S66 Poster Presentations / Resuscitation 84S (2013) S8–S98

AP144

Differences between out-of-hospital cardiacarrest in high and low-incidence areas andimplications for public access defibrillation

Carolina Malta Hansen 1,∗, Mads Wissenberg 1,Peter Weeke 1, Line Zinckernagel 2, Martin H.Ruwald 1, Lena Karlsson 1, Freddy Lippert 3,Gunnar H. Gislason 1, Søren L. Nielsen 3, LarsKøber 4, Christian Torp-Pedersen 5, Fredrik Folke 1

1 Department of Cardiology, Copenhagen UniversityHospital Gentofte, Copehagen, Denmark2 National Institute of Public Health, University ofSouthern Denmark, Copehagen, Denmark3 Emergency Medicine and EMS, Head Office, CapitalRegion of Denmark, Copehagen, Denmark4 The Heart Centre, Copenhagen University HospitalRigshospitalet, Copehagen, Denmark5 Institute of Health, Science and Technology,Aalborg University, Aalborg, Denmark

Purpose: Current guidelines recommend placement of auto-mated external defibrillators (AEDs) for public access defibrillationin high-incidence areas of out-of-hospital cardiac arrest (OHCA).However, it remains unclear how large a proportion of OHCAsoccurs in high-incidence areas, whether this proportion varies overtime and whether patient characteristics are different from thosein low-incidence areas.

Materials and methods: All OHCAs in public locations in Copen-hagen, Denmark (1994–2011) were plotted geographically and allOHCAs within a 100 m × 100 m area were counted. High-incidenceareas were defined as those with ≥1 OHCA every 2 years and low-incidence areas as those with <1 OHCA every 2 years. Daytime,evening and nighttime were defined as from 8:00 to 15:59, 16:00to 23:59 and 00:00 to 07:59, respectively.

Results: Of 1864 OHCAs in public locations, 18.0% (n = 335) werein high-incidence areas and this proportion did not vary according

Table 1Characteristics of subjects with out-of-hospital cardiac arrest in public (1994–2011).

High-incidenceareasd (n = 335)

Low-incidencearease (n = 1529)

p valuef

City area, km (%) 1 (1.0) 33 (33.0) –Patient characteristic

Average age, y ± SD 58.4 ± 17.3 62.1 ± 19.3 0.0006Male gender, n (%) 261 (78.6) 1149 (75.7) 0.26Mean response time,min ± SD

3.9 ± 2.1 5.1 ± 2.4 <0.0001

First-recorded heart rhythmVF/pVTb 114 (34.0) 595 (38.9) 0.10Asystole 571 (37.3) 135 (40.3) 0.31Pulseless electricactivity

202 (13.2) 42 (12.5) 0.74

Other/unknownrhythmc

161 (10.5) 44 (13.1) 0.17

Survival after 30 days, n(%)

52 (16.5) 235 (17.2) 0.78

Time of cardiac arrest, n (%)Daytime (8:00–15:59) 151(45.1) 815 (53.0) 0.06Evening (16:00–23:59) 136 (40.6) 518 (33.9) 0.02Nighttime(00:00–07:59)

48 (14.3) 196 (12.8) 0.46

Abbreviations: IQR, interquartile range; SD, standard deviation; km, kilometer.aInterval between call to Emergency Medical Services and ambulance arrival.

b VF/pVT is ventricular fibrillation or pulseless ventricular tachycardia.c Other/unknown rhythm includes pace rhythms, atrioventricular blocks and

unknown rhythm.d High-incidence areas were defined as areas with ≥1 cardiac arrest every 2 years.e Low-incidence areas were defined as areas with ≥1 cardiac arrest that did not

fulfill criteria for high-incidence areas.f p value for difference between high and low-incidence areas.

to year (p = 0.48). High-incidence areas comprised 1.1% (1 km2) ofthe study area (Table 1). The proportion of OHCAs was lower dur-ing daytime in high-incidence compared to low-incidence areas(45.1% vs. 53.3%, p = 0.06) but higher during the evening (40.6% vs.33.9%, p = 0.02). OHCA patients in high-incidence areas comparedto low-incidence areas were younger (58.4 vs. 62.1 years, p = 0.004)and had a shorter response interval to ambulance arrival (3.9 vs.5.1 min, p < 0.0001). There was no significant difference betweenthe proportion of male gender, shockable heart rhythm and 30-daysurvival between high- and low-incidence areas.

