Nanjing and offers significant insights for the optimization of urban emergency resource allocation.

Sudden cardiac death or sudden cardiac arrest (SCD/SCA) is a major public health problem, responsible for several million victims worldwide every year. SCA survival rates are still low, around 5-10%, mostly due to delayed cardiopulmonary resuscitation and defibrillation. The advent of automated external defibrillators (AED) has allowed for quick and effective lay resuscitation. To achieve the goals of Public Access Defibrillation (PAD) project, ensuring a large number of easily available AEDs (in the US there are one million AED per 350 million people) with a large, nation-wide pool of educated and motivated lay persons/bystanders is essential. Unfortunately, over the last three decades, the AED implementation rate has remained low, with only a marginal impact on survival, since the traditional PAD concept was focused on public places, where only a fifth of SCA/SCD happens, while the majority, some 70-80%, takes place in residential environments, which are currently almost excluded from such programs. This review makes the case for PAD extension to residential areas with prompt defibrillation even with no basic life support interventions. Indeed, recent technological advances may substantially shorten the accident-defibrillation time lag, e.g. using the smartphone of a victim-bystander/rescuer – the closest AED – or drone delivery of an AED to the victim’s location. The Croatian “Restart a Heart – Save a Life” program is still an underused tool for the emergency response by individuals, organizations, and institutions, and should be reinforced and aligned with the best current evidence. [ABSTRACT FROM AUTHOR]

Aim: This meta-analysis presented the impact of pandemic Coronavirus disease-2019 on the use of the public access defibrillation (PAD) system for adult patients with out-of-hospital cardiac arrest. Materials and Methods: This study was designed as a systematic review and meta-analysis and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We systematically searched PubMed, Medline, Embase, and the Cochrane Central Register of Controlled Trials databases until January 2024. Results: This meta-analysis included 30 analyzed studies. Pooled analysis showed that activation of PAD among those two periods varied and amounted to 3.8% vs. 3.9%, respectively [odds ratio (OR)=0.77; 95% confidence interval (CI): 0.66 to 0.89; p

Faten A AlRadini,1 Abdulrahman Y Sabbagh,2 Fahad A Alamri,3 Yasir Almuzaini,4 Yousef M Alsofayan,5 Ahmed A Alahmari,4 Anas A Khan,6 Samar A Amer,7 Reem C Alanazi,8 Ibrahim F Alanazi,8 Ahmed A Shubayli,9 Rola M Alkenani,10 Bandr Mzahim,11 Nisreen Maghraby,12 Abdulaziz M Salamah,13 Muna Aljahany1 1Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2Emergency Medicine, King Fahad Medical City, Second Health Cluster, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 3Global Center of Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia, Family Medicine Department, Primary Health Center, Riyadh, Saudi Arabia; 4Global Center of Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia; 5General Directorate of Data and Research, Saudi Red Crescent Authority, Riyadh, Saudi Arabia; 6Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Department of Chronic Diseases, Ministry of Health, Riyadh, Saudi Arabia; 8Vision College of Medicine, Vision Colleges, Riyadh, Saudi Arabia; 9Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 10Department of Nephrology Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia; 11Emergency Medicine, EMS and Disaster Department, King Fahad Medical City, Riyadh, Saudi Arabia; 12Emergency Medicine Department, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 13Mohammadiah Primary Healthcare, Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Muna Aljahany, Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +966118238711, Email msaljahany@pnu.edu.saBackground: The likelihood of survival of an out-of-hospital cardiac arrest quadruples with the rapid application of basic life support (BLS). The public’s ability to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AEDs) is extremely important. This study aimed to assess the public knowledge, attitudes, and practices (KAP) of utilizing AEDs and to understand barriers to AED application.Methods: We conducted a cross-sectional study from March 1– 30, 2022. An electronic questionnaire was constructed and validated to measure the KAP for public AED utilization and its barriers.Results: Of the 406 participants, 244 (60.10%) were males. Male respondents had 17% less knowledge and poorer attitude towards using an AED as compared to female respondents. Knowledge and attitudes on using AEDs were low (70.7%) among Saudi nationals compared to those of foreign nationals. Those who were BLS/CPR trained had a 2.5 times greater understanding and willingness to use AEDs in public than those who were not. Barriers to AEDs in CPR/BLS-trained participants were: (1) accidentally hurting the victim (14.3%), (2) duty as a bystander to just call the ambulance and wait for help (12.1%), (3) never taught what to do (n = 41, 18.4%), (4) did not want to be scolded if performed wrong (3.1%), and (5) never witnessed such a situation (51.6%).Conclusion: There is a strong association between knowledge of and willingness to use AEDs in emergency situations among the public. Misconceptions about AEDs hinder their use. This calls for urgent training programs through accessible technology to reach the public.Keywords: automated external defibrillator, AED, public, cardiac arrest

