Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest.
BACKGROUND
Disappointing survival rates from out-of-hospital cardiac arrests encourage strategies for faster defibrillation, such as use of automated external defibrillators (AEDs) by nonconventional responders.


RESULTS
AEDs were provided to all Miami-Dade County, Florida, police. AED-equipped police (P-AED) and conventional emergency medical rescue (EMS) responders are simultaneously deployed to possible cardiac arrests. Times from 9-1-1 contact to the scene were compared for P-AED and concurrently deployed EMS, and both were compared with historical EMS experience. Survival with P-AED was compared with outcomes when EMS was the sole responder. Among 420 paired dispatches of P-AED and EMS, the mean+/-SD P-AED time from 9-1-1 call to arrival at the scene was 6.16+/-4.27 minutes, compared with 7.56+/-3.60 minutes for EMS (P<0.001). Police arrived first to 56% of the calls. The time to first responder arrival among P-AED and EMS was 4.88+/-2.88 minutes (P<0.001), compared with a historical response time of 7.64+/-3.66 minutes when EMS was the sole responder. A 17.2% survival rate was observed for victims with ventricular fibrillation or pulseless ventricular tachycardia (VT/VF), compared with 9.0% for standard EMS before P-AED implementation (P=0.047). However, VT/VF benefit was diluted by the observation that 61% of the initial rhythms were nonshockable, reducing the absolute survival benefit among the total study population to 1.6% (P-AED, 7.6%; EMS, 6.0%).


CONCLUSIONS
P-AED establishes a layer of responders that generate improved response times and survival from VT/VF. There was no benefit for victims with nonshockable rhythms.
Division of Cardiology, University of Miami School of Medicine, Miami, Fla 33101, USA. rmyerbur@med.miami.edu
Robert J
RJ
Myerburg
Jeffrey
J
Fenster
Mauricio
M
Velez
Donald
D
Rosenberg
Shenghan
S
Lai
Paul
P
Kurlansky
Starbuck
S
Newton
Melenda
M
Knox
Agustin
A
Castellanos
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods / Q000639:trends; D003142:Communication; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D004554:Electric Countershock / Q000706:statistics & numerical data / Q000639:trends*; D004632:Emergency Medical Services / Q000458:organization & administration / Q000639:trends; D004869:Equipment Safety; D005260:Female; D005431:Florida; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D016495:Police / Q000458:organization & administration / Q000639:trends*; D012111:Residence Characteristics; D012151:Resuscitation / Q000706:statistics & numerical data; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome