Title: Optimisation of the Deployment of Automatic External Defibrillators in Public Places in England.
Funder: Department of Health and Social Care

Abstract: BACKGROUND_x000D_ _x000D_ NHS Ambulance Services treat around 30,000 people whose hearts suddenly stop each year. This is a condition known as cardiac arrest. Despite ambulance services best efforts less than one in ten (10%) survive. Electric shock treatment, known as defibrillation, is one of the most effective treatments. If an electric shock is given within a few minutes of the heart stopping, over half the people treated (50%) survive. The more time that passes before the electric shock is given the less effective it is. It takes an ambulance on average 8 minutes to get to someone whose heart has stopped. This is too late in many cases to save the patient’s life. It is now possible for members of the public to use an automatic machine (defibrillator) to safely give an electric shock to the heart. In order for the public to make best use of these machines, they need to be in the right places._x000D_ _x000D_ AIMS_x000D_ _x000D_ This project will work out where the best places to put electric shock machines (defibrillators) in our communities. This will make them more accessible and should save more lives._x000D_ _x000D_ DESIGN _x000D_ _x000D_ We have collected information about where people have cardiac arrest over the course of the last 5 years. This is a good marker for where people will have cardiac arrests in future years. We will compare where cardiac arrests occurred with the locations of the defibrillators. From this we can work out how much of the country is covered by defibrillators. We will see if there are better ways of deciding where to put the defibrillators. For example they could be placed according to:_x000D_ • Particular building types (e.g. schools, coffee shops);_x000D_ • Places where lots of people go (e.g. shopping centres, railway stations);_x000D_ • Divide the country up into small squares with a defibrillator placed in each square; or_x000D_ • Use a computer to model the best locations. _x000D_ _x000D_ There is a limited amount of money that the country spends on defibrillators each year (it was £2-5 million a year for the last 2 years). We will work out which of these ways will save most lives and give the best value for money._x000D_ _x000D_ PATIENT AND PUBLIC INVOLVEMENT_x000D_ _x000D_ We have worked closely with members of the public to develop this project. We will continue to work closely with patients, public, and charitable organisations, to ensure their views are fully included in the project. We are very fortunate to have an experienced user representative as part of our team. He has personal experience of losing someone in similar circumstances. He will work with our team and a group of patients and members of the public to guide the design, interpretation and communication of the research. Together this team will play an important role in developing the final recommendations._x000D_ _x000D_ DISSEMINATION_x000D_ _x000D_ Our team has experience of working with key people and organisations interested in improving survival from cardiac arrest. _x000D_ _x000D_ We will summarise the findings of this project in talks and written reports. We will work with key organisations who are responsible for deciding where defibrillators are placed in the community including charities. _x000D_ _x000D_ We will talk to Ambulance Services and those who organise healthcare (NHS England). Our press and communications teams will help us share our findings with the wider community. This will ensure the findings of this research are used to improve patient care.

Lay abstract: RESEARCH QUESTION_x000D_ _x000D_ What is the optimal location for public access automatic external defibrillators (AED) that would make them available to treat a patient having an out-of-hospital cardiac arrest (OHCA) promptly?_x000D_ _x000D_ BACKGROUND_x000D_ _x000D_ Use of AEDs by bystanders on OHCAs improves the chances of survival significantly. AEDs have been placed in public locations but their placement in the community is not optimised. This in part explains the low rate their use (<5% of cases)._x000D_ _x000D_ AIM_x000D_ _x000D_ To optimise the placement of public-access AEDs in England, using mathematical modelling techniques, to maximise the likelihood that an individual suffering an OHCA will have access to PAD, improving their chances of survival. To assess the cost-effectiveness of optimised public-access AED placement compared to current placement._x000D_ _x000D_ OBJECTIVES_x000D_ _x000D_ i. To determine the current coverage of known public-access AEDs relative to historical OHCAs;_x000D_ ii. To model the locations of different deployment strategies for public access AEDs;_x000D_ iii. To develop a mathematical optimisation model for AED deployment, accounting for spatial and temporal accessibility;_x000D_ iv. To determine the costs and benefits associated with the placement strategies developed and compare these against current practice._x000D_ _x000D_ METHODS_x000D_ _x000D_ The study will comprise of four work packages (WP):_x000D_ _x000D_ WP1: An analysis of the current coverage of historical OHCAs relative to locations of AEDs_x000D_ _x000D_ WP2: A comparison of different AED deployment strategies that will determine the best approach to improve OHCA coverage above the current situation. The evidence-based strategies will include the use of different landmarks for locating an AED, a grid-based strategy, plus the development of an optimisation mathematical model._x000D_ _x000D_ WP3: A cost-effectiveness analysis of the various strategies to determine the most economical strategy._x000D_ _x000D_ WP4: Synthesis of results and stakeholder involvement. Presentation of research findings to interested stakeholders and production of final report and guideline document._x000D_ _x000D_ TIMELINE FOR DELIVERY_x000D_ _x000D_ The study is planned to run for 33 months. Ethics and regulatory approvals are not required. WP1 (current coverage) months 1-9; WP2 (deployment strategies) months 10-23; WP3 (cost-effectiveness) months 24-29; WP4 (report writing and presentation) months 30-33; final report submitted month 33._x000D_ _x000D_ ANTICIPATED IMPACT AND DISSEMINATION_x000D_ _x000D_ The output from this research will be evidence based guidance on the optimal locations to place publically accessible AEDs in areas of the country where they are most needed. _x000D_ _x000D_ We are involving key stakeholders i.e. the NHS, Public Health England, Resuscitation Council (UK), Charities (e.g. British Heart Foundation, Arrhythmia Alliance), and patient and public representatives early in the study to create a sense of joint ownership of the research findings. This should help accelerate the dissemination and adoption of the project results to members of the public, charities, policy makers and the broader scientific community.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CARDIOVASCULAR