Background: : Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. Objective: This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. Methods: This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri–cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Results: Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Conclusions: Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/58780 [ABSTRACT FROM AUTHOR]

Delivering an automated external defibrillator (AED) to a patient suffering from out-of-hospital cardiac arrest (OHCA) as quickly as possible is a critical task. In this field, airborne drones may help to overcome long response times, especially in mountainous regions where topography and weather pose several challenges for rescuers. Drones are considered a fast option to shorten the time to the first AED shock. This study presents insights into the safety regulations, performance, reliability and public perception of this specific drone-based application. The findings are based on field tests that focused on the operational/logistical benefits and challenges of semi-autonomous drone-based AED delivery to simulated emergency sites in mountainous terrain. The generated results underline the operational and technical feasibility of the proposed system given successful AED delivery in all simulation scenarios. Several challenges remain, such as improvements in terms of the AED pick-up, mobile phone connectivity, tracking of GPS coordinates and weather resistance of the used drone are required. Overall, the study supports paving the way for future trials and real-world implementations of drones into existing emergency response systems.

Objective: To investigate the prognostic impact of bystander-initiated cardiopulmonary resuscitation (CPR) and public-access automated external defibrillator (AED) use on non-traumatic out-of-hospital cardiac arrest (OHCA) occurring during school-supervised sports activities in children. Methods: From a nationwide database of pediatric OHCAs occurring under school supervision in Japan, data between April 2008 and December 2020 were obtained. We analyzed non-traumatic OHCAs that occurred during school-supervised sports activities among schoolchildren from elementary, junior high, high, and technical colleges. A multivariable logistic regression model was used to evaluate the effect of basic life support (BLS) on 1-month survival with favorable neurological outcomes after OHCA. Results: In total, 318 OHCA cases were analyzed. The 1-month survival with favorable neurological outcomes was 64.8% (164/253) in cases receiving both bystander-CPR and AED application, 40.7% (11/27) in cases receiving CPR only, 38.5% (5/13) in patients receiving AED application only, and 28.0% (7/25) in cases receiving no bystander intervention. Compared with cases receiving no BLS, cases receiving both CPR and AED had a significantly higher proportion of 1-month survival with favorable neurological outcomes (adjusted odds ratio [AOR]: 3.97, 95% confidence interval [CI]: 1.32–11.90, p = 0.014). However, compared to cases receiving no BLS, there was no significant difference in the outcome in the cases receiving CPR only (AOR: 1.35, 95% CI: 0.34–5.29, p = 0.671) and the cases receiving AED application only (AOR: 1.26, 95% CI: 0.25–6.38, p = 0.778). Conclusion: The combination of CPR and AED as BLS performed by bystanders for non-traumatic OHCA during school-supervised sports activities improved the outcomes.

Aims: Human exposure to high-altitude and/or low-temperature areas is increasing and cardiac arrest in these circumstances represents an increasing proportion of all treated cardiac arrests. However, little is known about the performance of automated external defibrillators (AED) in these circumstances. The objective of this study is to assess the functional and electrical features of 6 commercially available AEDs in extreme environments. Methods: Accuracy of shockable rhythm detection, the time required for self-test, rhythm analysis, and capacitor charging, together with total energy, peak voltage, peak current, and phasic duration of defibrillation waveform measured after placing the AEDs in simulated high-altitude, simulated low-temperature, and natural composite high-altitude and low-temperature environment for 30 min, were compared to those measured in the standard environment. Results: All of the shockable rhythms were correctly detected and all of the defibrillation shocks were successfully delivered by the AEDs. However, the time required for self-test, rhythm detection, and capacitor charging was shortened by 1.2% (3 AEDs, maximum 12.4%) in the simulated high-altitude environment, was prolonged by 3.6% (4 AEDs, maximum 40.8%) in the simulated low-temperature environment, and was prolonged by 4.1% (5 AEDs, maximum 52.1%) in the natural environment. Additionally, the total delivered energy was decreased by 2.5% (2 AEDs, maximum 6.8%) in the natural environment. Conclusion: All of the investigated AEDs functioned properly in simulated and natural environments, but a large variation in the functional and electrical feature change was observed. When performing cardiopulmonary resuscitation in extreme environments, the impact of environmental factors may need consideration.

