Development of a US Development of a US National Model for AED National Model for AED

Placement in Rural AreasPlacement in Rural Areas

Greg Mears, M.D.Greg Mears, M.D.11

N. Clay Mann Ph.D., M.S.N. Clay Mann Ph.D., M.S.22

J. Michael Dean, M.D., M.B.A.J. Michael Dean, M.D., M.B.A.22

1University of North Carolina, Chapel Hill2University of Utah School Of Medicine, IICRC

IntroductionIntroductionDevelopment of AEDsDevelopment of AEDs

AEDs greatly expand the availability of AEDs greatly expand the availability of

defibrillatory shockdefibrillatory shock

AED placement in rural areas remains perplexingAED placement in rural areas remains perplexing

Out of Hospital Cardiac Arrests are rare and Out of Hospital Cardiac Arrests are rare and

unpredictableunpredictable

Populations are dispersedPopulations are dispersed

Bystander assistance is less commonBystander assistance is less common

EMS response times are variable and longEMS response times are variable and long

ObjectiveObjective

Develop a rural AED placement model based Develop a rural AED placement model based upon the mathematical evaluation of variables upon the mathematical evaluation of variables found to correlate with successful AED found to correlate with successful AED programsprograms

MethodsMethods

Study Design:Study Design: Literature SearchLiterature Search Risk-factor AnalysisRisk-factor Analysis

U.S. 2000 census dataU.S. 2000 census data CDC heart disease mortality dataCDC heart disease mortality data

Population:Population: Rural census tracts within 50 statesRural census tracts within 50 states

MethodsMethods

MeasurementsMeasurements Estimate of Cardiac Arrest rate for each census tractEstimate of Cardiac Arrest rate for each census tract

0.5 Cardiac Arrests/1,000 people/1 year0.5 Cardiac Arrests/1,000 people/1 year Risk adjustmentRisk adjustment

Demographic variables & heart disease mortalityDemographic variables & heart disease mortality AED service areaAED service area

MethodsMethods

Analysis:Analysis: Potential for AED usePotential for AED use Expected number of CA per AED (1 yr.)Expected number of CA per AED (1 yr.) Expected number of CA per AED (5 yrs.)Expected number of CA per AED (5 yrs.) Cost per life saved (initial equipment only)Cost per life saved (initial equipment only)

ResultsResults

Results:Results: Rural AED Literature RetrievalRural AED Literature Retrieval

AED Placement on emergency vehiclesAED Placement on emergency vehicles Minimum population densityMinimum population density Older populationOlder population Affluent communitiesAffluent communities

ResultsResults

ResultsResults

ResultsResults

ResultsResults

Intermountain Injury Control Research Center

ResultsResults

1 Arrest / AED / Yr1 Arrest / AED / Yr 11,946 AEDs Required11,946 AEDs Required $29.8 million dollars$29.8 million dollars

1 Arrest / AED / 5 Yr1 Arrest / AED / 5 Yr 17,417 AEDs Required17,417 AEDs Required $43.5 million dollars$43.5 million dollars

Cost per life SavedCost per life Saved 5% Survival Rate5% Survival Rate

US = $23,692 / LSavedUS = $23,692 / LSaved NC = $19,168 / LSavedNC = $19,168 / LSaved UT = $23,243 / LSavedUT = $23,243 / LSaved

* Calculation based on $2,500/AED (not including training or implementation cost)

ConclusionsConclusions

Literature Review FindingsLiterature Review Findings Placement among “first responders”Placement among “first responders” Population density and coordinated emergency Population density and coordinated emergency

systemsystem

Modeling ResultsModeling Results Predicted risk of CA (potential AED use)Predicted risk of CA (potential AED use) Number of AEDs requiredNumber of AEDs required

LimitationsLimitations

Generalizing to Census TractsGeneralizing to Census Tracts

Uniformity of AED Service AreasUniformity of AED Service Areas

Variable Death Rates in Rural CountiesVariable Death Rates in Rural Counties

Ambiguous Nature of the ModelAmbiguous Nature of the Model

Questions ?Questions ?

Funding for this project was provided by the US Office of Rural Health Policy