How Toronto Can Improve Cardiac Arrest Survival Rates
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How Toronto Can Improve Cardiac Arrest Survival Rates

U of T study finds most defibrillators are not accessible 24/7.

There are over 1,500 AEDs in Toronto. Photo courtesy of U of T Engineering.

There are over 1,500 AEDs in Toronto. Photo courtesy of U of T Engineering.

You’re standing on the subway platform, waiting for the next train, staring at the ads that line the tunnel. Out of the corner of your eye, you see someone fall to the ground. You and several other people rush over to him. He’s an older man, and he appears to be unconscious. What do you do?

Back in 1998, then mayor Mel Lastman and City Council declared Toronto a “Cardiac Safe City.” This was the start of a concerted effort to encourage people to learn cardiopulmonary resuscitation (CPR) and how to use automated external defibrillators (AED), also called public access defibrillators.

The Cardiac Safe City initiative also marked the start of the City’s acquisition of these devices—today, there are more than 1,500 AEDs placed around Toronto, many in public places such as community centres, police stations, skating rinks, City Hall, and subway stations.

“That initiative was set up, at the request of council, to enable bystanders to assist with resuscitating a patient suffering from a cardiac arrest prior to the arrival of the paramedics,” says Kim McKinnon, Toronto Paramedic Services superintendent.

An estimated 400,000 people die in North America every year from out-of-hospital cardiac arrest. There’s a less than 10 per cent survival rate.

An AED checks the heart’s rhythm and gives it an electric shock if it has stopped. It can be administered by anyone; training isn’t necessary. The device provides verbal or visual instructions.

AEDs save lives. Studies have shown that, with cardiac arrest, survival decreases by 10 per cent with every one-minute delay in medical help. Because it takes Toronto paramedics, on average, eight-and-a-half minutes to show up, use of an AED by passersby is crucial.

But, a study led by University of Toronto researchers has found that only 25 to 27 per cent of the city’s AEDs are in locations that are open 24/7.

The study, published this month in the Journal of the American College of Cardiology, analyzed the 2,440 cases of cardiac arrest that occurred in public places around Toronto from 2006 to 2014 as well as the 737 addresses where AEDs were located during that time.

One in five cardiac arrests, the researchers found, occurred near an AED that was inaccessible at the time of the incident.

“We’ve confirmed that there’s a problem,” says Timothy Chan, a professor in U of T’s Department of Mechanical and Industrial Engineering and one of the researchers.

“Now what can we do to fix it? That’s where the engineering stuff kicks in. Let’s build a model, which no one had done before—what if we could place AEDs intelligently, accounting for hours of operation?”

Guidelines for AED placement from the American Heart Association focus solely on where the devices are placed.

“It doesn’t say anything about the when,” says Chan. Similarly, his research prior to this study focused on where AEDs should be located to maximize coverage and not on the locations’ hours of operation.

This is an important factor, though. Cardiac arrest doesn’t happen at the same rate throughout the day—there’s a circadian pattern to it. The majority of cardiac arrests happen in the evenings, nights, or on weekends.

So far, the City’s focus has been on increasing the numbers of AEDs. Those in public buildings are only accessible whenever the building is open, and that’s not often 24/7.

“We encourage any positive step towards making AEDs accessible,” says McKinnon. “We try at many opportunities, when we have the funding to be able to do it, to place new AEDS in public places.”

She says Cardiac Safe City continues to see success—last year, 16 people were resuscitated by a public AED. That’s the highest number since the initiative began.

Some businesses and organizations will also buy AEDs for their workplace. Chan says many included in their study were privately purchased.

Other cities have taken unique approaches to AED accessibility. In Europe, some cities are pushing to have outdoor cabinets on the street containing the device. But that could be a challenge in Canada’s winters, Chan points out.

Meanwhile, in Japan, where vending machines are as common as ATMs, some have AEDs inside (available for free).

In Ontario, Chan says legislation mandating the placement of AEDs in public places like schools, gyms, and hockey rinks would go a long way in improving cardiac arrest survival rates. Also important? Mandating the registration of AEDs, particularly for those that are purchased privately.

If you buy an AED for your office, registering it with 911 means it’ll show up in the city’s AED database. Then, if a 911 call comes in from your office, emergency dispatchers will be able to see there’s an AED in the building and can direct someone to use it before the ambulance arrives.

Both McKinnon and Chan say while accessibility is undoubtedly key, people have to know how to use AEDs and know that they’re there.

Anyone can experience cardiac arrest—it’s not limited to older people. McKinnon knows of cases that have involved teenagers.

“We want to encourage people to step in and save a life,” she says.

Learn more about how to use an AED here.