Combinations of First Responder and Drone Delivery to Achieve 5-Minute AED Deployment in OHCA

Monique A Starks; Jamal Chu; K H Benjamin Leung; Audrey L Blewer; Denise Simmons; Carolina Malta Hansen; Anjni Joiner; José G Cabañas; Matthew R Harmody; R Darrell Nelson; Bryan F McNally; Joseph P Ornato; Christopher B Granger; Timothy C Y Chan; Daniel B Mark

doi:10.1016/j.jacadv.2024.101033

Combinations of First Responder and Drone Delivery to Achieve 5-Minute AED Deployment in OHCA

JACC Adv. 2024 Jun 25;3(7):101033. doi: 10.1016/j.jacadv.2024.101033. eCollection 2024 Jul.

Authors

Monique A Starks^{1

2}, Jamal Chu³, K H Benjamin Leung^{3

4}, Audrey L Blewer⁵, Denise Simmons⁶, Carolina Malta Hansen^{7

8

9}, Anjni Joiner^{10

11}, José G Cabañas^{12

13}, Matthew R Harmody¹⁴, R Darrell Nelson¹⁵, Bryan F McNally¹⁶, Joseph P Ornato¹⁷, Christopher B Granger^{1

2}, Timothy C Y Chan^{3

18}, Daniel B Mark^{1

2}

Affiliations

¹ Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
² Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
³ Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.
⁴ Scottish Ambulance Service, Edinburgh, Scotland, United Kingdom.
⁵ Department of Community and Family Medicine and Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
⁶ Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina, USA.
⁷ Division of Cardiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
⁸ Division of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen, Denmark.
⁹ Copenhagen Emergency Medical Services, Copenhagen University, Copenhagen, Denmark.
¹⁰ Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
¹¹ Durham County Emergency Medical Services, Durham, North Carolina, USA.
¹² Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹³ Wake County EMS, Raleigh, North Carolina, USA.
¹⁴ Emergency Medical Services, First Health of the Carolinas, Pinehurst, North Carolina, USA.
¹⁵ Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
¹⁶ Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA.
¹⁷ Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
¹⁸ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.

Abstract

Background: Defibrillation in the critical first minutes of out-of-hospital cardiac arrest (OHCA) can significantly improve survival. However, timely access to automated external defibrillators (AEDs) remains a barrier.

Objectives: The authors estimated the impact of a statewide program for drone-delivered AEDs in North Carolina integrated into emergency medical service and first responder (FR) response for OHCA.

Methods: Using Cardiac Arrest Registry to Enhance Survival registry data, we included 28,292 OHCA patients ≥18 years of age between 1 January 2013 and 31 December 2019 in 48 North Carolina counties. We estimated the improvement in response times (time from 9-1-1 call to AED arrival) achieved by 2 sequential interventions: 1) AEDs for all FRs; and 2) optimized placement of drones to maximize 5-minute AED arrival within each county. Interventions were evaluated with logistic regression models to estimate changes in initial shockable rhythm and survival.

Results: Historical county-level median response times were 8.0 minutes (IQR: 7.0-9.0 minutes) with 16.5% of OHCAs having AED arrival times of <5 minutes (IQR: 11.2%-24.3%). Providing all FRs with AEDs improved median response to 7.0 minutes (IQR: 6.2-7.8 minutes) and increased OHCAs with <5-minute AED arrival to 22.3% (IQR: 16.4%-30.9%). Further incorporating optimized drone networks (326 drones across all 48 counties) improved median response to 4.8 minutes (IQR: 4.3-5.2 minutes) and OHCAs with <5-minute AED arrival to 56.3% (IQR: 46.9%-64.2%). Survival rates were estimated to increase by 34% for witnessed OHCAs with estimated drone arrival <5 minutes and ahead of FR and emergency medical service.

Conclusions: Deployment of AEDs by FRs and optimized drone delivery can improve AED arrival times which may lead to improved clinical outcomes. Implementation studies are needed.

Keywords: automated external defibrillation; bystander; cardiopulmonary resuscitation; defibrillation; drone technology; emergency medical services; first responders; unmanned aviation vehicle.