1. Development of a US National Model for AED Placement in Rural Areas Greg Mears, M.D. 1 N. Clay Mann Ph.D., M.S. 2 J. Michael Dean, M.D., M.B.A. 2 1 University of North Carolina, Chapel Hill 2 University of Utah School Of Medicine, IICRC

2. Introduction Development of AEDs AEDs greatly expand the availability of defibrillatory shock AED placement in rural areas remains perplexing Out of Hospital Cardiac Arrests are rare and unpredictable Out of Hospital Cardiac Arrests are rare and unpredictable Populations are dispersed Populations are dispersed Bystander assistance is less common Bystander assistance is less common EMS response times are variable and long EMS response times are variable and long

3. Objective Develop a rural AED placement model based upon the mathematical evaluation of variables found to correlate with successful AED programs

4. Methods Study Design: Literature Search Literature Search Risk-factor Analysis Risk-factor Analysis U.S. 2000 census data U.S. 2000 census data CDC heart disease mortality data CDC heart disease mortality dataPopulation: Rural census tracts within 50 states Rural census tracts within 50 states

5. Methods Measurements Estimate of Cardiac Arrest rate for each census tract Estimate of Cardiac Arrest rate for each census tract 0.5 Cardiac Arrests/1,000 people/1 year 0.5 Cardiac Arrests/1,000 people/1 year Risk adjustment Risk adjustment Demographic variables & heart disease mortality Demographic variables & heart disease mortality AED service area AED service area

6. Methods Analysis: Potential for AED use Potential for AED use Expected number of CA per AED (1 yr.) Expected number of CA per AED (1 yr.) Expected number of CA per AED (5 yrs.) Expected number of CA per AED (5 yrs.) Cost per life saved (initial equipment only) Cost per life saved (initial equipment only)

7. Results Results: Rural AED Literature Retrieval Rural AED Literature Retrieval AED Placement on emergency vehicles AED Placement on emergency vehicles Minimum population density Minimum population density Older population Older population Affluent communities Affluent communities

8. Results

9. Results

10. Results

11. Results Intermountain Injury Control Research Center

12. Results 1 Arrest / AED / Yr 11,946 AEDs Required 11,946 AEDs Required $29.8 million dollars $29.8 million dollars 1 Arrest / AED / 5 Yr 17,417 AEDs Required 17,417 AEDs Required $43.5 million dollars $43.5 million dollars Cost per life Saved 5% Survival Rate 5% Survival Rate US = $23,692 / LSaved US = $23,692 / LSaved NC = $19,168 / LSaved NC = $19,168 / LSaved UT = $23,243 / LSaved UT = $23,243 / LSaved * Calculation based on $2,500/AED (not including training or implementation cost)

13. Conclusions Literature Review Findings Placement among “first responders” Placement among “first responders” Population density and coordinated emergency system Population density and coordinated emergency system Modeling Results Predicted risk of CA (potential AED use) Predicted risk of CA (potential AED use) Number of AEDs required Number of AEDs required

14. Limitations Generalizing to Census Tracts Uniformity of AED Service Areas Variable Death Rates in Rural Counties Ambiguous Nature of the Model

15. Questions ? Funding for this project was provided by the US Office of Rural Health Policy