An observational study describing the geographic-time distribution of cardiac arrests in Singapore: what is the utility of geographic information systems for planning public access defibrillation? (PADS Phase I).
BACKGROUND
Public access defibrillation (PAD) has shown potential to increase cardiac arrest survival rates.


OBJECTIVE
To describe the geographic epidemiology of prehospital cardiac arrest in Singapore using geographic information systems (GIS) technology and assess the potential for deployment of a PAD program.


METHODS
We conducted an observational prospective study looking at the geographic location of pre-hospital cardiac arrests in Singapore. Included were all patients with out-of-hospital cardiac arrest (OHCA) presented to emergency departments. Patient characteristics, cardiac arrest circumstances, emergency medical service (EMS) response and outcomes were recorded according to the Utstein style. Location of cardiac arrests was spot-mapped using GIS.


RESULTS
From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Mean age for arrests was 60.6 years with 68.0% male. 67.8% of arrests occurred in residences, with 54.5% bystander witnessed and another 10.5% EMS witnessed. Mean EMS response time was 9.6 min with 21.7% receiving prehospital defibrillation. Cardiac arrest occurrence was highest in the suburban town centers in the Eastern and Southern part of the country. We also identified communities with the highest arrest rates. About twice as many arrests occurred during the day (07:00-18:59 h) compared to night (19:00-06:59 h). The categories with the highest frequencies of occurrence included residential areas, in vehicles, healthcare facilities, along roads, shopping areas and offices/industrial areas.


CONCLUSIONS
We found a definite geographical distribution pattern of cardiac arrest. This study demonstrates the utility of GIS with a national cardiac arrest database and has implications for implementing a PAD program, targeted CPR training, AED placement and ambulance deployment.
Ong
Marcus Eng Hock
ME
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore. marcus.ong.e.h@sgh.com.sg
Tan
Eng Hoe
EH
Yan
Xiuyuan
X
Anushia
P
P
Lim
Swee Han
SH
Leong
Benjamin Sieu-Hon
BS
Ong
Victor Yeok Kein
VY
Tiah
Ling
L
Yap
Susan
S
Overton
Jerry
J
Anantharaman
V
V
D047548:Defibrillators; D004554:Electric Countershock; D005260:Female; D040362:Geographic Information Systems; D006285:Health Planning / Q000379:methods*; D006297:Health Services Accessibility; D006323:Heart Arrest / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology