title: Defibrillation in rural areas.
abstract: OBJECTIVE
  Automated external defibrillation (AED) and public access defibrillation (PAD) have become cornerstones in the chain of survival in modern cardiopulmonary resuscitation. Most studies of AED and PAD have been performed in urban areas, and evidence is scarce for sparsely populated rural areas. The aim of this review was to review the literature and discuss treatment strategies for out-of-hospital cardiac arrest in rural areas.
  
  
  METHODS
  A Medline search was performed with the keywords automated external defibrillation (617 hits), public access defibrillation (256), and automated external defibrillator public (542). Of these 1415 abstracts and additional articles found by manually searching references, 92 articles were included in this nonsystematic review.
  
  
  RESULTS
  Early defibrillation is crucial for survival with good neurological outcome after cardiac arrest. Rapid defibrillation can be a challenge in sparsely populated and remote areas, where the incidence of cardiac arrest is low and rescuer response times can be long. The few studies performed in rural areas showed that the introduction of AED programs based on a 2-tier emergency medical system, consisting of Basic Life Support and Advanced Life Support teams, resulted in a decrease in collapse-to-defibrillation times and better survival of patients with out-of-hospital cardiac arrest.
  
  
  CONCLUSIONS
  In rural areas, introducing AED programs and a 2-tier emergency medical system may increase survival of out-of-hospital cardiac arrest patients. More studies on AED and PAD in rural areas are required.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria. Electronic address: mathias.stroehle@uki.at.
authors.forename: Mathias
authors.initials: M
authors.lastname: Ströhle
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; International Commission for Mountain Emergency Medicine, ICAR MEDCOM. Electronic address: peter.paal@uki.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Paal
authors.affiliation: International Commission for Mountain Emergency Medicine, ICAR MEDCOM; EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy. Electronic address: giacomo.strapazzon@eurac.edu.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Strapazzon
authors.affiliation: EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy. Electronic address: giovanni.avancini@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Avancini
authors.affiliation: EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy. Electronic address: emily.procter@eurac.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Procter
authors.affiliation: International Commission for Mountain Emergency Medicine, ICAR MEDCOM; EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy. Electronic address: hermann.brugger@eurac.edu.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brugger
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D047548:Defibrillators; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*