title: Determining risk for out-of-hospital cardiac arrest by location type in a Canadian urban setting to guide future public access defibrillator placement.
abstract: OBJECTIVE
  Automated external defibrillator use by lay bystanders during out-of-hospital cardiac arrest rarely occurs but can improve survival. We seek to estimate risk for out-of-hospital cardiac arrest by location type and evaluate current automated external defibrillator deployment in a Canadian urban setting to guide future automated external defibrillator deployment.
  
  
  METHODS
  This was a retrospective analysis of a population-based out-of-hospital cardiac arrest database. We included consecutive public location, nontraumatic, out-of-hospital cardiac arrests occurring in Toronto from January 1, 2006, to June 30, 2010, captured in the Resuscitation Outcomes Consortium Epistry database. Two investigators independently categorized each out-of-hospital cardiac arrest and automated external defibrillator location into one of 38 categories. Total site counts in each location category were used to estimate average annual per-site cardiac arrest incidence and determine the relative automated external defibrillator coverage for each location type.
  
  
  RESULTS
  There were 608 eligible out-of-hospital cardiac arrest cases. The top 5 location categories by average annual out-of-hospital cardiac arrests per site were race track/casino (0.67; 95% confidence interval [CI] 0 to 1.63), jail (0.62; 95% CI 0.3 to 1.06), hotel/motel (0.15; 95% CI 0.12 to 0.18), hostel/shelter (0.14; 95% CI 0.067 to 0.19), and convention center (0.11; 95% CI 0 to 0.43). Although schools were relatively lower risk for cardiac arrest, they represented 72.5% of automated external defibrillator-covered locations in the study region. Some higher-risk location types such as hotel/motel, hostel/shelter, and rail station were severely underrepresented with respect to automated external defibrillator coverage.
  
  
  CONCLUSIONS
  We have identified types of locations with higher per-site risk for cardiac arrest relative to others. We have also identified potential mismatches between cardiac arrest risk by location type and registered automated external defibrillator distribution in a Canadian urban setting.
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada. brookss1@kgh.kari.net
authors.forename: Steven C
authors.initials: SC
authors.lastname: Brooks
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Hsu
authors.forename: Sabrina K
authors.initials: SK
authors.lastname: Tang
authors.forename: Roshan
authors.initials: R
authors.lastname: Jeyakumar
authors.forename: Timothy C Y
authors.initials: TC
authors.lastname: Chan
mesh_terms: D002170:Canada; D047548:Defibrillators / Q000600:supply & distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology* / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data*