Method for determining automatic external defibrillator need at mass gatherings☆
Introduction
Despite advances in medical technologies and treatments, survival from out-of-hospital cardiac arrest remains poor. The American Heart Association has identified early defibrillation as one of the most important links in the chain of survival [1], a ventricular fibrillation arrest survival decreases by 10% for each minute without defibrillation [2], [3]. With the development of automated external defibrillators (AEDs), personnel with minimal training are able to deliver early defibrillation. Thus, AEDs are becoming more commonplace on fire trucks, police cars, airplanes, and in settings where large numbers of people congregate, so that defibrillation may be performed prior to EMS arrival.
A previous study by Crocco et al. [4] derived a method for determining the number of AEDs needed to provide a 3-min response interval in settings of mass gathering. This method divided the setting into areas of different slopes, and used these areas and volunteer response times and distances to calculate the number of AEDs needed. The Crocco method used responders who ran to the designated area. In many systems, including our own, running is not permitted for responders within a mass gathering, due to the tendency for running to cause panic and unexpected crowd movements. In addition, Crocco's formulae were somewhat complicated, and the method was only tested in a single venue. Therefore, the purposes of our project were to modify the Crocco method, to replicate our new method in a second venue, and to validate the results.
Section snippets
Setting
Kenan Memorial Stadium and The Dean E. Smith Center (Fig. 1, Fig. 2) are the venues for football and basketball games at The University of North Carolina. Capacity seating is 60,000 and 21,444, respectively. Approximately 6 football games and 18 basketball games are held at these locations each year, along with various other activities, including concerts, band competitions, and graduations. Three cardiac arrests have occurred in these locations over the last four years (two in Kenan Memorial
Derivation data
Ten EMTs participated in data acquisition in Kenan Memorial Stadium. Average times were obtained and “worst-case” velocities calculated for each surface (Table 1; Formula 1 in Appendix A).
Replication of method in second venue
Ten EMTs participated when the study was replicated at The Dean E. Smith Center. Their times and velocities are listed in Table 2.
Validation
In the validation phase of the study, five EMT volunteers were timed responding to two pre-determined locations in each coliseum. Knowing the distance to each location, the
Discussion
Since the 1992 American Heart Association guidelines identified early defibrillation as one of the four interventions in the “chain of survival” [1], many methods to shorten the time to defibrillation have been explored. It is commonly accepted that survival decreases by approximately 10% for each minute that defibrillation is delayed [2], [3], and multiple studies have demonstrated improved survival with earlier defibrillation [5], [6], [7], [8], [9]. One of the most promising methods for
Conclusion
AEDs are becoming increasingly more common in settings of mass gatherings. Our method was easily replicated and appears to be valid for determining the required number of AEDs in these types of settings. To calculate the number of AEDs needed, first calculate the “worst-case” response velocities over each of the different slopes of the location. Then, using the velocities, determine the time necessary to traverse the longest response distance. This maximum response time can be used to figure
Acknowledgements
The authors wish to thank Orange County Emergency Management for their continued support of our research, the volunteers of Orange EMS and Rescue Squad for their participation, and The University of North Carolina Athletic Office for permission to perform the study in Kenan Memorial Stadium and The Dean E. Smith Center during athletic events. The authors report no financial or personal relationships with people or organizations related to this field of study that might serve as conflicts of
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Cited by (13)
Non-communicable health risks during mass gatherings
2012, The Lancet Infectious DiseasesCitation Excerpt :The acute challenge to health systems becomes apparent when these illnesses are added to the most frequent complaints—such as bruises, cuts, sprains, headaches, dizziness, asthma exacerbations, and abdominal pain—that require onsite medical care or transport to a health facility.22,29–41 Several methods of intervention have been proposed to reduce the rates of morbidity and mortality from non-communicable diseases or injury during MGs.22,40,42–68 These include pre-event planning of the public health response, such as preparedness for onsite emergency medical care, and implementation of strategies and mitigation measures to minimise risks from terrorism or disasters.39–65
Usefulness of Emergency Medical Teams in Sport Stadiums
2008, American Journal of CardiologyCitation Excerpt :Essential elements of an emergency action plan include an effective communication system, the training of anticipated responders in cardiopulmonary resuscitation and automated external defibrillator use, rapid access to an automated external defibrillator, the acquisition of necessary emergency equipment, the coordination and integration of on-site responders and automated external defibrillator programs with the local coronary care unit and ambulance services, and practice and evaluation of the response plan. Methods to determine where to deploy automated external defibrillators in a stadium are available.15,16 We recommend the presence of medical teams equipped with defibrillators and regularly evaluated, written emergency action plans at large venues that host sports and other activities.
Travel Medicine and the International Athlete
2007, Clinics in Sports MedicineCitation Excerpt :Large venues may require multiple AEDs. Motyka and colleagues [37] developed a simple process for determining the number of AEDs needed to provide early defibrillation by first responders in areas in which EMS may not be available or delayed. Events with established EMS and local hospitals should be contacted well in advance to help coordinate appropriate emergency care.
In this issue
2005, ResuscitationAcute cardiac events and deployment of emergency medical teams and automated external defibrillators in large football stadiums in the Netherlands
2009, European Journal of Cardiovascular Prevention and Rehabilitation
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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at doi: 10.1016/j.resuscitation.2004.09.016.
- 1
Huntsville Hospital Emergency Physicians Group, 903 Madison Street, Huntsville, AL 35801, USA.
- 2
Department of Emergency Medicine, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157-1089, USA
- 3
Pikeville College School of Osteopathic Medicine, 147 Sycamore Street, Pikeville, KY 41501, USA.