Estimated cost effectiveness of a police automated external defibrillator program in a suburban community:: 7 years experience☆,☆☆
Introduction
Providing early defibrillation is a key link in the chain of survival [1] and since the introduction of the automatic external defibrillator (AED), the goal of early defibrillation appears to be more achievable. There is an explosion of interest in public access defibrillation (PAD), which seeks to expand the availability and use of AEDs [2], [3]. As the majority of out-of-hospital cardiac arrests (OHCA) occur in private residences [4], it is as yet unclear how to best bring this technology quickly to the aid of the stricken person in a cost-effective manner. Police use of the AED is considered part of PAD [3] and has been studied in the treatment of OHCA. AED equipped first responders have been shown to improve process measures in the treatment of cardiac arrest [5], [6]. Nichol [7] estimated police use could be cost effective. Utilizing police to provide defibrillation with AEDs appears ideal, as they are well positioned to respond quickly and are more likely to be used than fixed based AEDs.
We evaluated police use of the AED within the context of a public safety EMS model in which police act as first responders with subsequent advanced life support (ALS) response. As each community must make difficult budget decisions, we used real costs incurred with the implementation of this model in order to estimate cost effectiveness of police defibrillation. Our primary objective was to estimate the cost effectiveness of a police AED program in four suburban communities. Secondarily we sought to quantify the impact of Police AED on time interval to arrival of defibrillator, time interval to first shock and the rate of successful discharge alive from hospital.
Section snippets
Methods
We conducted a retrospective, before and after, quasi-experimental study assessing the cost-effectiveness of the implementation of a Police AED program in four suburban communities in Southeastern Oakland County, Michigan. We used the concept of the communities for this analysis. The study communities (Berkley, Huntington Woods, Oak Park, and Beverly Hills) surround William Beaumont Hospital (WBH), a 929 bed academic community hospital. The communities had populations ranging from 10 600 to
Results
During the 10-year study period, 209 patients met study criteria (81 ALS, and 128 P-AED) with an overall rate of discharge alive from hospital of 11%. Demographics of the study population by survivorship are listed in Table 1. Survivors were more likely to arrest outside the home, have an arrest rhythm of VT/VF, receive bystander CPR and had a 1-min shorter ALS response time. The two study groups were not different by patient age, ALS response interval, arrest rhythm, percent witnessed arrest
Discussion
We observed that training police officers as AED equipped first responders in our suburban communities reliably decreased time to defibrillator arrival and time to first shock for VT/VF patients and can be estimated to be cost effective interventions with a range of cost/life saved of $23–71 000. Though out-of-hospital cardiac arrest continues to carry a high mortality, bystander CPR and early defibrillation are key to improving outcomes. In an early position statement, the American Heart
Conclusion
Police AED appears to be a cost-effective intervention in these suburban communities which have relatively rapid EMS response intervals. This study also demonstrated that AED equipped police will improve process measures in the treatment of OHCA. We measured significant reductions in intervals to defibrillation arrival, first defibrillation and subsequent ALS interventions. Given the intense interest in public access defibrillation, we believe that attention should focus first on utilizing
Acknowledgements
Funded by: Grant #RI-08-761, William Beaumont Hospital Research Institute.
