title: Expanding the first link in the chain of survival - Experiences from dispatcher referral of callers to AED locations.
abstract: Early use of automated external defibrillators (AED) increases survival in cases of out-of-hospital cardiac arrest (OHCA). Dispatchers play important roles in identifying OHCA, dispatching ambulances and providing callers with telephone-assisted cardiopulmonary resuscitation. Guidelines recommend that AED registries be linked to dispatch centres as tools to refer callers to nearby AED.
  
  
  
  The aim of this study was to investigate to what extent dispatchers, when provided with a tool to display AED locations and accessibility, referred callers to nearby AED.
  
  
  
  An application providing real-time visualization of AED locations and accessibility was implemented at four dispatch centres in Sweden. Dispatchers were instructed to refer callers to nearby AED when OHCA was suspected. Such cases were prospectively collected, and geographic information systems were used to identify those located ≤100m from an AED. Audio recordings of emergency calls were assessed to evaluate the AED referral rate.
  
  
  
  Between February and August 2014, 3009 suspected OHCA calls were received. In 6.6% of those calls (200/3009), an AED was ≤100m from the suspected OHCA. The AED was accessible and the caller was not alone on scene in 24% (47/200) of these cases. In two of those 47 cases (4.3%), the dispatcher referred the caller to the AED.
  
  
  
  Despite a tool for dispatchers to refer callers to a nearby AED, referral was rare. Only a minority of the suspected OHCA cases occurred ≤100m from an AED. We identified AED accessibility and callers being alone on scene as obstacles for AED referral.
authors.affiliation: Karolinska Institutet, Center for Resuscitation Science, Department of Medicine, Solna and Unit of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden. Electronic address: david.a.fredman@ki.se.
authors.forename: David
authors.initials: D
authors.lastname: Fredman
authors.affiliation: Karolinska Institutet, Center for Resuscitation Science, Department of Medicine, Solna and Unit of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.affiliation: KTH - Royal Institute of Technology, Department of Urban Planning & Environment, Division of Geoinformatics, Stockholm, Sweden.
authors.forename: Yifang
authors.initials: Y
authors.lastname: Ban
authors.affiliation: Karolinska Institutet, Center for Resuscitation Science, Department of Medicine, Solna and Unit of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Jonsson
authors.affiliation: Karolinska Institutet, Center for Resuscitation Science, Department of Medicine, Solna and Unit of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Jacob
authors.initials: J
authors.lastname: Hollenberg
authors.affiliation: Karolinska Institutet, Center for Resuscitation Science, Department of Medicine, Solna and Unit of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Nordberg
authors.affiliation: Karolinska Institutet, Center for Resuscitation Science, Department of Medicine, Solna and Unit of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Ringh
authors.affiliation: Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, SE-182 88 Stockholm, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.affiliation: SOS Alarm AB, SE-113 57 Stockholm, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Lundén
authors.affiliation: Karolinska Institutet, Center for Resuscitation Science, Department of Medicine, Solna and Unit of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Claesson
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods; D047548:Defibrillators / Q000706:statistics & numerical data*; D000071820:Emergency Medical Dispatch / Q000379:methods*; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration; D040362:Geographic Information Systems / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care; D013548:Sweden / Q000453:epidemiology; D013637:Tape Recording / Q000379:methods; D061665:Time-to-Treatment / Q000706:statistics & numerical data
keywords: AED; Cardiopulmonary resuscitation; Defibrillation; Dispatch centre; Dispatcher; Out-of-hospital cardiac arrest