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.
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.
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).
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.
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.
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