Importance: Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality in the US and Europe (∼600,000 incident events annually) and around the world (∼3.8 million). With every minute that passes without cardiopulmonary resuscitation or defibrillation, the probability of survival decreases by 10%. Preliminary studies suggest that uncrewed aircraft systems, also known as drones, can deliver automated external defibrillators (AEDs) to OHCA victims faster than ground transport and potentially save lives. Objective: To date, the United States (US), Sweden, and Canada have made significant contributions to the knowledge base regarding AED-equipped drones. The purpose of this Special Communication is to explore the challenges and facilitators impacting the progress of AED-equipped drone integration into emergency medicine research and applications in the US, Sweden, and Canada. We also explore opportunities to propel this innovative and important research forward. Evidence review: In this narrative review, we summarize the AED-drone research to date from the US, Sweden, and Canada, including the first drone-assisted delivery of an AED to an OHCA. Further, we compare the research environment, emergency medical systems, and aviation regulatory environment in each country as they apply to OHCA, AEDs, and drones. Finally, we provide recommendations for advancing research and implementation of AED-drone technology into emergency care. Findings: The rates that drone technologies have been integrated into both research and real-life emergency care in each country varies considerably. Based on current research, there is significant potential in incorporating AED-equipped drones into the chain of survival for OHCA emergency response. Comparing the different environments and systems in each country revealed ways that each can serve as a facilitator or barrier to future AED-drone research. Conclusions and relevance: The US, Sweden, and Canada each offers different challenges and opportunities in this field of research. Together, the international community can learn from one another to optimize integration of AED-equipped drones into emergency systems of care.

Aim: The 2021 European Resuscitation Council (ERC) guidelines recommend two automated external defibrillators (AEDs)/km2 and at least 10 first responders/km2. We examined 1) access to AEDs and volunteer first responders in line with these guidelines and 2) its associations with socioeconomic factors and income inequality, focusing on small spatial scales. Method: We considered data on 776 AEDs in February 2022 and 1,173 out-of-hospital cardiac arrests (OHCAs) including 713 OHCA with app-alerted volunteer first responders from February to September 2022 in Berlin. We fit multilevel models to analyse AED area coverage and Poisson models to examine first responder availability across 12 districts and 536 neighbourhoods. Results: Median AED area coverage according to the 2021 ERC guidelines was 43.1% (interquartile range (IQR) 2.3–87.2) at the neighbourhood level and median number of available first responders per OHCA case was one (IQR 0.0–1.0). AED area coverage showed a positive association with average income tax per capita, with better coverage in the highest compared to the lowest quartile neighbourhoods (coefficient: 0.13, 95% confidence interval (CI): 0.01–0.25). First responder availability was not associated with income tax. AED area coverage and first responder availability were positively associated with income inequality, with better coverage (coefficient: 0.13, 95% CI: 0.04–0.23) and availability (rate ratio: 1.31, 95% CI: 1.03–1.67) in quartiles of highest as compared to lowest inequality. Conclusion: Access to resuscitation resources is neither equitable nor in accordance with the 2021 ERC guidelines. Ensuring better access necessitates understanding of socioeconomic factors and income inequality at small spatial scales.

