Ranking Businesses and Municipal Locations by Spatiotemporal Cardiac Arrest Risk to Guide Public Defibrillator Placement

Abstract

Background Efforts to guide automated external defibrillator (AED) placement for out-of-hospital cardiac arrest (OHCA) treatment have focused on identifying broadly defined location categories without considering hours of operation. Broad location categories may be composed of many businesses with varying accessibility. Identifying specific locations for AED deployment incorporating operating hours and time of OHCA occurrence may improve AED accessibility. We aim to identify specific businesses and municipal locations that maximize OHCA coverage based on spatiotemporal assessment of OHCA risk in the immediate vicinity of franchise locations. Methods This study was a retrospective population-based cohort study using data from the Toronto Regional RescuNET Epistry cardiac arrest database. We identified all non-traumatic public OHCAs occurring in Toronto, Canada from Jan. 2007–Dec. 2015. We identified 41 unique businesses and municipal location types with 20 or more locations in Toronto from the YellowPages, Canadian Franchise Association, and the City of Toronto Open Data Portal. We obtained their geographic coordinates and hours of operation from websites, phone, or in-person. We determined the number of OHCAs that occurred within 100 m of each location when it was open (spatiotemporal coverage) for Toronto overall and downtown. The businesses and municipal locations were then ranked by spatiotemporal OHCA coverage. To evaluate temporal stability of the rankings, we calculated intra-class correlation (ICC) of the annual coverage values. Results There were 2,654 non-traumatic public OHCAs. Tim Hortons ranked first in Toronto covering 286 OHCAs. Starbucks ranked first in downtown covering 110 OHCAs. Coffee shops and bank machines from the five largest Canadian banks occupied eight of the top 10 spots in both Toronto and downtown. The rankings exhibited high temporal stability with ICC values of 0.88 (95% CI, 0.83–0.93) in Toronto and 0.79 (95% CI, 0.71–0.86) in downtown. Conclusions We identified and ranked businesses and municipal locations by spatiotemporal OHCA risk in their immediate vicinity. This approach may help policy makers and funders to identify and prioritize potential partnerships for AED deployment in public access defibrillator programs.

Year in Review in Cardiac Electrophysiology

“…Determining where to place AEDs in strategic downtown locations can be challenging. Sun et al 25 sought to identify locations in the city of Toronto for potential AED placement by assessing spatiotemporal cardiac arrest risk at these locations. By using the Toronto Regional RescuNET Epistry cardiac arrest database, they found that coffee shops and bank machines from the 5 largest Canadian banks occupied 8 of the top 10 locations in Toronto.…”

Spatiotemporal AED optimization is generalizable

“…Consequently, much effort has focused on implementing public access defibrillator (PAD) programs and developing guidelines for strategic AED placement, which recommend AEDs be placed in high-risk areas and be easily reachable within a few minutes [7,8]. Prior research has focused on quantifying OHCA risk in different location types in cities worldwide, demonstrating generalizability of many of the findings [3,6,[9][10][11][12][13][14]. For example, transportation and recreation facilities have been established in multiple studies as high-risk areas that can benefit from AED placement [3,6,9,15].…”

Public location and survival from out-of-hospital cardiac arrest in the public-access defibrillation era in Japan

“…A study on specific locations for AED deployment in Canada identified spatiotemporally better areas (e.g. coffee shops or banks) to cover OHCAs in public locations [26]. Therefore, further deployment of public-access AEDs and CPR training for staff in such high-risk areas is warranted to shorten the time to shock and improve outcomes after OHCA.…”