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Is public access defibrillation needed in Hong Kong?
1Accident and Emergency Department, North District Hospital, 9 Po Kin Road, Sheung Shui, Hong Kong.
Insights
Public access defibrillation can improve survival rates for out-of-hospital cardiac arrest (OHCA) in Hong Kong. Implementing this program, alongside public education and EMS coordination, is crucial for faster response times and better outcomes.
Area of Science:
- Emergency Medicine
- Public Health
- Cardiology
Background:
- Survival rates for non-traumatic out-of-hospital cardiac arrest (OHCA) in Hong Kong are critically low, ranging from 1.25% to 1.6%.
- Despite improvements in emergency medical service (EMS) response, the time from collapse recognition to defibrillation remains prolonged at 14.25 minutes.
Purpose of the Study:
- To evaluate the potential of a public access defibrillation (PAD) program to enhance OHCA survival rates in Hong Kong.
- To identify and analyze delays within the traditional EMS response pathway for OHCA.
Main Methods:
- Review of existing studies on out-of-hospital cardiac arrest in Hong Kong.
- Analysis of time intervals: collapse/recognition to call receipt, call receipt to vehicle arrival, and vehicle arrival to first defibrillatory shock.
- Assessment of PAD program's potential to mitigate pre-hospital delays.
Main Results:
- Significant delays identified in the EMS response: public education (collapse/recognition to call receipt) and dispatch logistics (call receipt to defibrillation).
- PAD programs utilizing lay responders can potentially eliminate the initial collapse recognition and call receipt delays.
- High-traffic public locations like airports are suitable sites for PAD implementation due to projected OHCA incidence.
Conclusions:
- A public access defibrillation program offers a viable strategy to improve OHCA survival in Hong Kong by reducing critical response times.
- Successful PAD implementation necessitates a robust public education strategy and seamless coordination with existing emergency medical services.
- Targeted PAD deployment in high-risk, high-traffic areas can significantly impact immediate resuscitation efforts.
Abstract:
The survival rate for non-traumatic out-of-hospital cardiac arrest in Hong Kong is low (1.25%-1.6%). Despite the reduced time interval between call receipt and first defibrillatory shock to 11.12 minutes during the past decade, the time interval between collapse/recognition and first defibrillatory shock, at 14.25 minutes, is too long. Studies of out-of-hospital cardiac arrest performed in Hong Kong were reviewed to ascertain whether a public access defibrillation programme can improve survival in Hong Kong. Three delays were found in the traditional response by emergency medical service, namely in the collapse/recognise-to-call receipt, call receipt-to-vehicle stops, and vehicle stops-to-first defibrillatory shock time intervals. The first delay is related to public education, while the second and third delays are intrinsic to a dispatched response. A public access defibrillation programme employing responders at scenes of cardiac arrests can eliminate the collapse/recognise-to-call receipt and call receipt-to-vehicle stops time intervals before defibrillation. Possible sites of public access defibrillation could include the airport and other immigration points, which have a high volume of people passing through, with projected figures for out-of-hospital cardiac arrest at these sites supporting this consideration. For successful implementation of public access defibrillation, a comprehensive educational programme and coordination with the emergency medical service are required.
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