title: Population movement and sudden cardiac arrest location.
abstract: BACKGROUND
  Although the benefits of automatic external defibrillators are undeniable, their effectiveness could be dramatically improved. One of the key issues is the disparity between the locations of automatic external defibrillators and sudden cardiac arrests (SCAs).
  
  
  RESULTS
  From emergency medical services and other Parisian agencies, data on all SCAs occurring in public places in Paris, France, were prospectively collected between 2000 and 2010 and recorded using 2020 grid areas. For each area, population density, population movements, and landmarks were analyzed. Of the 4176 SCAs, 1255 (30%) occurred in public areas, with a highly clustered distribution of SCAs, especially in areas containing major train stations (12% of SCAs in 0.75% of the Paris area). The association with population density was poor, with a nonsignificant increase in SCAs with population density (P=0.4). Occurrence of public SCAs was, in contrast, highly associated with population movements (P<0.001). In multivariate analysis including other landmarks in each grid cell in the model and demographic characteristics, population movement remained significantly associated with the occurrence of SCA (odds ratio, 1.48; 95% confidence interval, 1.34-1.63; P<0.0001), as well as grid cells containing train stations (odds ratio, 3.80; 95% confidence interval, 2.66-5.36; P<0.0001).
  
  
  CONCLUSIONS
  Using a systematic analysis of determinants of SCA in public places, we demonstrated the extent to which population movements influence SCA distribution. Our findings also suggested that beyond this key risk factor, some areas are dramatically associated with a higher risk of SCA.
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.). eloi_marijon@yahoo.fr.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Wulfran
authors.initials: W
authors.lastname: Bougouin
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Nicole
authors.initials: N
authors.lastname: Karam
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Jost
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Frankie
authors.initials: F
authors.lastname: Beganton
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Patricia
authors.initials: P
authors.lastname: Pelloux
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Hervé
authors.initials: H
authors.lastname: Degrange
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Guillaume
authors.initials: G
authors.lastname: Béal
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Tourtier
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Albert A
authors.initials: AA
authors.lastname: Hagège
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Michel
authors.initials: M
authors.lastname: Desnos
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: David S
authors.initials: DS
authors.lastname: Celermajer
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.affiliation: From Université Paris Descartes, France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., A.H., J.-Y.L.H., M.D., F.D., C.S., A.C., X.J.); Paris Cardiovascular Research Center (PARCC-Inserm U970), France (E.M., W.B., M.T., N.K., L.L., F.B., G.B., F.D., C.S., A.C., X.J.); Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France (E.M., N.K., A.H., J.-Y.L.H., M.D., C.S., X.J.); Département de Réanimation Médicale, Hôpital Cochin, Paris, France (W.B., A.C.); Service Médical d'Urgence-Brigade de Sapeurs-Pompiers de Paris, France (D.J., H.D., J.-P.T.); Service d'Aide Médicale Urgente de Paris (SAMU 75), France (L.L.); Atelier d'Urbanisme Parisien, Paris, France (P.P.); Département des Urgences, Hôpital Cochin, Paris, France (F.D.); and Sydney Medical School, Australia (D.S.C.).
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D047548:Defibrillators / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D003710:Demography; D004554:Electric Countershock / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology* / Q000628:therapy; D010297:Paris / Q000453:epidemiology; D011446:Prospective Studies; D011633:Public Facilities; D012307:Risk Factors; D013997:Time Factors; D014505:Urban Population; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000628:therapy
keywords: cardiopulmonary resuscitation; death, sudden, cardiac; defibrillators; heart arrest