title: Identifying locations for public access defibrillators using mathematical optimization.
abstract: BACKGROUND
  Geospatial methods using mathematical optimization to identify clusters of cardiac arrests and prioritize public locations for defibrillator deployment have not been studied. Our objective was to develop such a method and test its performance against a population-guided approach.
  
  
  RESULTS
  All public location cardiac arrests in Toronto, Ontario, Canada, from December 16, 2005, to July 15, 2010, and all automated external defibrillator (AED) locations registered with Toronto Emergency Medical Services as of September 2009 were plotted geographically. Current AED coverage was quantified by determining the number of cardiac arrests occurring within 100 m of a registered AED. Clusters of cardiac arrests without a registered AED within 100 m were identified. With the use of mathematical optimization techniques, cardiac arrest coverage improvements were computed and shown to be superior to results from a population-guided deployment method. There were 1310 eligible public location cardiac arrests and 1669 registered AEDs. Of the eligible cardiac arrests, 304 were within 100 m of at least 1 registered AED (23% coverage). The average distance from a cardiac arrest to the closest AED was 281 m. With AEDs deployed in the top 30 locations, an additional 112 historical cardiac arrests would be covered (32% total coverage), and the average distance to the closest AED would be 262 m.
  
  
  CONCLUSIONS
  Geographic clusters of cardiac arrests can be easily identified and prioritized with the use of mathematical modeling. Optimized AED deployment can increase cardiac arrest coverage and decrease the distance to the closest AED. Mathematical modeling can augment public AED deployment programs.
authors.affiliation: Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada. tcychan@mie.utoronto.ca
authors.forename: Timothy C Y
authors.initials: TC
authors.lastname: Chan
authors.forename: Heyse
authors.initials: H
authors.lastname: Li
authors.forename: Gerald
authors.initials: G
authors.lastname: Lebovic
authors.forename: Sabrina K
authors.initials: SK
authors.lastname: Tang
authors.forename: Joyce Y T
authors.initials: JY
authors.lastname: Chan
authors.forename: Horace C K
authors.initials: HC
authors.lastname: Cheng
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
authors.forename: Steven C
authors.initials: SC
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000592:standards / Q000706:statistics & numerical data*; D047548:Defibrillators / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009864:Ontario / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies