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Figure. 聽Key Elements to Perform a Successful Bystander Defibrillation

A successful bystander defibrillation requires the bystander to possess adequate knowledge of automated external defibrillator (AED) use, a positive attitude toward public access defibrillation, willingness to use an AED, and the ability to access an AED when needed, whether through passive or active means.

Table. 聽Result of the Questionnaire Survey and Factors Associated With Awareness of Nearest AED Location
1.
Pei-Chuan Huang 聽E锘, Chiang 聽WC锘, Lu 聽TC锘, 聽et al. 聽Barriers to bystanders defibrillation: a national survey on public awareness and willingness of bystanders defibrillation.聽锘 聽J Formos Med Assoc. 2021;120(3):974-982. doi:锘
2.
Schober 聽P锘, van Dehn 聽FB锘, Bierens 聽JJ锘, Loer 聽SA锘, Schwarte 聽LA锘. 聽Public access defibrillation: time to access the public.聽锘 聽Ann Emerg Med. 2011;58(3):240-247. doi:锘
3.
Huang 聽CH锘, Chien 聽CY锘, Ng 聽CJ锘, 聽et al. 聽Effects of dispatcher-assisted public-access defibrillation programs on the outcomes of out-of-hospital cardiac arrest: a before-and-after study.聽锘 聽J Am Heart Assoc. 2024;13(3):e031662. doi:锘
4.
Schierbeck 聽S锘, Svensson 聽L锘, Claesson 聽A锘. 聽Use of a drone-delivered automated external defibrillator in an out-of-hospital cardiac arrest.聽锘 聽N Engl J Med. 2022;386(20):1953-1954. doi:锘
5.
Liu 聽CH锘, Sung 聽CW锘, Fan 聽CY锘, 聽et al. 聽Strategies on locations of public access defibrillator: a systematic review.聽锘 聽Am J Emerg Med. 2021;47:52-57. doi:锘
6.
McCoy 聽CE锘, Rahman 聽A锘, Rendon 聽JC锘, 聽et al. Randomized controlled trial of simulation vs standard training for teaching medical students high-quality cardiopulmonary resuscitation. 聽West J Emerg Med. 2019;20(1):15-22. doi:锘
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Research Letter
Emergency Medicine
翱肠迟辞产别谤听10, 2024

Public Awareness of Automated External Defibrillator Locations

Author Affiliations
  • 1Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
  • 2Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
  • 3Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
  • 4Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
  • 5Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
JAMA Netw Open. 2024;7(10):e2438319. doi:10.1001/jamanetworkopen.2024.38319
Introduction

Timely defibrillation on patients with shockable rhythm during out-of-hospital cardiac arrest significantly increases chances of survival. Despite extensive implementation and educational promotion of automated external defibrillators (AEDs), various studies worldwide still indicate a low rate of public access defibrillation (PAD). A 2013 nationwide survey in Taiwan revealed that although 86.6% of respondents were willing to use an AED on strangers, only 40.6% were aware of the existence of AEDs, and only 37.3% could locate them in public places.1 These results suggest that the ability to locate an AED may be key to increasing the usage rate.

Based on previous research, we hypothesized that successful bystander defibrillation requires knowledge, attitude, willingness, and ability to retrieve the nearest AED (Figure).1,2 AED retrieval can be divided into passive (guidance from dispatchers or direct device delivery) and active (bystanders retrieving device themselves) approaches.3,4 A comprehensive nationwide survey was conducted to examine the public鈥檚 perception and willingness to use AEDs.

Methods

This cross-sectional, nationwide survey study was conducted by a professional polling agency via telephone and cellphone surveys from April 21 to 24, 2021. Respondents were chosen through stratified random sampling and random-digit dialing. Respondents were asked for their consent. They were told, 鈥淲e would like to explain and seek your consent: You are free to choose whether or not to participate in this interview.鈥 An 18-item questionnaire obtained demographic data (year of birth, sex, education level, marital status, religious belief, current occupation, medical occupation, personal and family medical history, and whether participant had individuals aged >65 years living with them) and knowledge about and attitude and willingness toward PAD. The questionnaire also investigated public awareness of nearest AED locations from home, on public transportation, and in schools or workplaces (eAppendixes 1 and 2 in Supplement 1). Respondents were asked 鈥淒o you have confidence in recognizing an AED (automated external defibrillator) in public places?鈥 Stratified sampling and repeated weighting statistical analysis aligned survey results with national census data. Forced-entry logistic regression was used for multivariable analysis to examine correlation between predictor variables and AED location awareness. P鈥<鈥.05 was considered significant. The reporting guideline was followed. Data were analyzed using IBM SPSS Statistics, version 24. This study was approved by the National Taiwan University Hospital institutional review board.

Results

A total of 1083 respondents completed the survey. Most respondents (n鈥=鈥938 [86.6%]) expressed a willingness to perform bystander defibrillation. Among these, 196 of 938 (20.9%) were aware of the AED location near their homes; 141 of 913 (15.4%) were near public transportation, and 225 of 662 (34.0%) were near their school or workplace. Basic demographics of respondents were not associated with increased awareness of AED locations (Table). However, knowledge-related factors showed significant correlations. Respondents confident in recognizing AEDs in public places were significantly more aware of their locations (adjusted odds ratio, 4.48; 95% CI, 1.69-11.89; P鈥=鈥.003).

Discussion

Our research yielded 2 major findings: most respondents willing to use AEDs on strangers could not locate the device during emergencies, and those confident in recognizing AEDs displayed greater awareness of AED locations. Previous research on AED location has primarily focused on deployment strategies.5 Furthermore, studies also discovered innovative approaches, such as dispatcher-assisted AED retrieval or drone delivery, that align more closely with the concept of passive access to the AED.3,4 Although inspiring, these methods may require additional time for telephone calls and dispatcher confirmation. Various urban environments and high costs may also hinder device delivery feasibility. In contrast, active AED retrieval, where bystanders know and retrieve the nearest AED themselves, may lead to shorter time to defibrillation during high-stress situations.

Despite potential response bias and inherent limitations of questionnaire surveys, we aim to propose public health policies to enhance AED location awareness. Clear and prominent signage, both visual and auditory, and proactive promotion campaigns may help increase confidence in AED recognition. Knowledge about PAD appears to be closely related to public awareness of nearest AED location, indicating a need for further educational promotion. Simulation-based training, where participants can practice cardiopulmonary resuscitation, call for assistance, locate the nearest AED, and engage in briefing and debriefing sessions, could be integrated into the existing educational framework.6 A well-implemented AED deployment strategy, combined with public active awareness of AED locations and effective passive delivery, may address the missing piece in bystander defibrillation.

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Article Information

Accepted for Publication: July 31, 2024.

Published: October 10, 2024. doi:10.1001/jamanetworkopen.2024.38319

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Huang CT et al. 糖心vlog Open.

Corresponding Author: Edward Pei-Chuan Huang, MD, MS, Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei City, Taiwan (edward56026@gmail.com).

Author Contributions: Drs C.-T. Huang and C.-H. Chen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: C.-T. Huang, J.-W. Chen, Ma, E. P.-C. Huang.

Acquisition, analysis, or interpretation of data: C.-T. Huang, C.-H. Chen, C.-H. Huang, Fan, J.-W. Chen, Ma.

Drafting of the manuscript: C.-T. Huang, C.-H. Chen, J.-W. Chen.

Critical review of the manuscript for important intellectual content: C.-T. Huang, C.-H. Huang, Fan, J.-W. Chen, Ma, E. P.-C. Huang.

Statistical analysis: C.-T. Huang, C.-H. Chen, Fan, J.-W. Chen.

Obtained funding: J.-W. Chen.

Administrative, technical, or material support: J.-W. Chen, E. P.-C. Huang.

Supervision: C.-T. Huang, J.-W. Chen, Ma, E. P.-C. Huang.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by the Ministry of Science and Technology, Taiwan (grant MOST 111-2320-B-002-054) and the National Taiwan University Hospital Hsin-Chu branch, Department of Medical Research (grant 112-HCH026).

Role of the Funder/Sponsor: The funders had a role in the design and conduct of the study but had no role in the collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The role of the funders primarily involved providing the costs for the professional polling agency, statistical consultation, and article processing charge.

Data Sharing Statement: See Supplement 2.

References
1.
Pei-Chuan Huang 聽E锘, Chiang 聽WC锘, Lu 聽TC锘, 聽et al. 聽Barriers to bystanders defibrillation: a national survey on public awareness and willingness of bystanders defibrillation.聽锘 聽J Formos Med Assoc. 2021;120(3):974-982. doi:锘
2.
Schober 聽P锘, van Dehn 聽FB锘, Bierens 聽JJ锘, Loer 聽SA锘, Schwarte 聽LA锘. 聽Public access defibrillation: time to access the public.聽锘 聽Ann Emerg Med. 2011;58(3):240-247. doi:锘
3.
Huang 聽CH锘, Chien 聽CY锘, Ng 聽CJ锘, 聽et al. 聽Effects of dispatcher-assisted public-access defibrillation programs on the outcomes of out-of-hospital cardiac arrest: a before-and-after study.聽锘 聽J Am Heart Assoc. 2024;13(3):e031662. doi:锘
4.
Schierbeck 聽S锘, Svensson 聽L锘, Claesson 聽A锘. 聽Use of a drone-delivered automated external defibrillator in an out-of-hospital cardiac arrest.聽锘 聽N Engl J Med. 2022;386(20):1953-1954. doi:锘
5.
Liu 聽CH锘, Sung 聽CW锘, Fan 聽CY锘, 聽et al. 聽Strategies on locations of public access defibrillator: a systematic review.聽锘 聽Am J Emerg Med. 2021;47:52-57. doi:锘
6.
McCoy 聽CE锘, Rahman 聽A锘, Rendon 聽JC锘, 聽et al. Randomized controlled trial of simulation vs standard training for teaching medical students high-quality cardiopulmonary resuscitation. 聽West J Emerg Med. 2019;20(1):15-22. doi:锘
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