Conclusions: High-incidence OHCA areas comprised a smallpart of the total study area but accounted for nearly 1/5 of allOHCAs with no significant variation according to year. Further,OHCA patients in high-incidence areas were more likely to have anevent in the evening. Collectively these results support AED place-ment in high-incidence OHCA areas and underscore the importanceof AED accessibility outside business hours.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.169

AP145

Implementing CPR teaching in secondaryschools—A qualitative study of school leaders’and teachers’ perspectives

Line Zinckernagel 1,∗, Carolina Malta Hansen 2,Fredrik Folke 2, Christian Torp-Pedersen 3, MortenHulvej Rod 1, Tine Tjørnhøj-Thomsen 1

1 National Institute of Public Health, University ofSouthern Denmark, Copenhagen, Denmark2 Department of Cardiology, Copenhagen UniversityHospital Gentofte, Hellerup, Denmar3 Department of Health Science and Technology,Aalborg University, Aalborg, Denmark

Introduction: The purpose of the study was to explore impor-tant conditions for implementation of CPR teaching in secondaryschools. In Denmark CPR teaching has been compulsory since 2005,but less than half of Danish schools had included this in their cur-riculum in 2012.1 The reasons for this are poorly understood.

Method: We used qualitative methods to explore school lead-ers’ and teachers’ perspectives on CPR teaching. The study includedeight Danish secondary schools, and consisted of eight semi-structured individual interviews with school leaders along withfour focus group interviews with 15 teachers. Thematic analysiswas used to identify regular patterns of meaning both within andacross the interviews.2

Results: CPR teaching was taught in four of the schools, but invarying degrees. We found that teachers’ and principals’ perspec-tives on CPR teaching are connected to four interrelated conditions:(1) Knowledge and interpretation of the legislation on CPR teach-ing which was perceived differently, ranging from optional tomandatory. (2) Specific beliefs about and experiences with CPR,CPR teaching and automatic external defibrillators (AED), such asbeliefs about difficulty and potential danger when using an AED.(3) Organization of the teaching, such as assigning responsibility,skill requirements, and teaching materials. The responsibility wasdiffuse, most perceived a CPR course to be a prerequisite for educat-ing pupils in CPR, and manikins as a necessary element in teachingmaterial. (4) Perceived role of the school in educating pupils in CPR.Those with actual experiences with CPR (teaching) were more pos-itive towards the teaching and identified fewer barriers than thosewithout.

Conclusion: In order to facilitate implementation of CPR teach-ing in schools and meet legal requirements, it is necessary to

Poster Presentations / Resuscitation 84S (2013) S8–S98 S67

address school leaders’ and teachers’ beliefs and experiences withCPR and CPR teaching, as well as challenge the institutional andorganizational barriers for implementation.

References

1. TNS Gallup for the Danish Heart Association. First aid education in elementaryschools; 2012.

2. Bernard H. Research methods in anthropology – qualitative and quantitativeapproaches. 2nd ed. Walnut Creek: AltaMira Press; 1995.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.170

AP146

Dispatcher assisted CPR: Implementation of2010 guidelines in Germany

Hartwig Marung 1,∗, Jörg Blau 2, Wolfgang Lenz 3,Heinzpeter Moecke 1

1 Institute of Emergency Medicine, Hamburg,Germany2 Emergency Medical Director, Main-Taunus County,Germany3 Emergency Medical Director, Main-Kinzig County,Germany

Purpose of the study: According to 2010 guidelines Emer-gency Medical Dispatchers are supposed to offer CPR instructionsvia telephone.1 Current publications show that implementation ofguidelines is a crucial point.2 Aim of the study was to determinethe degree of implementation in Germany.

