Spatiotemporal AED optimization is generalizable

Abstract

Aims: Mathematical optimization of automated external defibrillator (AED) placements has the potential to improve out-of-hospital cardiac arrest (OHCA) coverage and reverse the negative effects of limited AED accessibility. However, the generalizability of optimization approaches has not yet been investigated. Our goal is to examine the performance and generalizability of a spatiotemporal AED placement optimization methodology, initially developed for Toronto, Canada, to the new study setting of Copenhagen, Denmark.

Methods: We identified all public OHCAs (1994-2016) and all registered AEDs (2016) in Copenhagen, Denmark. We calculated the coverage loss associated with limited temporal accessibility of registered AEDs, and used a spatiotemporal optimization model to quantify the potential coverage gain of optimized AED deployment. Coverage gain of spatiotemporal deployment over a spatial-only solution was quantified through 10-fold cross-validation. Statistical testing was performed using χ² and McNemar's tests.

Results: We found 2149 public OHCAs and 1573 registered AED locations. Coverage loss was found to be 24.4% (1104 OHCAs covered under assumed 24/7 coverage, and 835 OHCAs under actual coverage). The coverage gain from using the spatiotemporal model over a spatial-only approach was 15.3%. Temporal and geographical trends in coverage gain were similar to Toronto.

Conclusions: Without modification, a previously developed spatiotemporal AED optimization approach was applied to Copenhagen, resulting in similar OHCA coverage findings as Toronto, despite large geographic and cultural differences between the two cities. In addition to reinforcing the importance of temporal accessibility of AEDs, these similarities demonstrate the generalizability of optimization approaches to improve AED placement and accessibility.

Keywords: Automated external defibrillator; Cardiac arrest; Public access defibrillation; Resuscitation.