Access to automated external defibrillators and first responders: Associations with socioeconomic factors and income inequality at small spatial scales

Dokyeong Lee; Martin Bender; Stefan Poloczek; Christopher Pommerenke; Eiko Spielmann; Ulrike Grittner; Christof Prugger

doi:10.1016/j.resplu.2024.100561

Access to automated external defibrillators and first responders: Associations with socioeconomic factors and income inequality at small spatial scales

Resusc Plus. 2024 Feb 1:17:100561. doi: 10.1016/j.resplu.2024.100561. eCollection 2024 Mar.

Authors

Dokyeong Lee¹, Martin Bender², Stefan Poloczek², Christopher Pommerenke², Eiko Spielmann², Ulrike Grittner^{3

4}, Christof Prugger¹

Affiliations

¹ Institute of Public Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
² Emergency Medical Services Department, Berlin Fire and Rescue Service, Voltairestraße 2, 10179 Berlin, Germany.
³ Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
⁴ Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.

Abstract

Aim: The 2021 European Resuscitation Council (ERC) guidelines recommend two automated external defibrillators (AEDs)/km² and at least 10 first responders/km². We examined 1) access to AEDs and volunteer first responders in line with these guidelines and 2) its associations with socioeconomic factors and income inequality, focusing on small spatial scales.

Method: We considered data on 776 AEDs in February 2022 and 1,173 out-of-hospital cardiac arrests (OHCAs) including 713 OHCA with app-alerted volunteer first responders from February to September 2022 in Berlin. We fit multilevel models to analyse AED area coverage and Poisson models to examine first responder availability across 12 districts and 536 neighbourhoods.

Results: Median AED area coverage according to the 2021 ERC guidelines was 43.1% (interquartile range (IQR) 2.3-87.2) at the neighbourhood level and median number of available first responders per OHCA case was one (IQR 0.0-1.0). AED area coverage showed a positive association with average income tax per capita, with better coverage in the highest compared to the lowest quartile neighbourhoods (coefficient: 0.13, 95% confidence interval (CI): 0.01-0.25). First responder availability was not associated with income tax. AED area coverage and first responder availability were positively associated with income inequality, with better coverage (coefficient: 0.13, 95% CI: 0.04-0.23) and availability (rate ratio: 1.31, 95% CI: 1.03-1.67) in quartiles of highest as compared to lowest inequality.

Conclusion: Access to resuscitation resources is neither equitable nor in accordance with the 2021 ERC guidelines. Ensuring better access necessitates understanding of socioeconomic factors and income inequality at small spatial scales.

Keywords: App-based alert system; Automated external defibrillator; Income inequality; Small spatial scale; Socio-economic factors.