Materials and methods: A questionnaire containing 15 itemswas handed out to participants of the German Association ofEmergency Medical Directors’ conference at Muenster, Germanyin September 2012.

Results: 44 out of 59 attending members (74.6%) took part in thesurvey representing 19.1 million inhabitants resp. 23.4% of the Ger-man population. In 63.6% of the dispatch centres (n = 28) dispatcherassisted CPR had already been implemented; in 29.6% (n = 13)implementation had been scheduled and in 6.8% (n = 3) was neverintended. In 64.7% instructions were given in accordance with theprotocol developed by Rea et al., 23.5% used self-developed instruc-tions. Callers received CPR instructions in 33 out of 200 cases peryear (median). 50% reported problems within the implementationprocess.

Conclusions: In most German dispatch centers dispatcherassisted CPR had been implemented two years after guideline pub-lication. However, instructions were given in one out of six casesonly compared to 60% in current publications.3 These fact may bebased upon failure to detect cardiac arrest, use of non-validatedinstructions or deficits in quality management. Development of aworldwide standard for telephone CPR analogue to BLS and ACLSalgorithms result in a higher rate of lay person CPR.

References

1. Nolan JP, Soar J, Zideman DA, et al. Resuscitation 2010;81:1219–762.2. Dainty KN, Brooks SC, Morrison LJ. Resuscitation 2013;84:433–253.3. Dami F, Fuchs V, Prazl L, Vader JP. Resuscitation 2010;81:848–52.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.171

AP147

Social networks and serious games as a tool topromote the week of cardiac arrest awareness“VIVA!” in Italy

Federico Semeraro 1,∗, Niccolò Grieco 2, TommasoPellis 3, Giuseppe Ristagno 4, Andrea Scapigliati 5,Erga L. Cerchiari 1

1 Maggiore Hospital, Bologna, Italy2 Intensive Cardiac Care Unit & PrehospitalEmergency, Milan, Italy3 Intensive Care and Emergency Medical Service,Santa Maria degli Angeli Hospital, Pordenone, Italy4 Istituto di ricerche farmacologiche “Mario Negri” –IRCCS, Milan, Italy5 Institute of Anesthesia and Intensive Care,Department of Cardiovascular Sciences, CatholicUniversity of the Sacred Heart, Rome, Italy

Purpose of the study: On June 14th, 2012, a declaration from theEuropean Parliament called for a week of cardiac arrest awareness,to be held throughout Europe.1 The Italian Resuscitation Council(IRC) has answered to this call and planned a series of structuredprojects to best organize the week of awareness in Italy (October14th–20th 2013), the so called “Viva!” (that means both “alive” and“long life for”) week (http://www.viva2013.it).

Materials and methods: On February 13th, 2013 the “Viva!”Board decided to launch the cardiac arrest awareness campaignin Italy through a viral web campaign that took advantage of allthe most popular social network tools available on Internet, i.e.Facebook, Twitter, and YouTube. More specifically, the awarenessprocess started by spreading a poster with the ‘8 rules’ on howto perform a compression only CPR in order to promote a call toaction in the general population. The poster named “Life in yourhands. How to deal with cardiac arrest” was released on Facebookon March 21st, 2013 at 23.49.

Results presented in sufficient detail to support the con-clusions: There was an incredible growth of unique users thatvisualized the poster on Facebook over the initial 72 h from its post.Indeed, from March 21st, 2013 at 22.49 to March 24th, 2013 at22.49, we observed an explosive increase in the number of visual-ization up to 30.000 in less than 24 h from the release, and overallto 57.088, at the end of this report.

Conclusions: In conclusion, social networks like Facebook areextremely promising for resuscitation councils and educator com-munities as a tool for sparking interest and spreading importantmessages to the lay population.

Reference

1. http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P7-TA-2012-0266+0+DOC+XML+V0//EN&language=EN (in press).

http://dx.doi.org/10.1016/j.resuscitation.2013.08.172