OBJECTIVE: In Italy, only around 10% of people who experience out-of-hospital cardiac arrest (OHCA) survive. A large portion of OHCA events in public settings are characterized by an initial shockable rhythm, which requires prompt defibrillation. We aimed to create a system to quickly locate nearby public access automated external defibrillators (AEDs) on the campus of Sapienza University of Rome, the largest public university in Europe. MATERIALS AND METHODS: We developed the AED webMap through a 6-step process involving the: 1) collection of information and geographical coordinates for each AED from the university management system; 2) development of a new geolocation database; 3) integration of information contained in the new database with data provided by university departments; 4) geolocation of AEDs in the Google MyMaps environment; 5) graphic representation of all AEDs on digital map templates using specific symbols, with pop-ups containing additional information for each AED; and 6) publication of the webMap on the university website. RESULTS: The AED webMap was published on the university website (https://www.uniroma1. it/it/pagina/defibrillatori-sapienza-in-rete) and facilitates prompt identification of nearby AEDs by providing: 1) detailed AED geolocalization with interactive pop-up information for each AED, including whether the AED is located internally or externally; 2) the option to use different base maps (e.g., digital street map); 3) calculation and display of the route to reach the chosen AED; and 4) the possibility to migrate towards multiple platforms. CONCLUSIONS: The webMap can help bystanders quickly identify, locate, and reach nearby AEDs present on the campus of the largest public university in Europe, a measure that could help speed defibrillation and maximize the life-saving potential of AEDs in the event of OHCA. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The aim of our study was to determine the prehospital variables as predictors of survival outcomes in out-of-hospital cardiac arrest (OHCA) victims. Materials and Methods: This was a retrospective observational cohort study of OHCA cases. EMS protocols created in accordance with the Utstein style reporting for OHCA, first responder intervention reports, medical dispatch center dispatch protocols and hospital medical reports were all reviewed. Multivariate logistic regression was performed with the following variables: age, gender, witnessed status, location, bystander CPR, first rhythm, and etiology. Results: A total of 381 interventions with resuscitation attempts were analyzed. In more than half (55%) of them, bystander CPR was performed. Thirty percent of all patients achieved return of spontaneous circulation (ROSC), 22% of those achieved 30-day survival (7% of all OHCA victims), and 73% of those survived with Cerebral Performance Score 1 or 2. The logistic regression model of adjustment confirms that shockable initial rhythm was a predictor of ROSC [OR: 4.5 (95% CI: 2.5–8.1)] and 30-day survival [OR: 9.3 (95% CI: 2.9–29.2)]. Age was also associated (≤67 years) [OR: 3.9 (95% CI: 1.3–11.9)] with better survival. Conclusions: Elderly patients have a lower survival rate. The occurrence of bystander CPR in cardiac arrest remains alarmingly low. Shockable initial rhythm is associated with a better survival rate and neurological outcome compared with non-shockable rhythm. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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 Copenhagens 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

Abstract Aim The aim of this retrospective observational study was to determine how response intervals correlated to the experience of the community first responders (CFRs) using data collected from the Danish Island of Langeland via a global positioning system (GPS)-based system. Methods All medical emergency calls involving CFRs in the time period from 21st of April 2012 to 31st of December 2017 were included. Each emergency call activated 3 CFRs. Response intervals were calculated using the time from when the system alerted the CFRs to CFR time of arrival at the emergency site measured by GPS. CFRs response intervals were grouped depending on their level of experience according to ≤ 10, 11–24, 25–49, 50–99, ≥ 100 calls accepted and arrived on-site. Results A total of 7273 CFR activations were included. Median response interval for the CFR arriving first on-site (n = 3004) was 4:05 min (IQR 2:42–6:01) and median response interval for the arrival of the CFR with an automated external defibrillator (n = 2594) was 5:46 min (IQR 3:59–8:05). Median response intervals were 5:53 min (3:43–8:29) for ≤ 10 calls (n = 1657), 5:39 min (3:49–8:01) for 11–24 calls (n = 1396), 5:45 min (3:49–8:00) for 25–49 calls (n = 1586), 5:07 min (3:38–7:26) for 50–99 calls (n = 1548) and 4:46 min (3:14–7:32) for ≥ 100 calls (n = 1086) (p

