title: The Northern Ireland Public Access Defibrillation (NIPAD) study: effectiveness in urban and rural populations.
abstract: OBJECTIVE
  To assess the impact of mobile automated external defibrillators (AEDs) on out-of-hospital cardiac arrests (OHCAs) in urban and rural populations.
  
  
  METHODS
  Prospective before and after intervention, population study.
  
  
  METHODS
  Urban and rural areas of 160,000 each. Patients, interventions and
  
  
  METHODS
  In 2004-6 the demographics of OHCAs were assessed. In 2005-6 AEDs were deployed (29 urban, 53 rural): 335 urban first responders (FRs) and 493 rural FRs were trained in AED use and dispatched to OHCAs. Call-to-response interval (CRI), resuscitation and survival-to-discharge rates for OHCA were compared.
  
  
  RESULTS
  In 2004 there were 163 urban OHCAs and the emergency medical services (EMS) attended 158 (ventricular fibrillation (VF) 27/158 (17.1%)). In 2005-6 there were 226 OHCAs, EMS attended 216 (VF 30/216 (13.9%)). In 2005-6 FRs were paged to 128 OHCAs (56.6%), FRs attended 88/128 (68.8%): 18/128 (14.1%) reached before the EMS. The best combined FR/EMS mean (SD) CRI in 2005-6 (5 min 56 s (4)) was better than the EMS alone in 2004 (7 min (3); p = 0.002). Survival rate was 5.1% in 2004, 1.4% in 2005-6 (p = NS). In 2004 there were 131 rural OHCAs, EMS attended 121 (VF 19/121 (15.7%)). In 2005-6 there were 122 OHCAs, EMS attended 114 (VF 19/114 (16.7%)). In 2005-6 FRs were paged to 49 OHCAs, FRs attended 42/49 (85.7%): 23/49 (46.9%) reached before the EMS. The best combined FR/EMS mean (SD) CRI in 2005-6 (9 min 22 s (6)) was better than the EMS alone in 2004 (11 min 2 s (6); p = 0.018). Survival rate was 2.5% in 2004, 3.5% in 2005-6 (p = NS).
  
  
  CONCLUSIONS
  Despite improvement in CRI there was no impact on survival (witnessed arrest 32.8%, VF 15.6%).
  
  
  BACKGROUND
  ISRCTN07286796.
authors.affiliation: Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland. Jennifer.adgey@belfasttrust.hscni.net
authors.forename: M J
authors.initials: MJ
authors.lastname: Moore
authors.forename: A J
authors.initials: AJ
authors.lastname: Hamilton
authors.forename: K J
authors.initials: KJ
authors.lastname: Cairns
authors.forename: A
authors.initials: A
authors.lastname: Marshall
authors.forename: B M
authors.initials: BM
authors.lastname: Glover
authors.forename: C J
authors.initials: CJ
authors.lastname: McCann
authors.forename: J
authors.initials: J
authors.lastname: Jordan
authors.forename: F
authors.initials: F
authors.lastname: Kee
authors.forename: A A J
authors.initials: AA
authors.lastname: Adgey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047548:Defibrillators / Q000600:supply & distribution*; D004554:Electric Countershock / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D009660:Northern Ireland; D012423:Rural Health; D014504:Urban Health