Portuguese Abstract and Keywords
Objectivo: Avaliar a relação custo/eficácia de um programa de desfibrilhação automática externa (DAE) da polı́cia, com 7 anos, em quatro comunidades suburbanas. Método: Estudo retrospectivo até 10 anos (7/89–7/99) de doentes de quatro comunidades suburbanas durante dois perı́odos de estudo: (1) resposta primária pela polı́cia e cuidados de suporte avançado de vida (SAV) sem DAE (No-DAE) e; (2) resposta primária pela policia equipada com DAE (P-DAE), com SAV
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Cited by (0)
Portuguese Abstract and Keywords
Objectivo: Avaliar a relação custo/eficácia de um programa de desfibrilhação automática externa (DAE) da polı́cia, com 7 anos, em quatro comunidades suburbanas. Método: Estudo retrospectivo até 10 anos (7/89–7/99) de doentes de quatro comunidades suburbanas durante dois perı́odos de estudo: (1) resposta primária pela polı́cia e cuidados de suporte avançado de vida (SAV) sem DAE (No-DAE) e; (2) resposta primária pela policia equipada com DAE (P-DAE), com SAV subsequente. Obtivemos os custos do programa de DAE das agências policiais, utilizando a perspectiva das comunidades. Estimamos o custo/vida salva e o custo/ano de vidas poupadas utilizando como critério a redução do tempo da FV até ao choque pelos serviços de emergência médica (SEM). Realizamos uma análise uma análise pormenorizada avaliando o beneficio potencial na melhoria de sobrevivência estimada como resultado da diminuição do intervalo de resposta dos SEM e obtivemos os dados da sobrevida. Utilizamos estimativas baseadas na literatura para a esperança de vida após sobrevivência a paragem cardı́aca para fazer a estimativa do custo/ano de vida salva. Estimamos as diferenças entre os grupos utilizando o teste t de student e o χ2. Resultados: Durante o perı́odo de 10 anos do estudo, 208 doentes preencheram os critérios de inclusão; (81 No-DAE, 128 P-DAE). Os grupos não diferiram na idade dos doentes, intervalo para a resposta de SAV, percentagem de FV, percentagem de paragem presenciada ou local de paragem. O intervalo até à chegada do primeiro veı́culo dos SEM equipado com desfibrilhador foi menor no grupo P-DAE (2.0 vs. 5.4 min, P<0.001) tal como o intervalo desde a chamada ao 911 até ao primeiro choque da FV (6.6 vs. 8.4 min, P=0.02). A sobrevida não foi estatisticamente diferente com P-DAE (11.9 vs. 9.9%, P=0.66) mas este estudo não tinha poder suficiente para detectar a diferença. A estimativa do custo por vida salva com P-DAE variou entre 32.542 e 70.342 dolares. O custo por ano de vida salva variou entre 1.582 e 16.060 dólares. Conclusão: DAE pela policia parece ser uma intervenção com eficácia de custo nestas comunidades suburbanas que têm intervalos de resposta dos SEM relativamente rápidos.
Palavras chave: Custo/eficácia; Desfibrilhação; Paragem cardı́aca
Spanish Abstract and Keywords
Objetivo: estimar la relación costo efectividad de un programa policial de desfibrilación automática externa (AED) de 7 años de duración en cuatro comunidades suburbanas. Método: estudio retrospectivo de 10 años (7/89–7/99) en pacientes de cuatro comunidades suburbanas durante dos perı́odos de estudio: (1) respuesta inicial policial y cuidados de soporte vital avanzado (ALS) (no AED) y; (2) respuesta inicial por policı́as equipados con AED (P-AED) y cuidados ALS subsecuentes. Basándose en las comunidades estudiadas, obtuvimos costos de los programas de AED de las agencias de policı́as. Calculamos costo /vida salvada y costo/año vidas salvadas usando el ahorro de tiempo al primer shock por EMS (Servicio de emergencias médicas). Realizamos un análisis de sensibilidad para calculo de beneficio potencial usando calculo de sobrevida mejorada como resultado de la disminución del intervalo de respuesta EMS y datos obtenidos de la sobrevida. Usamos cálculos de expectativa de vida después de sobrevivir un paro cardı́aco basados en la literatura para calcular el costo/año de vida salvado. Usamos el test de la T de Student y χ2 para calcular las diferencias entre grupos. Resultados: Durante el perı́odo de 10 años estudiado 208 pacientes cumplı́an los criterios de estudio; (81 No-AED, 128 P-AED. Los dos grupos no diferı́an en edad de los pacientes, intervalo de respuesta ALS, porcentaje en VF, porcentaje presenciado (WIT), o lugar donde ocurre el paro. El intervalo hasta la llegada del primer vehı́culo del EMS equipado con desfibrilador fue menor en el grupo P-AED (2.0 vs. 5.4 minutos, P<0.001) como fue el intervalo entre la llamada al 911 hasta la primera descarga para desfibrilación (6.6 vs. 8.4 min, P=0.02). La sobrevida a DC (alta del hospital) no fue estadı́sticamente diferente con P-AED (11.9 vs. 9.9%, P= 0.66) pero este estudio no fue capaz de detectar la diferencia. El costo estimado por vida salvada con P-AED varió de $23542 a $70342 y el costo por año de vida salvado varió entre $1582 y $16060. Conclusión: AED policial parece ser una intervención costo-efectiva en estas comunidades suburbanas que tienen intervalos de respuesta de EMS relativamente rápidos.
Palabras clave: Costo efectividad; Desfibrilación; Paro cardı́aco
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Presented at Society for Academic Emergency Medicine, Annual Meeting, San Francisco, 2000.
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A Wayne State University School of Medicine Affiliated Program.