Background and Objectives: International institutions together with the World Health Organisation recommend the teaching of BLS in schools. Therefore, the objective of this research was to study the feasibility of teaching CPR and AED through the flipped classroom, exploring the medium- and long-term retention of knowledge and practical skills among high school students. Materials and Methods: The sample consisted of 260 secondary schoolchildren (137 in the experimental group (EG) and 123 in the control group (CG)) between 12 and 14 years old (M = 12.75 ± 1.02). Results: The data revealed that the EG obtained better post-course results in the correct position of the hands (p = 0.011), the depth of external cardiac compression (p > 0.001), and the mean time to apply an effective shock with the AED (p = 0.013). The CG obtained better results in compressions with complete chest re-expansion (p = 0.025). These differences disappeared at 6 months (p > 0.05) and 12 months (p > 0.05). Conclusions: A training program based on the flipped classroom is as effective and viable as traditional training, although more efficient since it is applied in less time, in the sequence of action in BLS, CPR skills, and the application of an effective shock with an AED. [ABSTRACT FROM AUTHOR]

BACKGROUND: To evaluate whether a simplified self-instruction card can help potential rescue providers use automated external defibrillators (AEDs) more accurately and quickly. METHODS: From June 1, 2018, to November 30, 2019, a prospective longitudinal randomized controlled simulation study was conducted among 165 laypeople (18--65 years old) without prior AED training. A self-instruction card was designed to illuminate key AED operation procedures. Subjects were randomly divided into the card (n=83) and control (n=82) groups with age stratification. They were then individually evaluated in the same simulated scenario to use AED with (card group) or without the self-instruction card (control group) at baseline, post- training, and at the 3-month follow-up. RESULTS: At baseline, the card group reached a significantly higher proportion of successful defibrillation (31.1% vs. 15.9%, P=0.03), fully baring the chest (88.9% vs. 63.4%, P<0.001), correct electrode placement (32.5% vs. 17.1%, P=0.03), and resuming cardiopulmonary resuscitation (CPR) (72.3% vs. 9.8%, P<0.001). At post-training and follow-up, there were no significant differences in key behaviors, except for resuming CPR. Time to shock and time to resume CPR were shorter in the card group, while time to power-on AED was not different in each phase of tests. In the 55-65 years group, the card group achieved more skill improvements over the control group compared to the other age groups. CONCLUSION: The self-instruction card could serve as a direction for first-time AED users and as a reminder for trained subjects. This could be a practical, cost-effective way to improve the AED skills of potential rescue providers among different age groups, including seniors. [ABSTRACT FROM AUTHOR]

Training of first responders in cardiopulmonary resuscitation and the use of the automated external defibrillator should be designed to maximise retention of acquired knowledge. The objective of this study was to investigate whether the use of elearning as a supplement to face-to-face training can lead to better knowledge retention among training participants than face-to-face training alone. A quasi-experiment was conducted between May 2017 and February 2018. Both the intervention and control groups participated in two days of training (totalling ten hours). The intervention group also participated in an additional 15-minute e-learning course. The knowledge of all participants was assessed immediately after the training and six months after the training with a paper-based test. The use of an e-learning course to supplement face-to-face instruction resulted in a significant positive improvement in knowledge retention. After a period of six months, a statistically significant decrease in test scores was observed in the control group (p = 0.005), in contrast to the intervention group (p = 0.114). The use of e-learning as a supplement to face-to-face training could be a valid approach to improve knowledge retention among course participants. [ABSTRACT FROM AUTHOR]

Sudden cardiac arrest/death (SCA/D) is the leading medical cause of death in athletes. Masters athletes (≥35 years old) are increasing in numbers and are responsible for the vast majority of sport-related SCDs. Automated external defibrillators (AEDs) and emergency action plans (EAPs) have been shown to unequivocally reduce SCD, however, their prevalence in masters athletics remains unknown. We sought to identify the perceived AED accessibility and EAP preparedness amongst a group of masters athletes. A 40-item survey was sent to 735 master athletes identified through the Masters Athlete Screening Study. Participants were athletes with no known significant cardiac history. The survey inquired on the availability and location of AEDs within exercise settings, the presence of EAPs, and participants' cardiac concerns. Sixty-eight percent of athletes completed the survey. Ninety-seven percent and 99% of athletes believed CPR and AEDs were effective at saving lives, respectively. Thirty-eight percent of athletes were aware of an AED in proximity to where they exercise, with 40% aware of one available during competition events, and 28% during training events. Only 10% of athletes were aware of an EAP active in their place of exercise. Half of the athletes perceive their risk of cardiac arrest during exercise to be ≤0.5 in 100,000. These findings indicate that nearly all athletes believe CPR and AED are effective at saving lives, but only a minority are aware of an AED near their place of exercise, with even fewer aware of an active EAP. Master athletes underestimate their own risk for exercise-related cardiac events, affirming the importance of educating masters athletes on their increased cardiac risk and the importance of EAPs. [ABSTRACT FROM AUTHOR]

In Japan, the number of automated external defibrillators (AEDs) installed in public spaces is increasing, but the use of AEDs for cardiopulmonary arrest (CPA) injuries and illnesses remains extremely limited. In this study, we used a geographic information system (GIS) to analyze the extent to which existing public access defibrillation system is able to capture CPA casualties in terms of space and time, based on information on the location and time of the CPA cases obtained from emergency records. In addition, we identified changes in accessibility when new AEDs were installed at post office ATMs in addition to existing AEDs. The results demonstrated that AED accessibility is significantly related not only to the constraint of the spatial proximity of AEDs, but also to the constraint of whether the time of CPA occurred was within the available time of the nearby AEDs. It also became clear that increasing the number of AEDs would only improve accessibility to a limited extent as long as time constraints existed. [ABSTRACT FROM AUTHOR]

Aim: The aim of this retrospective observational study was to determine how response intervals correlated to the experience of the community first responders (CFRs) using data collected from the Danish Island of Langeland via a global positioning system (GPS)-based system. Methods: All medical emergency calls involving CFRs in the time period from 21st of April 2012 to 31st of December 2017 were included. Each emergency call activated 3 CFRs. Response intervals were calculated using the time from when the system alerted the CFRs to CFR time of arrival at the emergency site measured by GPS. CFRs response intervals were grouped depending on their level of experience according to ≤ 10, 11–24, 25–49, 50–99, ≥ 100 calls accepted and arrived on-site. Results: A total of 7273 CFR activations were included. Median response interval for the CFR arriving first on-site (n = 3004) was 4:05 min (IQR 2:42–6:01) and median response interval for the arrival of the CFR with an automated external defibrillator (n = 2594) was 5:46 min (IQR 3:59–8:05). Median response intervals were 5:53 min (3:43–8:29) for ≤ 10 calls (n = 1657), 5:39 min (3:49–8:01) for 11–24 calls (n = 1396), 5:45 min (3:49–8:00) for 25–49 calls (n = 1586), 5:07 min (3:38–7:26) for 50–99 calls (n = 1548) and 4:46 min (3:14–7:32) for ≥ 100 calls (n = 1086) (p < 0.001). There was a significant negative correlation between experience and response intervals (p < 0.001, Spearman's rho = -0.0914). Conclusion: This study found an inverse correlation between CFR experience and response intervals, which could lead to increased survival after a time-critical incident. [ABSTRACT FROM AUTHOR]

Background: Sudden cardiac death (SCD) during physical exercise is devastating. Aims: To evaluate causes and circumstances of exercise‐related SCD in the young in Australia. Methods: We reviewed the National Coronial Information System database for deaths in Australia relating to cardiovascular disease in cases aged 10–35 years between 2000 and 2016. Cases who had undertaken physical exercise at the time of the event were included. We collected demographics, circumstances of death, type of physical exercise, bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival. Results: Over a 17‐year period, 1925 SCD cases were identified, of which 110 (6%) cases (median age 27 years (interquartile range 21–32 years); 92% male) were related to sports/physical exercise. Thirteen (12%) cases occurred in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Among Aboriginal and Torres Strait Islanders (n = 10), all deaths were related to CAD. Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequent physical exercise activities. Prior symptoms were present in 39% (chest pain 37%, pre‐syncope/syncope 26%). Most (87%) were witnessed, with bystander CPR in 70%. AED use prior to ambulance arrival was 8%. Conclusions: The present study demonstrates the high occurrence of CAD and SADS in SCD in the young related to physical exercise. Aboriginal and Torres Strait Islanders were disproportionately affected by CAD. Although events were commonly witnessed, AED was seldom used prior to ambulance arrival and highlights an important opportunity to improve outcomes in the post‐arrest chain of survival. [ABSTRACT FROM AUTHOR]